Breasts to Spare.

There can be no woman, of whatever age and cup size, who failed to shiver at the news: A recent study from the Mayo Clinic shows that the removal of both breasts, while they are still in first-rate condition, can reduce the chance of breast cancer by 90 percent. You might think that such a drastic intervention would be 100 percent effective, but no. It turns out that the tiniest remaining smidgen of breast tissue can harbor the seeds of doom. Obviously, the unsentimental solution is to excise every last little mammary cell before it starts to rampage. At least that's how the medical profession seems to see it.

In an age of Similac and pacifiers, a few breasts more or less shouldn't be any big deal. But breasts have always been much more than lumps of unsightly chest fat. Cleavage is a competitive advantage, signaling abundance and comfort, while a more level playing field, at least in our culture, symbolizes only famine and dearth. Check out the magazine racks at your local newsstand, and you'll find that even the more pretentiously upscale ones now bear cover art indistinguishable from that of publications like Buns and Boobs.

Women, even those with a family history of breast cancer, tend to be fond of these protuberances. To their owners, breasts are the female body's closest thing to a phallic symbol--best when upturned with nipples erect, and certainly the only one of our body parts of which it can be said that size absolutely, and in all cases, matters. In some depictions, the great goddess Artemis has dozens of breasts, though scholars debate whether the excess ones were actually the scrota of bulls sacrificed in her honor. From a breast-proud perspective, same difference.

Only yesterday--or was it just this morning?--the medical profession seemed to subscribe wholeheartedly to the dominant, breast-positive, view. Surgeons strove to preserve as much as possible of even diseased breasts, opting for lumpectomies whenever they could; general practitioners sometimes steered the small-breasted toward help.

"Your breasts aren't a problem," one doctor told a former neighbor of mine, "so long as your husband doesn't mind."

In the eighties, plastic surgeons announced that small-breastedness is, in fact, a disease--"micromastia"--which they stood ready to save us from. I'm a victim of this tragic disorder myself, though I still manage to hobble around, so I was briefly cheered when a doctor told me recently that I didn't have to worry much about breast cancer, given my size. She was wrong (remember those smidgens), but the interesting thing is that this small-town practitioner had already picked up on her profession's new view of the breast as cancer sac. If this mentality spreads, the mastectomy-scarred chest may well replace the Alpine bosom as an emblem of reproductive fitness. Already, seeing Elizabeth Hurley on the cover of a recent Details, I could not help but think, "My lord, has she had that situation checked out?"

Of course, it's only the "high-risk" breasts that the doctors are eyeing at this point--those belonging, for example, to women with breast cancer in their families or who test positive for breast-cancer-related genes.

But heredity plays a role in only about 10 percent of breast cancer cases; and of those who possess the so-called breast cancer genes, 20 percent will never get the disease. Just to make things a little messier, geneticist Patricia Kelly reports that a significant number of women from breast-cancer-afflicted families don't carry the evil genes at all.

If genes and heredity are not exactly infallible guides to risk, the other commonly employed "risk factors"--or at least indications for surgery--are far dicier. Take "number of biopsies": The more breast biopsies a woman has had in her life, the more likely she is to be judged a candidate for preventive mastectomies. Now unless biopsies actually cause cancer--which would be eye-popping news if true--the reasoning must be that the more doctors have suspected you of having cancer in the past, the more likely you are to get it. Or here's another "risk factor" in the eyes of some doctors: "cancer phobia," as if the fear of getting cancer might be a carcinogen itself.

If fear on the part of women and suspicion on the part of doctors are risk factors for the disease, there's an easy, low-budget way to improve the public health: Stop the breast cancer hysteria that is spreading, by contagion, from the medical profession to women at large. Most women will die of heart disease anyway, and if cancer gets us it is more likely to be that equal-opportunity killer, cancer of the lungs. At the very least, women contemplating the prophylactic removal of their breasts should be asking: How many guys are lining up to have their prostates or testicles lopped off in the name of preventive medicine?

But whatever the mix of science and sexism--weird attachment to, or hatred of, the Mother--that guides the breast cancer business, you do get the sense of a profession that has abandoned its mission. The doctor's job is to protect the human body from disease, not whittle it down so there's less of it for disease to afflict. Hearts, lungs, kidneys, and even brains are all capable of turning on their owners and destroying them with fatal diseases: Will these organs be the next targets for prophylactic removal by a medical profession grown too lazy to search for cures?

And what about the environmental factors that have long been suspected of playing a role in breast cancer? Do we really know enough to rule them out, or has science determined that mammary mutilation is just the price we have to pay for our pollution-rich way of life?

Finally, there's the small matter of self-interest. If everyone else's breasts are removed, I will loom as the Jayne Mansfield of the twenty-first century. But--if only for financial reasons--the doctors will surely want to replace all the surgically removed tissue with implants of generous proportions. And here is my ultimate fear, perhaps deeper even than the fear of disease: that in the mastectomized and reconstructed future, when breasts have become entirely optional ornaments, 42D will be the national norm. Breasts were a problem, medical science will announce, but "breasts"--why they're just fine.

Barbara Ehrenreich, author of "Blood Rites" and "The Snarling Citizen," writes each month for The Progressive.