Three diseases are the leading causes of death in the United States: cancer, heart disease, and stroke. Among these, heart disease is responsible for more deaths among women. For women, breast cancer is second to lung cancer as a cause of death. The recent uproar over the revised guidelines of the U.S. Preventive Services Task Force, advisory to the Department of Health and Human Services, concerning the recommended frequency of mammograms for detecting breast cancer is some indication of the levels of interest, concern, and activism around breast cancer as a disease. How has breast cancer become such a political flash point in the United States?

The answer may be found in two recent books that focus on political activism around issues of disease. Karen Baird and her colleagues in Beyond Reproduction and Karen Kedrowski and Marilyn Sarow in Cancer Activism address these questions by investigating the intersections of women's health activism, mobilization around gendered issues of disease, and public policy responses.

Beyond Reproduction examines four major health issues for women: women's inclusion in clinical research trials funded by the U.S. government; HIV/AIDS; breast cancer; and violence against women as a national health issue. Baird and her colleages ask how women's health became “a problem for government to solve” (p. 34, original emphasis) and why the movement for women's health succeeded. Comparative across issues, the book also provides a cross-time perspective, with Baird's introductory chapter surveying the development of the women's health movement from the 1960s through the 1990s. The introduction presents the book's theoretical foundation, relying on political-opportunity structural analysis from research on social movements, on Mary Fainsod Katzenstein's models of interest organizing and discursive politics (Faithful and Fearless, 1998, pp. 16–17), and on the broader research on feminist movements and their strategies.

Baird suggests a convergence of factors that helped to advance women's health issues in Congress and that account for much of the movement's success. One factor is the increased numbers of women in Congress following the 1992 elections. The evidence in this book suggests a strong case for the importance of a “critical mass of women” in advancing women's issues, as the Congressional Caucus for Women's Issues and key women in the House, such as Mary Rose Oakar, intervened to ensure that funding for breast cancer research was not eliminated from congressional budget proposals.

In addition, activists framed issues as important for “all women” in a context generally favorable toward women's rights; politicians appreciative of the power of women's votes were thus inclined to support women's health initiatives, particularly in the absence of any obvious organized opponents. Also important was the AIDS activism of the 1980s, which served as the leading edge for activists to mobilize for congressional intervention in federally funded medical research and to insist upon political attention to a specific disease. The epidemic nature of HIV/AIDS, the swiftness of its emergence, its devastating impact upon the gay community, and the reluctance of the Reagan administration to address the problem provoked mobilization by gay activists and others—and served as the example for breast cancer successor groups to organize targeted campaigns, with equally sophisticated publicity and media strategies.

Finally, as feminist activists moved into middle age, abortion and reproductive issues became less salient for them than other women's health issues. Because breast cancer and heart disease were less contentious issues on the national level than abortion, and more congruent with a rights frame that argued for equal access to health care for women, members of Congress found it easier to support—and more difficult to oppose—such policies as increased funding for breast cancer research.

Baird and her colleagues find that the issues themselves make a difference, influencing activists' strategic decisions. Proponents of the Violence Against Women Act and advocates for increased federal support for breast cancer treatment, prevention, and research employed discursive politics to transform relatively hidden, individual concerns into political issues requiring federal action: “At the other end of the spectrum [of women's movements' strategies], advocates for women's medical research engaged more often in interest group politics” (p. 114), targeting existing agencies, such as the National Institutes of Health, for inclusion of women in clinical research trials and requiring women's representation in federally funded medical research. Baird concludes that the issue-specific nature of women's health activism made it difficult to develop a “feminist perspective that recognizes and fights against gender inequality” (p. 121). Nonetheless, she demonstrates that in a relatively hostile political opportunity structure, “the state increased its responsibility for women's health” (p. 122).

A major strength of Beyond Reproduction is its mapping of the changes in the party balance in Congress and the shifts in presidential administrations, which created opportunities for advancing women's health policy initiatives. Although the book focuses primarily upon the decade of the 1990s, it employs a longitudinal analysis that takes into account shifts in the political opportunity structure from the 1960s through the 1990s. The book concludes with a comprehensive summary table of the dimensions of the women's health movement (p. 120).

