Breast cancer awareness
Encyclopedia
Breast cancer awareness is an effort to raise awareness
of breast cancer
and reduce the disease's stigma
by educating people about its symptoms and treatment options. Supporters hope that greater knowledge will lead to earlier detection of breast cancer, which is associated with higher long-term survival rates, and that money raised for breast cancer will produce a reliable, permanent cure.
Because there is no cure at this time, awareness is the primary way to decrease the number of people who die from breast cancer. Breast cancer patients who had a family history of breast cancer, and were therefore more aware of the risk factors of breast cancer, are more likely to detect the disease early and also had a higher survival rate, than those who did not have a family history of breast cancer (Verkooijen, 2011). The results from this study demonstrate the purpose of awareness and how it can lead to early detection. Often times the purpose of breast cancer awareness becomes unclear because people become caught up in the pink ribbon
campaign and the media-oriented aspects of breast cancer awareness. The true purpose of breast cancer awareness is to make women aware of the risk of breast cancer, so that they can detect symptoms of breast cancer as early as possible.
Breast cancer advocacy and awareness efforts are a type of health advocacy
. Breast cancer advocates raise funds
and lobby
for better care, more knowledge, and more patient empowerment
. They may conduct educational campaigns or provide free or low-cost services. Breast cancer culture, sometimes called pink ribbon culture, is the cultural outgrowth of breast cancer advocacy, the social movement
that supports it, and the larger women's health
movement.
The pink ribbon
is the most prominent symbol of breast cancer awareness, and in most countries, the month of October is National Breast Cancer Awareness Month
. As "the darling of corporate America", national breast cancer organizations receive substantial financial support from corporate sponsorships (King 2006, page 2).
" for breast cancer, its detection, its treatment, and the need for a reliable, permanent cure. Increased awareness has increased the number of women receiving mammograms, the number of breast cancers detected, and the number of women receiving biopsies (Sulik 2010, pages 157–210). It has also shifted the stage at which breast cancers are detected, so that more tumors are discovered in an earlier, more treatable stage. Marketing efforts have significantly reduced the stigma associated with the disease.
Generally speaking, breast cancer awareness campaigns have been highly effective in getting attention for the disease. Breast cancer receives significantly more media coverage than other prevalent cancers, such as prostate cancer
(Arnst 2007).
Because breast cancer awareness receives so much attention, and has become such a large scale campaign the actual purpose of the campaign can become hidden. People talk about the "fight" against breast cancer, but the awareness campaign is not about the cure. The awareness campaign is about raising people's awareness,to increase the chance of early detection, and thus decrease the fatality rate of breast cancer.
by most governments, the media, and cancer survivors
. The month-long campaign has been called Pinktober because of the proliferation of pink goods for sale, and National Breast Cancer Industry Month by critics like Breast Cancer Action
(Sulik 2010, pages 48, 370). NBCAM was begun in 1985 by the American Cancer Society
and pharmaceutical giant AstraZeneca
, which manufactures breast cancer drugs Arimidex and tamoxifen
. The primary purpose has been to promote mammography
and other forms of early detection as the most effective means of saving lives (King 2006, page xxi).
Typical NCBAM events include fundraising-based foot races, walk-a-thons, and bicycle rides (Ehrenreich 2001). Participants solicit donations to a breast cancer-related charity, in return for their promise to run, walk, or ride in the event. These mass-participation events effectively signal to society that breast cancer survivors have formed a single, united group that speaks, acts and believes the same things, without any significant internal dissension (Sulik 2010, page 56). They also reinforce the cultural connection between each individual's physical fitness
and moral fitness
(King 2006, pages 46–49). Typically, one-quarter to one-third of the money donated is spent on advertising and organizing the event itself (Ehrenreich 2001).
Various landmark
s are illuminated in pink lights as a visible reminder of breast cancer, and public events, such as American football games, may use pink equipment or supplies. In 2010, all King Features Syndicate
comic strips on one Sunday were printed in shades of red and pink, with a pink ribbon logo appearing prominently in one panel.
Private companies may arrange a "pink day", in which employees wear pink clothes in support of breast cancer patients, or pay for the privilege of a relaxed dress code, such as Lee National Denim Day
(Ehrenreich 2001).
Some events are directed at people in specific communities, such as the Global Pink Hijab Day
, which was started in America to encourage appropriate medical care and reduce the stigma of breast cancer among Muslim women, and Male Breast Cancer Awareness Week, which some organizations highlight during the third week of October.
Most events are well-received, but some, like the unauthorized painting of the Pink Bridge
in Huntington, West Virginia
, are controversial.
These symbolic actions do not prevent cancer, improve treatments, or save lives. However, they are effective forms of promoting the pink ribbon culture: fear of breast cancer, the hope for a scientific breakthrough, and the goodness of the people who support the cause. These supporters may feel socially compelled to participate, in a type of "obligatory voluntarism" that critics say is "exploitative" (Sulik 2010, page 250, 308).
