015|STAND+(7)

The subtitle of the second episode of "STAND+" is: "The Overlooked Medical Data of Women." 

After reviewing this episode, Zhong Shao and Yu Cheng experienced a whirlwind of emotions that were difficult to speak. They are not the type to openly express their feelings, yet at this moment, they feel compelled to voice their realisations and convey their gratitude.

With the rapid iteration of internet technology, the concept of the "new middle class" has emerged, distinct from the traditional middle class defined by three standards[1]. The "new middle class," primarily composed of individuals born in the 1980s and 1990s, is characterised by higher education, elevated material living standards, and poor financial investment outcomes [2]. Concurrently, following continuous reforms in reproductive policies, society has witnessed a brief surge in birth rates, which has since declined to a low point. On a macro level, we observe the current youth's fear of marriage and childbirth, alongside the desire for larger families among those who are already married and have children. However, on a micro level, under these reproductive policies, our focal point—women—whether from traditional or new middle-class families, remain the ones who are let down. The increase in motherhood, the ongoing decline in women's participation in paid labour, and the resurgence of traditional gender norms all indicate that the progress toward gender equality in our country is facing stagnation, or even regression.

So, as women continue to bear the role of sacrificing their careers for their families, how can they undertake the necessary and healthy reconstruction of their identities? When we rewind to the moment a couple gets married, the common blessing bestowed upon newlyweds is "May you have a prosperous family soon," with little awareness of the journey women must navigate and overcome before and after childbirth.

"Do you regret getting married?" 

"Do you regret becoming a mother?" 

"Do you regret being a stay-at-home mom?" 

Ten typical middle-class (motherhood) women were asked one, two, or all three of these questions. 

Among their responses, there were mentions of "regret" or "having regretted," but more often, there was silence. 

The experience of becoming a mother, despite its challenges, has not led them to regret; rather, their remorse lies in being a full-time mother. 

"The oldest of these ten women was born in 1975, while the youngest was born in 2001. Their lives essentially encapsulate the current model of typical middle-class (formerly) married women in China. Aside from (formerly being) mothers, they share another commonality: each of them has experienced gynaecological or reproductive health issues. From these conditions, we discover—" 

"Our modern healthcare system is failing women." Dong Yi, referencing Alyson McGregor's words in "Gendered Medicine," unveiled this tragic truth.

"I used to be a parenting blogger," Rong Tian reminisced about the days before she seized the opportunity presented by the internet. "When we had our first child, we made compromises for our soon-to-be family of three. Since he earned more, we reverted to a traditional family model—him as the breadwinner and me managing the home. Before the baby was born, I believed I could excel in the 'home' role, but the reality was quite the opposite. I faced unprecedented doubts about my identity as a woman and a mother. My life revolved solely around the child, and I struggled to recognise my own worth. My lack of financial independence made me overly meticulous about material matters; the baby's cries, the physical recovery after childbirth, and the overwhelming demands of motherhood left me feeling utterly defeated. Yet, no one told me what a postpartum mother should do."

"I became a parenting influencer because I wanted to engage in something comparable to work, something that wouldn't conflict with my role as a caregiver. From having my first follower to now amassing over 8 million fans across all platforms, I continuously share a diverse mix of parenting experiences while also learning and refining more scientific approaches to child-rearing. My life and this new career have seamlessly integrated."

Rong Tian's living room has been transformed into her studio, with an assistant, a photographer, and a post-production team comprising her entire crew, all working from her home.

"Does being a parenting blogger make you happy?" Rong Tian sat on the sofa, her son beside her. Upon hearing the question, she visibly paused, shaking her head in disbelief. "Not happy." 

Expressing her answer brought a sense of relief, as if a long-held burden had finally been lifted. "I never imagined I could reach this level, but this job has caused me significant physical and psychological distress. I feel drained. When my parenting blog began to gain traction, conflicts arose between us. He believed I shouldn't portray our child and our lives as a facade for public entertainment. As my account garnered more attention and traffic, I found myself investing an overwhelming amount of time and energy into this virtual space, all while trying to balance my roles as a mother and a wife, navigating multiple identities."

