Thu Feb 15

Feminist narratives are being hijacked to market medical tests not backed by evidence

Written by: Brooke Nickel, NHMRC Emerging Leader Research Fellow, University of Sydney

Corporations have used feminist language to promote their products for decades. In the 1980s, companies co-opted messaging about female autonomy to encourage women’s consumption of unhealthy commodities, such as tobacco and alcohol ^[1].

Today, feminist narratives around empowerment and women’s rights are being co-opted to market interventions that are not backed by evidence across many areas of women’s health. This includes by commercial companies, industry, mass media and well-intentioned advocacy groups.

Some of these health technologies, tests and treatments are useful in certain situations and can be very beneficial to some women.

However, promoting them to a large group of asymptomatic healthy women that are unlikely to benefit, or without being transparent about the limitations, runs the risk of causing more harm than good. This includes inappropriate medicalisation, overdiagnosis and overtreatment.

In our analysis published today in the BMJ ^[2], we examine this phenomenon in two current examples: the anti-mullerian hormone (AMH) test and breast density notification.

The AMH test

The AMH test is a blood test associated with the number of eggs in a woman’s ovaries and is sometimes referred to as the “egg timer” test.

Although often used in fertility treatment, the AMH test cannot reliably predict the likelihood of pregnancy ^[3], timing to pregnancy or specific age of menopause ^[4]. The American College of Obstetricians and Gynaecologists therefore strongly discourages testing ^[5] for women not seeking fertility treatment.

The AMH test can’t predict your chance of getting pregnant. Anastasia Vityukova/Unsplash ^[6]

Despite this, several fertility clinics ^[7] and online companies ^[8] market the AMH test to women not even trying to get pregnant. Some use feminist rhetoric promising empowerment, selling the test as a way to gain personalised insights into your fertility. For example, “you deserve ^[9] to know your reproductive potential”, “be proactive ^[10] about your fertility” and “knowing your numbers ^[11] will empower you to make the best decisions when family planning”.

The use of feminist marketing makes these companies appear socially progressive and champions of female health. But they are selling a test that has no proven benefit outside of IVF and cannot inform women about their current or future fertility.

Our recent study ^[13] found around 30% of women having an AMH test in Australia may be having it for these reasons.

Misleading women to believe that the test can reliably predict fertility can create a false sense of security about delaying pregnancy. It can also create unnecessary anxiety, pressure to freeze eggs, conceive earlier than desired, or start fertility treatment when it may not be needed.

While some companies mention the test’s limitations if you read on, they are glossed over and contradicted by the calls to be proactive and messages of empowerment.

Breast density notification

Breast density is one of several independent risk factors for breast cancer. It’s also harder to see cancer on a mammogram image of breasts with high amounts of dense tissue than breasts with a greater proportion of fatty tissue.

While estimates vary, approximately 25–50% of women in the breast screening population have dense breasts ^[14].

Dense breasts can make it harder to detect cancer. Tyler Olsen/Shutterstock ^[15]

Stemming from valid concerns about the increased risk of cancer, advocacy efforts have used feminist language around women’s right to know such as ^[16] “women need to know the truth” and “women can handle the truth” to argue for widespread breast density notification.

However, this simplistic messaging overlooks that this is a complex issue and that more data is still needed ^[17] on whether the benefits of notifying and providing additional screening or tests to women with dense breasts outweigh the harms.

Additional tests (ultrasound or MRI) are now being recommended for women with dense breasts as they have the ability to detect more cancer. Yet, there is no or little mention of the lack of robust evidence ^[19] showing that it prevents breast cancer deaths. These extra tests also have out-of-pocket costs and high rates of false-positive results.

Large international advocacy groups are also sponsored by companies that will financially benefit from women being notified ^[20].

While stronger patient autonomy is vital, campaigning for breast density notification without stating the limitations or unclear evidence of benefit may go against the empowerment being sought.

Ensuring feminism isn’t hijacked

Increased awareness and advocacy in women’s health are key to overcoming sex inequalities in health care.

But we need to ensure the goals of feminist health advocacy aren’t undermined through commercially driven use of feminist language pushing care that isn’t based on evidence. This includes more transparency about the risks and uncertainties of health technologies, tests and treatments and greater scrutiny of conflicts of interests.

Health professionals and governments must also ensure that easily understood, balanced information based on high quality scientific evidence is available. This will enable women to make more informed decisions about their health.