A pink ribbon
is a symbol of breast cancer awareness. It may be worn to honor those who have been diagnosed with breast cancer, or to identify products that the manufacturer would like to sell to consumers that are interested in breast cancer. Pink ribbons, which can be made inexpensively, are sometimes sold as fundraisers, much like poppies on Remembrance Day.
The pink ribbon is associated with individual generosity, faith in scientific progress, and a "can-do" attitude. It encourages consumers to focus on the emotionally appealing ultimate vision of a cure for breast cancer, rather than on the fraught path between current knowledge and any future cures (Sulik 2010, pages 359–361).
Promotion of the pink ribbon as a symbol for breast cancer has not been credited with saving any lives. Wearing or displaying a pink ribbon has been denounced as a kind of slacktivism
, because it has no practical positive effect (Landeman 2008). Critics say that the feel-good nature of pink ribbons and pink consumption distracts society from the lack of progress (Sulik 2010, pages 365–366). It is also criticized for reinforcing gender stereotypes and objectifying women and their breasts (Sulik 2010, pages 372–374).
that displays the wearer's interest in breast cancer. Others are everyday products that have been repackaged or repositioned to take advantage of cause-related marketing, such as teddy bears, clothing, jewelry, candles, and coffee mugs (Ehrenreich 2001). These blended value
objects offer consumers an opportunity to simultaneously buy an object and make a tiny donation to a breast cancer organization.
Typically, a manufacturer will produce a product with a pink label or pink ribbon logo, and promise to donate a sum of money to support the cause (Levine 2005). The donation is typically capped, so that it is reached after a low level of sales, although in some cases, the company is providing only free advertising for a selected charity. Although advertising costs are rarely disclosed, companies often spend far more money advertising "pink products" and tie-ins than they donate to charitable organizations supporting research or patients. For example, in 2005, 3M
spent US $500,000 advertising post-it notes printed with a pink ribbon logo. Sales were nearly double what the company expected, but the campaign resulted in only a $300,000 donation (Levine 2005).
Some of these products are produced or sold by breast cancer survivors or charities for fundraising purposes (Ehrenreich 2001).
The first breast cancer awareness stamp in the U.S., featuring a pink ribbon, was issued 1996. As it did not sell well, a semi-postal stamp without a pink ribbon, the breast cancer research stamp
, was designed in 1998. Products like these emphasize the relationship between being a consumer and supporting women with breast cancer (King 2006, pages 61–79).
In Canada, the Royal Canadian Mint produced 30 million 25-cent coins with pink ribbons during 2006 for normal circulation (Royal Canadian Mint 2006). Designed by the mint's director of engraving, Cosme Saffioti (reverse), and Susanna Blunt (obverse), this colored coin is the second in history to be put into regular circulation (Royal Canadian Mint 2006).
Business marketing campaigns, particularly sales promotions for products that increase pollution or that encourage the development of breast cancer, such as high-fat foods, alcohol, pesticides, or the parabens
and phthalates
used by most cosmetic companies, have been condemned as pinkwashing (a portmanteau of pink ribbon and whitewash
) (Mulholland 2010). Such promotions generally result in a token donation to a breast cancer-related charity, while exploiting the consumers' fear of cancer and grief for people who have died to drive sales (Landeman 2008). Critics say that these promotions, which net more than US $30 million each year just for fundraising powerhouse Susan G. Komen for the Cure
, do little more than support the marketing machines that produce them (Stukin 2006).
Pink products have also been condemned as promoting consumerism
, materialism
, and environmental degradation. Critics are also concerned that the ubiquity of pink products may mislead people into thinking that significant progress has been made, and that small, individual actions, like buying a breast cancer-themed product, are sufficient (Stukin 2006).
Two significant campaigns against pink consumption are the National Breast Cancer Coalition
's "Not Just Ribbons" campaign, and Breast Cancer Action
's "Think Before You Pink" campaign. NBCC's "Not Just Ribbons" which opposed the hypocrisy of people and businesses who use pink ribbons to promote their products or themselves, but ignore or oppose substantive issues, such as genetic discrimination
, access to medical care, patient rights, and anti-pollution legislation (Sulik 2010, pages 366–368). "Think Before You Pink" encouraged consumers to ask questions about pink products, e.g., to find out how much of a donation was being made (Sulik 2010, pages 369–372).
for a chosen charity. Medical institutions may run advertisements for mammogram or other breast-related services. Non-profit organizations often benefit from public service announcement
s, which are free advertisements provided by newspapers, radio and television stations, and other media.
Some marketing blurs the line between advertisements and events, such as flash mob
s as a form of guerrilla marketing
. Advertising campaigns on Facebook
have encouraged users to use sexual innuendo and double entendres in their status updates to remind readers about breast cancer. In 2009, the campaign asked women to post the color of their brassieres, and in 2010, the campaign asked women to post where they keep their purses, resulting in status messages such as "I like it on the floor" (Kingston 2010). These campaigns have been criticized as sexualizing the disease (Kingston 2010).