"One day, while showering, I discovered a bean-sized lump on my left breast. Since it was neither painful nor itchy, I didn't pay much attention to it. Later, it began to hurt, and the pain intensified over time." Taking a deep breath, she continued, "There was a hard mass measuring 12x20mm, and the doctor diagnosed it as 'stage III breast cancer.' Following the doctor's advice, I underwent neoadjuvant systemic therapy to shrink the tumour and improve the chances of successful surgical removal. However, my condition did not improve or stabilise; the skin around my breast turned red and developed abscesses. At that point, I began to question the doctor's diagnosis. Subsequently, I visited several top hospitals in the country, and after a joint consultation with specialists, I was ultimately diagnosed with granulomatous mastitis."

Current research has yet to clarify the exact causes of granulomatous mastitis. The prevailing views suggest it may be related to autoimmune factors, lactation factors, and infectious factors, particularly the infection caused by K. kroppenstetii[3].

"What is the impact of misdiagnosis on health and life?" 

"Rather than saying that this illness has changed my life, it is more accurate to say that my life has made this experience an inevitable journey for me. Milk stasis, sleepless nights, stress, and emotional instability have led to a decline in my immune system, while long-term use of antidepressants and anti-anxiety medications are contributing factors to the development of granulomatous mastitis. But this is my life; what can I do? I forced back my tears, realising that only after becoming a full-time mother did I understand that a woman often has to sacrifice her entire self to bear all that may happen in this unpaid profession. I cannot do it; I cannot abandon my independence and autonomy, nor can I lose myself. When my child was only three months old, I began to experience symptoms of postpartum depression. Any action from my child would irritate and anxiety me, and during his crying spells, I even had thoughts of harming him. The remaining rationality pushed me to seek help from a psychologist and to start taking psychiatric medication."

"Throughout our countless arguments, many were sparked by issues surrounding my medication. Without understanding my condition, he prematurely equated all my negative emotions with being overly sensitive and creating problems, completely disregarding the challenges I faced as a full-time mother. During the period of misdiagnosis, the pain from the illness magnified my negative emotions, and I temporarily stopped updating my situation. When I learned that I had missed the non-surgical treatment window due to the misdiagnosis, I fell into a very dark place—one where I had no desire to live."

Currently, there are two primary treatment approaches for patients with granulomatous mastitis in clinical practice. The first involves the use of corticosteroids and immunosuppressive therapy to reduce the mass to a manageable size before surgical excision of the lesion. The second option is a "simple mastectomy." While the former can preserve the shape and aesthetic of the breast to a significant extent, clinical practice often resorts to the latter method. This is not only because it is the most direct and least risky way to eradicate breast disease, but also because this surgery is covered by health insurance. However, this approach overlooks the psychological distress it causes patients[4].

After navigating through several hospitals, Rong Tian finally received a "breast-conserving" surgical plan from her doctor, with the risks she faces being the potential for recurrence post-surgery and a heightened sensitivity to hormone therapy.

In front of the camera, Dr. Gao, a gynaecological expert, responded to the issue of misdiagnosis by stating.

"As a female gynaecologist with twenty-six years of experience, I feel ashamed. Granulomatous mastitis was first reported by Kessler et al. in 1972, and this condition is relatively rare in clinical settings, although its incidence has increased in recent years. Research on idiopathic granulomatous mastitis (IGM) is still insufficiently deep, and questions regarding its pathogenesis, disease progression, and outcomes remain to be explored further. IGM presents with imaging and clinical features that are strikingly similar to breast cancer, typically manifesting as localised breast masses accompanied by pain, abscesses, and fistulas. Imaging studies such as breast ultrasound, mammography, and MRI lack specificity, and a definitive diagnosis relies on histopathology, characterised by non-caseating necrotising granulomas centred around the lobules of the breast[5]. The disease has a prolonged course, and inappropriate treatment can lead to relapses, causing significant harm to both the physical and mental well-being of patients, with no optimal treatment plan currently available."

"Typically, physicians in relevant departments do not give sufficient attention and recognition to this disease, lacking vigilance, which prevents them from making accurate diagnoses and treatments in a timely manner, leading to errors in treatment and even medical accidents. In my view, this condition no longer belongs to a single speciality; whether it is early diagnosis of the disease, early identification of its causes, or timely and effective treatment, it requires the reasonable application of a multidisciplinary collaborative treatment model. As a women's disease that has been reported for 50 years, why have we still not identified clear, definitive causes and mechanisms of onset supported by detailed scientific evidence? This is due to the neglect of female medical data and the lack of female-specific medical research within today's male-dominated healthcare system.

