My comments will use breast cancer as a module for raising questions about access, voice and participation.  I will briefly discuss how the explanatory discourses center and distinguish biomedical explanations over social and environmental explanations, and how the biomedical focus is pulling racial disparities in breast cancer into a genetic framework.  Comments on access, voice and participation will evaluate the ways in which mainstream breast cancer activists have partnered with the biomedical establishment in ways that have enhanced patients’ rights while reinforcing the privilege accorded to biomedical explanations and the ways in which calls for access narrowly focus on payment and technology use.