The typical participant in the breast cancer movement, and therefore the advertisers' target audience
, is a white, middle-aged, middle-class, well-educated woman (King 2006, pages 110–111).
Some corporate sponsors are criticized for having a conflict of interest
. For example, some of the prominent sponsors of these advertisements include businesses that sell the expensive equipment needed to perform screening mammography; an increase in the number of women seeking mammograms means an increase in their sales. Their sponsorship is thus not a voluntary act of charity, but an effort to increase their sales (King 2006, page 37). The regulated drug and medical device industry uses the color pink, positive images, and other themes of the pink ribbon culture in direct-to-consumer advertising
to associate their breast cancer products with the fear, hope, and wholesome goodness of the breast cancer movement (Sulik 2010, page 206–208). This is particularly evident in advertisements designed to sell screening mammograms.
Despite having been determined to be ineffective in low-risk and average-risk women, many charities still advertise breast self-examination
s as a means of simultaneously raising awareness, encouraging early detection, and increasing the visibility of their organizations. Other organizations' advertisements now advocate breast awareness, which is paying attention to any changes in the breast that may require medical attention.
, breast cancer receives far more attention in women's magazines than any other cancer. Until the mid-1990s, nearly all of these stories were written from the perspective of the expert, who doled out advice. Since then, the illness narrative, describing the personal experiences of individual patients, has become prominent. (Sulik 2010, page 133).
Embedded marketing, branded content
, and frequent feature stories amount to free advertising for the breast cancer brand and for the organizations that support it.
and the color pink
as a concept brand to raise money and increase screening. The breast cancer brand is strong: People who support the "pink brand" identify themselves as members of the socially aware niche market
, who are in favor of women's health, screening mammography, positive thinking, and willing submission to the current mainstream medical opinion (Sulik 2010, page 22).
The brand ties together fear of cancer, hope for early identification and successful treatment, and the moral goodness of women with breast cancer and anyone who visibly identifies themselves with breast cancer patients. This brand permits and even encourages people to substitute conscientious consumption and individual symbolic actions, like buying or wearing a pink ribbon, for concrete, practical results, especially collective political action
aimed at discovering non-genetic causes of breast cancer (Sulik 2010, pages 133–146).
The establishment of the brand and the entrenchment of the breast cancer movement has been uniquely successful, because no countermovement
opposes the breast cancer movement or believes breast cancer to be desirable (King 2006, page 111).
or lifestyle. Socially aware, pro-woman people, businesses, politicians, and organizations use pink ribbons and other trappings of breast cancer awareness to signal their support for women, health, and mainstream medicine.
of breast cancer is the woman who publicly maintains a pleasant personal appearance and optimism while aggressively fighting breast cancer through compliance with mainstream medical advice. The ideal survivor is always diagnosed early because of her unswerving obedience to the aggressive screening mammography standards put forward by American (but not European or Asian) breast cancer organizations. She is educated as a medical consumer and firmly believes that modern science can cure breast cancer. She is always brave, always victorious, and never dies (Sulik 2010, page 158, 243).
The careful presentation of feminine qualities, such as emphasizing a feminine appearance and concern for others, restores the woman to her proper gender role
by balancing the masculine qualities the women display in responding to breast cancer, such as taking an active role in decision-making, being "selfish" by putting their immediate needs before others', and bravely "fighting" cancer. The military metaphors are particularly masculine: the woman must fight, must persevere, must do her duty (by following medical advice), must be strong, must be victorious, and must conquer the enemy (Sulik 2010, pages 78–89). She regains her femininity by using breast reconstruction
, prosthetic devices, wigs, cosmetics, and clothing to present an aesthetically appealing, upper-class, heterosexual feminine appearance and by cultivating relationships in which she can nurture other people (Sulik 2010, page 42, 374). Programs such as Reach to Recovery and Look Good, Feel Better educate breast cancer patients of this cultural standard and help them conform to it (Olson 2002, page 120; Sulik 2010, pages 37–38).
The breast cancer she-ro closely follows the feeling rules
of the breast cancer culture, or tries to: She remains optimistic of a permanent, physical cure, and relentlessly cheerful in public. She is selfish—that is, she prioritizes her greater needs above others' lesser needs—and justifies this either as a short-term, rational coping strategy or as an inevitable, although guilt-inducing, situation. She also feels guilty: She may conceive of herself as an inadequate she-ro, or she may believe that her previous choices caused her breast cancer, or she may feel that she is doing too little to care for others, especially her family and other women with breast cancer (Sulik 2010, pages 225–272, 277).
A type of have-it-all superwoman
, the she-ro tries to present a normal appearance and activity level and minimize the disruption that breast cancer causes to people around her. Women with breast cancer are often more comfortable caring for other people than being cared for. They may find it difficult or inappropriate to ask for help they need or want, and later feel bitter that their friends and family did not offer these services unbidden (Sulik 2010, pages 279–301). The success of their normalization efforts may paradoxically increase their dissatisfaction, as their apparent ability to handle it all discourages people from offering help (Sulik 2010, page 283, 286).
