Sexualizing cancer: HPV and the politics of cancer prevention. By LauraMamo, Chicago: University of Chicago Press. 2023. pp. 360. $35.00. ISBN: 978‐0226829296

In Sexualizing Cancer, sociologist Laura Mamo examines the production of human papillomavirus (HPV) knowledge and the entanglements between sex and cancer. Joining scholars who have documented the HPV vaccine rollout in the early 2000s, Mamo’s work deepens our understanding of viral sociality and, in the case of HPV, the gendered sexual politics at play in a new regime of cancer prevention. Employing a multi-sited ethnographic approach to trace HPV knowledge, talk and clinical practice backward and forward, what unfolds in Sexualizing Cancer is not a simple story of Big Pharma’s vaccine production or Big Brother surveillance, but rather, as Mamo makes clear, one of emergent and varying arrangements of practice and meaning that include complex agencies—agencies that vary across region and time and ones that structure how care and prevention are enacted. Indeed, the text carries readers through a diversity of places and spaces in which HPV knowledge emerges and proliferates and through the ranging population groups’ whose subjectivity is interpellated in the HPV-cancer prevention arena. Mamo characterises the emergence of a ‘prevention regime’ in 21st century biomedicine, which not only enacts prevention as a central priority of medicine, but also one in which individuals perceive and monitor their health in terms of risk and threat and are conditioned to make choices to manage that risk. She contends that this regime was established first through the molecular knowledge of HPV’s role in a set of cancers (cervical, anal and oral), leading to the development screening tests (e.g. the Pap test) and later when the Pap was deemed no longer ‘good enough’, the development of vaccines and novel screening tools. Mamo explicates how different risk groups were called to action to get vaccinated and monitor their risk and how such targeting expanded from group to group, ‘subsuming and animating gendered sexual risk along the way’ (Mamo 2023, p. 19). A core argument of the text is that the narrative shape of science and technology has consequences for the production of meaning around risk, the conditions in need of prevention and the subjects in need of protection. Mamo traces how marketing campaigns called upon individuals, initially girls and their mothers, to manage the threat of HPV. From the earliest days of Merck’s campaigns for the Gardisil vaccine, the HPV story has critically not been about sexually transmitted infection prevention—but rather about cancer prevention—even while sex is omnipresent. Early educational campaigns targeted girls and their mothers to know the risk and to ‘tell someone’ about the link between HPV and cervical cancer. These educational advertisements were followed by advertising campaigns that painted preteen girls on the precipice of becoming bold, powerful, ‘can do’ young women, as youth that could become ‘One Less’. Carefully articulating how girls’ sexuality and sex lives were distanced from HPV in these campaigns, Mamo explicates a tension between individual liberty and public health goals in these campaigns (and how Merck became a key actor in privatising and pharmaceuticalising public health) and how they were marked by long-standing controversies around sex and gender. Given Merck’s early and singular focus on preteen girls as its target group, Mamo provocatively asks ‘what’s in it for the boys?’, and deftly turns to the ways boys and men became risk groups in need of protection from HPV’s related cancers and markets for expansion. The management of sex and sexuality throughout this turn is essential and Mamo attends to the ghostly hauntings of HIV/AIDS and the construction of men who have sex with men as a ‘high risk’ epidemiological category. In later chapters, Mamo turns to the cancers to which HPV is linked: cervical, anal and oral cancers, again attending to how awareness and screening campaigns were discursively constructed and how risk groups were captured in ways that did not flatten their varying sexual orientations and practices. In chapter 3, ‘The Cancer that Dare Not Speak Its Name’, the sexual and gender politics of anal cancer screening come to the fore as Mamo traces how HPV-anal cancer interventions and knowledge grew out of LGBTQ health and HIV/AIDS care in the 1980s and 1990s. She sheds light on the particular screening politics for anal cancer—a cancer once considered rare but now on the rise and a highly stigmatised condition—and how groups advocated for the repurposing of the Pap smear used for cervical cancer. In chapter 5, the ‘coming epidemic’, Mamo turns to the integration of a relatively unmarked risk category: middle aged heterosexual men. In the early 2000s, oral cancers were linked to HPV through oral sex (cunnilingus, specifically) and became widely discussed in the media by way of a few celebrities’ public discussion of their diagnosis. Practices that had been considered as ‘less risky’ (though inaccurately so, as Mamo points out) than penetrative sex were now in the spotlight. Perhaps most clearly in this chapter, we also see the conflation and simplification that marks scientific media representations as headlines read akin to, ‘oral sex causes cancer?’ without mention of HPV. In this chapter, we observe the management of sex and sexuality from a new angle and see how an explicit sexualisation of hetero-masculinity was possible. This chapter also lends itself to Mamo’s apt critique of the ways in which a cisgender and hetero approach to oral cancer research left out non-binary bodies and non-hetero-women, missing groups from HPV research and indeed and more broadly from health research in general. Mamo’s arguments about health equity and justice are evident throughout the text. She demonstrates how the vision and pursuit of what she terms ‘me’ precision biomedicine—which has captured biotech and pharmaceutical companies, national health research funders and global health organisations and philanthropies—comes at a cost for the public health ‘we’. And second, she shows how the management of sex and sexuality, namely through efforts to sanitise discussions of HPV and desexualise viral life, results in a lack of public knowledge and understanding and acceptance of the ordinariness of sex and intimate relations (and the ubiquity of HPV infection through those relations). She contends that vaccines and screening tools for HPV and its associated cancers have become commodities of care, part of the privatizsation of public health and an aspect of biomedicalisation that creates ‘citizen consumers’ (Mamo 2023, p. 260) and technoscientisation that promotes a cycle of fear (of health risk) followed by the production and marketing of technological tools that promise to mitigate risk and provide some semblance, however small, of individual control over health risk. The prioritization of this kind of innovation and precision imaginary reproduces health inequities by privileging the very people who already have health and are (largely) well. Mamo’s book is a significant contribution to understanding the entanglements of biomedicine, sex and sexuality, gender and the construction and management of risk and how they are enfolded in 21st century precision medicine that prioritises prevention not only of health problems, but the risk of health risk. Peeling back layer by layer, Mamo shows us why sexualizing cancer is not only good but requisite and that the root of the problem lies in the stigmatising, moralising and ever-persistent efforts to discipline and control bodies and sexual practices.