Resistance, agency, and liminality in women's accounts of symptom appraisal and help-seeking upon discovery of a breast irregularity

In the breast cancer literature, “delayed presentation” is defined as a period of 3 months or more between the self-detection of a new breast symptom and the decision to seek help for it. Delay studies have overlooked the relevance of dominant medical discourses such as those concerning “proper” health. In this paper we use a critical discursive method to analyze interviews with 14 women about their symptom appraisal process to demonstrate how many inhabited a liminal space comprised of both “knowing and not knowing” about the symptom, and “acting and not acting” on it (interviews took place from January 2006 to April 2007). We describe three discursive themes that arose in the transcripts including “Doing the Right Thing”, “Deliberate Ignorance”, and “Passive Resistance.” These women's narratives are juxtaposed with two commonly accepted medical discourses in relation to self-detected breast symptoms: That of the woman who was unaware of her symptom, or interpreted it as being insignificant, and therefore, not requiring medical attention; or that of the woman who noticed the symptom, interpreted it as threatening, and immediately sought medical attention. We suggest that such discourses are constricting and fail to account for the sizeable number of women who do not fit this mold (i.e., those who are both aware of the concerning change and delay presentation). We conclude that these constricting medical discourses effectively have a role to play in the contradictory reasoning or perceived irrationality of women's delay behavior when it occurs.

► Addresses the medical and societal discourses that relate to women's help-seeking behavior around a breast abnormality.
► Provides an improved understanding of the psychosocial complexities associated with seeking care for a breast irregularity.
► Presents a pre-diagnostic liminality period characterized by competing tensions with respect to knowing and action.
► Provides a novel perspective on help-seeking and delay behavior with implications for improving women's breast cancer care.