The effect of the she-ro model is to reduce the stigma of having breast cancer, and to increase the stigma of being overwhelmed, depressed, anxious, abrasive, or unattractive as a result of having breast cancer (Sulik 2010, page 45). The culture celebrates women who display the attitude deemed correct, and declares that their continued survival is due to this positive attitude and fighting spirit, even though cheerfulness, hope, and displaying a cosmetically enhanced appearance do not kill cancer cells (Sulik 2010, page 243–244).
Women who reject the she-ro model may find themselves socially isolated by the breast cancer support group
s that are nominally supposed to help them. Support from "the sisterhood" is reserved for the "passionately pink", rather than those whose response is deemed inappropriate because it is angry, unhappy, or afraid (Sulik 2010, page 274–277).
The breast cancer culture is also ill-equipped to deal with women who are dying or who have died (Sulik 2010, page 4). Despite occasional efforts at memorials, such as displaying the names of women who have died, these women's experiences are not validated and represented. They are, instead, ignored and shunned as failures and as hope-destroying examples of reality. Similarly, the culture is ill-equipped to deal with the news that a previously hyped treatment or screening procedure has been determined to be ineffective, with women demanding acceptance and promotion of useless activities and harmful drugs (Ehrenreich 2001; Olson 2002, pages 204–205; Sulik 2010, pages 200–203).
(Sulik 2010, page 236). Breast cancer thereby becomes a rite of passage
rather than a disease (Ehrenreich 2001; Sulik 2010, page 3).
The emphasis on cheerfulness allows society to blame women for developing breast cancer and to the limit their responses to culturally approved scripts. The requirement of cheerful optimism arises from a now-discredited idea that people who were diagnosed with cancer had a "cancer personality" that was depressed, repressed, and self-loathing. The cure for cancer was therefore psychotherapy
to produce a cheerful, self-affirming identity (Olson 2002, pages 460–469; Sulik 2010, page 342).
Pink ribbon culture is pro-doctor, pro-medicine, and pro-mammogram. Health care professionals are sources of information, but the rightness of their advice is not to be seriously questioned. Patients are not encouraged to notice the absence of any meaningful method of prevention or treatments that are non-mutilating, non-debilitating, or noticeably more successful than what existed in the 1930s (Sulik 2010, pages 365–366).
Breast cancer culture values and honors suffering, selecting its she-roes by a "misery quotient" (Sulik 2010, page 319). Elizabeth Edwards
, for example, personifies the breast cancer she-ro. Women whose treatment requires less suffering feel excluded and devalued. The suffering, particularly the extended suffering of months of chemotherapy and radiation treatment, forms a type of ordeal
that initiates women into the inner circle of the breast cancer culture (Ehrenreich 2001).
Mainstream pink ribbon culture is also trivializing, silencing, and infantilizing (Sulik 2010, page 98). Women who choose not to conform to the culture feel excluded and isolated; those who cannot conform to the prescribed triumphant storyline feel unable to share their stories honestly. Anger, negativity and fatalism transgress the feeling rules, and women with breast cancer who express anger or negativity are corrected and disciplined by other women with breast cancer and members of the breast cancer support organizations (Ehrenreich 2001; Sulik 2010, page 240–242). Appearing unattractive—such as going out in public with a bare, bald head if treatment causes temporary hair loss—transgresses the approved, upper-class style of pink femininity and provokes shaming comments from strangers. Women with breast cancer are surrounded by sentimental kitsch and baby toys, such as pink teddy bears, when the equivalent for men, like a blue toy car, is unthinkable (Ehrenreich 2001).
Since the beginning of the 21st century, breast cancer culture has become more sexualized, and many awareness campaigns now reflect the old advertising truism that sex sells. The "booby campaigns", such as "Save the Tatas"
and the "I ♥ Boobies" gel bracelets, rely on a cultural obsession with breasts and a market that is already highly aware of breast cancer (Kingston 2010). This message reflects a belief that breast cancer is important not because it kills women prematurely, but because cancer and its treatment makes women feel less sexually desirable and interferes with men's sexual access to women's breasts (Sulik 2010, page 347). These campaigns tend to attract a younger audience than traditional campaigns (Kingston 2010).
Breast cancer culture tends to overlook men with breast cancer
and women who do not fit the white, middle-class archetype. African-Americans involved with breast cancer organizations often feel like their role is to be the token minority (Sulik 2010, pages 308–309).
The primary purposes or goals of breast cancer culture are to maintain breast cancer's dominance as the preëminent women's health issue, to promote the appearance that society is "doing something" effective about breast cancer, and to sustain and expand the social, political, and financial power of breast cancer activists (Sulik 2010, page 57).