So, how does a male-centric healthcare system impact women's health? 

Dr. Gao continues to provide answers, stating, 'According to data from the World Health Organization (WHO), the incidence of gynaecological diseases among women in China exceeds 90% over their lifetime[6]. Therefore, it is not just the case we are discussing today; in all analyses of misdiagnosed cases, even when doctors are not intentionally negligent, one undeniable fact remains—most cases involve women's diseases, particularly with a high misdiagnosis and missed diagnosis rate for endocrine-related ovarian cysts, which are often treated as 'ovarian cysts' leading to cystectomy and abnormal uterine bleeding treatment[7]. Furthermore, even in diseases that affect both genders, the probability of women being misdiagnosed is significantly higher than that of men. For instance, in the case of cardiovascular diseases, if you are a woman, the likelihood of being misdiagnosed from the moment a heart attack occurs is over 50% greater than that of men, as the diagnostic methods for heart disease differ between genders[8], because the methods for diagnosing heart disease differ between men and women. Recent studies suggest a close relationship between psychological factors and cardiovascular diseases, with mechanisms of mental stress-induced myocardial ischemia (MSIMI) showing gender differences. Women have a higher incidence compared to men, as they often face greater psychosocial stress [9]. I can state unequivocally that the neglect of women in medicine is pervasive, and the most significant and flawed assumption is that if something is true for men, it must also be true for women."

So, what is the relationship between the reconstruction of a healthy identity that women deserve and the modern healthcare system?

— Health is paramount, and lives are entrusted... I will strive to alleviate human suffering and promote the perfection of health... dedicating my life to the development of medical and health services for my country and the physical and mental well-being of humanity.

— ... I will prioritise the health and happiness of my patients; I will respect their autonomy and dignity; I will maintain the utmost respect for human life; I will not consider a patient's age, illness or disability, beliefs, ethnic origin, gender, nationality, political beliefs, race, sexual orientation, social status, or any other factors... I will not use my medical knowledge to violate human rights and civil liberties, even when faced with threats; I solemnly, autonomously, and honourably make these commitments.

"If I had taken a moment longer to reflect on the Hippocratic Oath or the Oath of Medical Students, my choices might have been different. In recent years, the perspective of women's gender issues has gained traction, leading to a growing awareness among women regarding their identities. Countless children in this society share a trajectory similar to mine, born into ordinary and traditional families, subjected to an education system focused on exams and ranking. Parents impose numerous constraints on your development, even dictating your career and marital choices. Your identity is defined as a child, a good or bad student, a minor, and so forth, but never as your true self. I first realised 'who I am' in college when our professor stated, 'Reproduction is not merely an individual or familial matter; it is intricately connected to society and humanity as a whole. Before deciding to become a reproductive health specialist, how do you perceive your identity? How do you view the world and the clinical disciplines? The responsibility with which you bring a child into this world will reflect that understanding.' So, I firmly believe that a healthy and appropriate sense of identity involves a profound curiosity about life and society before being assigned any roles, as well as the development of independent cognition and a knowledge framework. When confronted with reality, can one truly comprehend what is happening."

"The male-centric healthcare system, lacking authentic and effective medical data, only exacerbates the challenges in accurately diagnosing and treating women's health issues. When a woman, once shining brightly in her career, returns home due to childbirth or other gynaecological conditions, she embarks on a journey of identity reconstruction upon her recovery. Her resilience is not synonymous with traditional notions; she experiences fear and fatigue, yet remains fervently dedicated, for she has come to a profound realisation: the completeness of life and responsibility is never contingent upon marriage or motherhood, but rather on self-awareness, beginning with a commitment to women's health from within."

To reach a flourishing world, one must traverse the harsh winter, but it is not a necessity. 

You may disappoint anyone, but never yourself.

— Can women's technology transform women's healthcare?

As the final question of this chapter. Zhong Shao and Yu Cheng have decided to omit the responses and discussions from researchers and scholars in women's technology regarding this issue, choosing instead to leave it open for public contemplation. The reasons are manifold, but ultimately, it can be distilled into one statement: our entire society remains profoundly ignorant of the power of women.