In Cancer Activism, Kedrowski and Marilyn undertake a comparative case study of gendered activism around two cancers: breast cancer among women and prostate cancer among men. They analyze these “grassroots survivor organizations” (GSOs) from the 1980s into the mid-2000s. The book provides informed descriptions of the diseases themselves, their incidence in the mass public, and their survival rates. It also presents detailed event chronologies for the breast cancer and prostate cancer stories, including popular cultural events and books, celebrities' experiences with these diseases, and congressional and other action.

Kedrowski and Sarow frame their research with theories from policy studies, media studies, and social movements research. They ask how activists succeeded in agenda setting, framed their issues to mobilize supporters, strategized to attract media attention, engaged in social marketing of their demands, and developed relationships with corporate allies to raise private monies for their causes. To answer these questions, the authors have produced a data-rich book, based on quantitative evidence of patterns of funding and congressional action, media attention, and concern about breast and prostate cancer in public opinion; qualitative analyses of media narratives; and interviews with activists, survivors, politicians, and others.

Kedrowski and Sarow analyze the impact of media reports and how targeting the media contributed to cancer activists' successes for breast cancer and prostate cancer GSOs. They analyze coverage of breast and prostate cancer stories in five major newspapers, from 1980 to 1998, and in news broadcasts on the three major television networks (ABC, CBC, and NBC). The authors find that breast cancer GSOs were significantly more successful in getting their issues on the media agenda than were prostate cancer GSOs, in communicating an urgency of the issue to the mass public, in forming an “attentive public” (p. 159), and in moving breast cancer issues from the media agenda to the policy agenda. Their chapters on the relationship between the media agenda and the policy agenda constitute an excellent case study of how organized citizens succeed in influencing policy outcomes.

The conclusion of Cancer Activism is that women, usually politically disempowered in the face of the state, were highly successful in increasing funding for breast cancer, directing funding for specific types of cancer research, and socializing the scope of the issue to make it salient for all women and for elected officials—and that men, active around issues of prostate cancer, speaking to other men who govern, were strikingly less effective in getting prostate cancer on the congressional agenda, securing funding for prostate cancer research, and sustaining attention and levels of funding across time. Perhaps the most fascinating component of the book is the role of gender in shaping strategy and success for breast cancer and prostate cancer activists. The differences in gendered behaviors between women and men active around sex-specific cancer results, ironically, in “a story of women's power and men's weakness” (p. 223).

Missing from these books is a discussion of the role of opponents in affecting GSOs' policy success. As Kedrowski and Sarow recognize in passing (p. 183), there is “no ‘anti-breast cancer’ or ‘un-prostate cancer’ lobby.” GSOs appear only to have competitors, those GSOs that are trying to get their particular disease—for example, heart disease among women—on the policy agenda. What difference does it make for GSOs with no opponents in terms of the policy process, compared to those social movement organizations (SMOs) mobilizing for support of reproductive rights, who have many well-organized opponents? These books say little. Also missing is any discussion of collective identity among GSOs. Are there substantial identity-formation differences between GSOs, based on disease survivorship, and other SMOs whose collective identities are grounded in race or religion or ethnicity, in terms of policy strategy and success in achieving goals?

Finally, one minor quibble: Both books would have been improved by the inclusion of a table of abbreviations for organizations, diseases and groups. Those readers unfamiliar with such acronyms as NCI, CDMRP, NBCC, ORWH, OVW, PID, IRB, SAWHR, NPCC, and CCWI, will find the going difficult. That these abbreviations appear in the context of more recognizable abbreviations, such as NIH (National Institutes of Health), GAO (Government Accountability Office), and AIDS, does not make reading easier. Editors and publishers, take note.

Beyond Reproduction offers a view across several women's health policy issues, giving us the perspective of the horizon; Cancer Activism provides us with a close focus on two gendered health policy issues. Both books chronicle the positive impact of the AIDS activism model on breast cancer GSOs and, ultimately, on prostate cancer GSOs. They both identify the advantage for breast cancer GSOs of their rootedness in the feminist movement. Where “the personal is political,” walking one's body into the U.S. Congress, the seat of national policymaking, is a powerful tool for advancing women's health interests. This embodiment of the policy issue in actual breast cancer survivors who testify before Congress and lobby their representatives has been a major tactic in persuading legislators to act. Both books, in conjunction, provide us with focused analysis and a broad sweep across women's and men's health activism to show how gendered political strategies affect policy outcomes in an equally gendered Congress.