The breast cancer culture tells women with breast cancer that their participation in fundraising, social support other women with breast cancer, and appearance at public events are critical activities that promote their own emotional recovery. Women begin to believe that refusing to raise money for breast cancer organizations or to become mentors for newly diagnosed women with breast cancer is an unhealthy response to breast cancer (Sulik 2010, pages 305–311).
(Olson 2002, pages 195–202; Soffa 1994, page 208). Before the feminist movement, women with breast cancer were often treated as passive, dependent objects
, incapable of making appropriate choices, whose role was to accept whatever treatment was decreed by the physicians, surgeons, or husbands, who held all of the power (Ehrenreich 2001). Because of sexism in education, few women were trained to be surgeons, and until the 1990s, when Susan Love
of the UCLA Breast Center published Dr. Susan Love's Breast Book, the physicians who provided breast cancer treatments were generally men. Love said that some male physicians tended to impose their own values on women, such as recommending mastectomy to older women because, being past the age of child bearing and breastfeeding, they no longer "needed" their breasts (Olson 2002, page 198). The women's health movement promoted mutual aid, self-help, networking
, and an active, informed role in the patient's health care (Ehrenreich 2001).
The breast cancer wars were a series of conflicts between advocates and others about the causes, treatments, and societal responses to breast cancer (Olson 2002, pages 192–220). Women in the late 1980s and 1990s followed the successful approach used by ACT-UP and other AIDS awareness groups, of staging media-friendly protests to increase political pressure. Prominent women who made the "wrong" choice were publicly excoriated, as when Nancy Reagan
chose mastectomy over lumpectomy followed by six weeks of
radiation therapy
. The abortion–breast cancer hypothesis was formulated when an early study showed a connection between voluntary abortion
s and the development of breast cancer in premenopausal women, which pitted breast cancer advocates against abortion rights advocates (Olson 2002, pages 192–220).
Since the end of the breast cancer wars, feminists have again objected to the breast cancer culture's treatment of women with breast cancer as little girls who need to be obedient to authority figures, cooperative, pleasant and pretty (Ehrenreich 2001).
subject. The breast cancer movement, which developed in the 1980s and 1990s out of 20th century feminist movements and the women's health movement, has mostly remove those taboos through its modern advocacy and awareness campaigns (Sulik 2010, page 4).
published her book, Breast Cancer: A Personal History and Investigative Report, which she had written while recovering from a modified radical mastectomy. The media reported these women's health and their treatment choices, and even invited some to appear on talk show
s to discuss breast cancer frankly (Olson 2002, pages 124–144).
The breast cancer movement has resulted in widespread acceptance of second opinion
s, the development of less invasive surgical procedures, the spread of support group
s, and other advances in patient care (Olson 2002, pages 121, 171–220). The movement successfully separated diagnostic biopsy from mastectomy surgery; before about 1980, it was common to perform the biopsy and, if a quick review of tissues indicated a probable need, a mastectomy in the same surgery (Ehrenreich 2001; Olson 2002, pages 168–191). The one-step surgery prevented women from seeking different opinions about their treatment, and sent them into the surgery without knowing whether their breasts would be removed that day. In response to women's concerns over lymphedema
after routine removal of lymph nodes during mastectomy, the more limited approach of sentinel node biopsy was developed. Advocacy efforts also led to the formal recommendation against the routine use of the Halsted radical mastectomy in favor of simple mastectomies and lumpectomies (Olson 2002, pages 176, 185–186, 250).
The breast cancer movement has supported practical, educational, emotional, and financial care for women with breast cancer. Support groups, individual counseling opportunities, and other resources are made available to patients.
Breast cancer advocates have successfully increased the amount of public money being spent on cancer research and shifted the research focus away from other diseases and towards breast cancer. Most breast cancer research is funded by government agencies (Mulholland 2010). Breast cancer advocates also raise millions of dollars for research into cures each year, although most of the funds they raise is spent on screening programs, education and treatment.
The high level of awareness and organized political lobbying has resulted in a disproportionate level of funding and resources given to breast cancer research and care. Favoring breast cancer with disproportionate research may have the unintended consequence
of costing lives elsewhere (Browne 2001). In 2001 UK MP Ian Gibson
said, "The treatment has been skewed by the lobbying, there is no doubt about that. Breast cancer sufferers get better treatment in terms of bed spaces, facilities and doctors and nurses" (Browne 2001).
Because breast cancer is a highly visible disease, most women significantly overestimate their personal risk of dying from it. Misleading statistics, such as the claim that one in eight women will be diagnosed with breast cancer during their lives—a claim that depends on the patently unrealistic assumption that no woman will die of any other disease before the age of 95 (Olson 2002, pages 199–200)—obscure the reality, which is that about ten times as many women will die from heart disease
or stroke
than from breast cancer (Ave 2006).
Awareness has also led to increased anxiety for women. Early detection efforts result in overdiagnosis of precancerous and cancerous tumors that would never risk the woman's life (about one-third of breast cancers), and result in her being subjected to invasive and sometimes dangerous radiological and surgical procedures (Aschwanden 2009).
The breast cancer culture has also promoted an expansive definition of breast cancer, which includes non-invasive, non-cancerous conditions like lobular carcinoma in situ
(LCIS) and pre-cancerous or "stage 0" conditions like ductal carcinoma in situ (DCIS). Despite the now-regretted decision to use the word carcinoma in these relatively common conditions (almost a quarter of "breast cancer" diagnoses in the USA), they are not life-threatening cancer
s (Sulik 2010, page 165–171). Women with these conditions are promoted as breast cancer survivors due to the fear they experienced before they became educated about their condition, rather than in respect of any real threat to their lives. This effectively increases the market size for breast cancer organizations, medical establishments, pharmaceutical manufacturers, and the makers of mammography equipment (Sulik 2010, page 170–171).
An emphasis on educating women about lifestyle changes that may have a small impact on preventing breast cancer often makes women feel guilty if they do develop breast cancer. Some women decide that their own cancer resulted from poor diet, lack of exercise, or other modifiable lifestyle factor, even though most cases of breast cancer are due to non-controllable factors, like genetics or naturally occurring background radiation. Adopting such a belief may increase their sense of being in control
of their fate. Increased awareness inadvertently increases victim blaming
(Olson 2002, pages 240–242, Sulik 2010, page 74, 263). Women who resist screening mammography or breast self-exams are subjected to social pressure, scare tactics, guilt, and threats from some physicians to terminate the relationship with the patient
(Welch 2010). Similarly, the emphasis on early detection results in women blaming themselves if their cancer is not detected at an early stage.
The promotion of research to make screening programs find ever more cancers is also criticized. One-third of diagnosed breast cancers might recede on their own (Aschwanden 2009). Screening mammography efficiently finds non-life-threatening, asymptomatic breast cancers and pre-cancers, even while overlooking serious cancers. According to H. Gilbert Welch of the Dartmouth Institute for Health Policy and Clinical Practice, research on screening mammography has taken the "brain-dead approach that says the best test is the one that finds the most cancers" rather than the one that finds dangerous cancers (Aschwanden 2009).
to the breast cancer industry, including big pharma, mammography equipment manufacturers, and pollution-causing industries, as well as large corporations, creating or exacerbating other problems.
For example, Ford Motor Company
ran a "Warriors in Pink" promotion on their Ford Mustang
sports car, which critics say was intended to sell cars and counter the bad publicity the company received by reducing its workforce by tens of thousands of people, causing many of them to lose their health insurance
, rather than to prevent or cure breast cancer (Sulik 2010, page 130-135).
However, the primary sponsors are part of the breast cancer industry, particularly cancer drug makers like AstraZeneca, Bristol-Myers Squibb, and Novartis. Because the national breast cancer organizations are dependent on corporate sponsorships for survival, this situation may represent a conflict of interest
that prevents these organizations from representing the needs of current and future people with breast cancer when those needs conflict with the profit-making motives of the corporate sponsors. To avoid offending sponsors or to woo new ones, breast cancer organizations may self-censor their message and oversell options like screening mammography and new chemotherapeutic agents (Sulik 2010, page 209–210).
The structure of the breast cancer movement may allow large organizations to claim to be the voice of women with breast cancer, while simultaneously ignoring their desires (Sulik 2010, page 376).
Some breast cancer organizations, such as Breast Cancer Action
, refuse to accept funds from medical or other companies they disapprove of.
, and existing treatments (Ave 2006). Only a small fraction of the funds is spent on research, and most of that funding is spent on research to improve diagnosis and treatment of breast cancer. To the dismay of advocates like Breast Cancer Action
and women's health issues scholar Samantha King, relatively little money or attention is devoted to identifying the non-genetic causes of breast cancer or taking steps to prevent breast cancer from occurring (Ave 2006). The mainstream breast cancer culture is focused on a cure for existing breast cancer cases, rather than on preventing future cases.
As a result, screening mammography is promoted by the breast cancer industry as the sole possible approach to public health
for breast cancer (Sulik 2010, page 204). Alternatives, such as pollution prevention, are largely ignored.
As the majority of women with breast cancer have no risk factors other than sex and age, the environmental breast cancer movement suspects pollution as a significant cause, possibly from pesticides, plastics, or petroleum products (Ehrenreich 2001). The largest organizations, particularly Susan G. Komen for the Cure and the American Cancer Society, are not part of the environmental breast cancer movement (Ehrenreich 2001). These organizations benefit the most from corporate sponsorships that critics deride as pinkwashing, e.g., polluting industries trying to buy public goodwill by publishing advertisements emblazoned with pink ribbons, rather than stopping their pollution under the precautionary principle
(King 2006, pages 1–2).
Samantha King says that prevention research is minimized by the breast cancer industry because there is no way to make money off of cases of breast cancer that do not happen, whereas a mammography imaging system that finds more possible cancers, or a "magic bullet" that kills confirmed cancers, would be highly profitable (King 2006, page 38). This prejudice applies equally to breast cancer organizations, because a reliable form of prevention would deplete their future supply of dedicated volunteers.
In 1998, the Art.Rage.Us art collective published a book that collected some of the art work from their traveling collection. This included art that was shocking, painful and realistic rather than beautiful, such as several self-portraits that showed mastectomy scars (Sulik 2010, pages 326–332).
Another art form has a wider range: the illness narrative has become a staple of breast cancer literature. This may take the form of a restitution or cure narrative (the protagonist seeks a physical or spiritual return to a pre-diagnosis life), a quest narrative (the protagonist must meet a goal before dying), or a chaos narrative (the situation inexorably goes from bad to worse). The cure and quest narratives fit neatly with the breast cancer culture. Chaos narratives, rarer with breast cancer, oppose it (Sulik 2010, pages 321–326).
Early campaigns included the "Women's Field Army", run by the American Society for the Control of Cancer (the forerunner of the American Cancer Society
) during the 1930s and 1940s. Explicitly using a military metaphor, they promoted early detection and prompt medical intervention as every woman's duty in the war on cancer. In 1952, the first peer-to-peer support group, called "Reach to Recovery", was formed. Later taken over by the American Cancer Society, it provided post-mastectomy, in-hospital visits from women who had survived breast cancer, who shared their own experiences, practical advice, and emotional support, but never medical information. This was the first program designed to promote restoration of a feminine appearance, e.g., through providing breast prostheses, as a goal (Sulik 2010, pages 37–38).
While the large organizations dominate the media, most of the practical, day-to-day support for women with breast cancer is provided by small, local groups. While providing the bulk of unglamorous, practical assistance, like driving women to and from medical appointments, these organizations typically struggle for funding in the shadow of the large groups (Sulik 2010, page 53).
Raising awareness
"Raising awareness" is a phrase that advocacy groups commonly use when promoting a particular issue, organization or event. Raising awareness refers to alerting the general public that a certain issue exists and should be approached the way the group desires...
of breast cancer
Breast cancer
Breast cancer is cancer originating from breast tissue, most commonly from the inner lining of milk ducts or the lobules that supply the ducts with milk. Cancers originating from ducts are known as ductal carcinomas; those originating from lobules are known as lobular carcinomas...
and reduce the disease's stigma
Social stigma
Social stigma is the severe disapproval of or discontent with a person on the grounds of characteristics that distinguish them from other members of a society.Almost all stigma is based on a person differing from social or cultural norms...
by educating people about its symptoms and treatment options. Supporters hope that greater knowledge will lead to earlier detection of breast cancer, which is associated with higher long-term survival rates, and that money raised for breast cancer will produce a reliable, permanent cure.
Because there is no cure at this time, awareness is the primary way to decrease the number of people who die from breast cancer. Breast cancer patients who had a family history of breast cancer, and were therefore more aware of the risk factors of breast cancer, are more likely to detect the disease early and also had a higher survival rate, than those who did not have a family history of breast cancer (Verkooijen, 2011). The results from this study demonstrate the purpose of awareness and how it can lead to early detection. Often times the purpose of breast cancer awareness becomes unclear because people become caught up in the pink ribbon
Pink ribbon
The pink ribbon is an international symbol of breast cancer awareness. Pink ribbons, and the color pink in general, identify the wearer or promoter with the breast cancer brand and express moral support for women with breast cancer....
campaign and the media-oriented aspects of breast cancer awareness. The true purpose of breast cancer awareness is to make women aware of the risk of breast cancer, so that they can detect symptoms of breast cancer as early as possible.
Breast cancer advocacy and awareness efforts are a type of health advocacy
Health Advocacy
Health advocacy encompasses direct service to the individual or family as well as activities that promote health and access to health care in communities and the larger public. Advocates support and promote the rights of the patient in the health care arena, help build capacity to improve...
. Breast cancer advocates raise funds
Fundraising
Fundraising or fund raising is the process of soliciting and gathering voluntary contributions as money or other resources, by requesting donations from individuals, businesses, charitable foundations, or governmental agencies...
and lobby
Lobbying
Lobbying is the act of attempting to influence decisions made by officials in the government, most often legislators or members of regulatory agencies. Lobbying is done by various people or groups, from private-sector individuals or corporations, fellow legislators or government officials, or...
for better care, more knowledge, and more patient empowerment
Patient empowerment
The patient empowerment concept, a recent outgrowth of the natural health movement, asserts that to be truly healthy, people must bring about changes in their social situations and in the environment that influences their lives, not only in their personal behavior.According to advocates of the...
. They may conduct educational campaigns or provide free or low-cost services. Breast cancer culture, sometimes called pink ribbon culture, is the cultural outgrowth of breast cancer advocacy, the social movement
Social movement
Social movements are a type of group action. They are large informal groupings of individuals or organizations focused on specific political or social issues, in other words, on carrying out, resisting or undoing a social change....
that supports it, and the larger women's health
Women's health
Women's health refers to health issues specific to human female anatomy. These often relate to structures such as female genitalia and breasts or to conditions caused by hormones specific to, or most notable in, females. Women's health issues include menstruation, contraception, maternal health,...
movement.
The pink ribbon
Pink ribbon
The pink ribbon is an international symbol of breast cancer awareness. Pink ribbons, and the color pink in general, identify the wearer or promoter with the breast cancer brand and express moral support for women with breast cancer....
is the most prominent symbol of breast cancer awareness, and in most countries, the month of October is National Breast Cancer Awareness Month
National Breast Cancer Awareness Month
Breast Cancer Awareness Month is an annual international health campaign organized by major breast cancer charities every October to increase awareness of the disease and to raise funds for research into its cause, prevention, diagnosis, treatment and cure...
. As "the darling of corporate America", national breast cancer organizations receive substantial financial support from corporate sponsorships (King 2006, page 2).
Marketing approaches
The goal of breast cancer awareness campaigns is to raise the public's "brand awarenessBrand awareness
Brand awareness is a marketing concept that enables marketers to quantify levels and trends in consumer knowledge and awareness of a brand's existence...
" for breast cancer, its detection, its treatment, and the need for a reliable, permanent cure. Increased awareness has increased the number of women receiving mammograms, the number of breast cancers detected, and the number of women receiving biopsies (Sulik 2010, pages 157–210). It has also shifted the stage at which breast cancers are detected, so that more tumors are discovered in an earlier, more treatable stage. Marketing efforts have significantly reduced the stigma associated with the disease.
Generally speaking, breast cancer awareness campaigns have been highly effective in getting attention for the disease. Breast cancer receives significantly more media coverage than other prevalent cancers, such as prostate cancer
Prostate cancer
Prostate cancer is a form of cancer that develops in the prostate, a gland in the male reproductive system. Most prostate cancers are slow growing; however, there are cases of aggressive prostate cancers. The cancer cells may metastasize from the prostate to other parts of the body, particularly...
(Arnst 2007).
Because breast cancer awareness receives so much attention, and has become such a large scale campaign the actual purpose of the campaign can become hidden. People talk about the "fight" against breast cancer, but the awareness campaign is not about the cure. The awareness campaign is about raising people's awareness,to increase the chance of early detection, and thus decrease the fatality rate of breast cancer.
Events
Each year, the month of October is recognized as National Breast Cancer Awareness MonthNational Breast Cancer Awareness Month
Breast Cancer Awareness Month is an annual international health campaign organized by major breast cancer charities every October to increase awareness of the disease and to raise funds for research into its cause, prevention, diagnosis, treatment and cure...
by most governments, the media, and cancer survivors
Cancer survivors
A cancer survivor is an individual with cancer of any type, current or past, who is still living. About 11 million Americans alive today—one in 30 people–are either currently undergoing treatment for cancer or have done so in the past." Currently nearly 65% of adults diagnosed with cancer in the...
. The month-long campaign has been called Pinktober because of the proliferation of pink goods for sale, and National Breast Cancer Industry Month by critics like Breast Cancer Action
Breast Cancer Action
Breast Cancer Action is a national grassroots education and advocacy organization dedicated to supporting people living with breast cancer and creating system-wide change that will end the breast cancer epidemic. It was founded in 1990 by Elenore Pred, Susan Claymon, and Linda Reyes...
(Sulik 2010, pages 48, 370). NBCAM was begun in 1985 by the American Cancer Society
American Cancer Society
The American Cancer Society is the "nationwide community-based voluntary health organization" dedicated, in their own words, "to eliminating cancer as a major health problem by preventing cancer, saving lives, and diminishing suffering from cancer, through research, education, advocacy, and...
and pharmaceutical giant AstraZeneca
AstraZeneca
AstraZeneca plc is a global pharmaceutical and biologics company headquartered in London, United Kingdom. It is the world's seventh-largest pharmaceutical company measured by revenues and has operations in over 100 countries...
, which manufactures breast cancer drugs Arimidex and tamoxifen
Tamoxifen
Tamoxifen is an antagonist of the estrogen receptor in breast tissue via its active metabolite, hydroxytamoxifen. In other tissues such as the endometrium, it behaves as an agonist, hence tamoxifen may be characterized as a mixed agonist/antagonist...
. The primary purpose has been to promote mammography
Mammography
Mammography is the process of using low-energy-X-rays to examine the human breast and is used as a diagnostic and a screening tool....
and other forms of early detection as the most effective means of saving lives (King 2006, page xxi).
Typical NCBAM events include fundraising-based foot races, walk-a-thons, and bicycle rides (Ehrenreich 2001). Participants solicit donations to a breast cancer-related charity, in return for their promise to run, walk, or ride in the event. These mass-participation events effectively signal to society that breast cancer survivors have formed a single, united group that speaks, acts and believes the same things, without any significant internal dissension (Sulik 2010, page 56). They also reinforce the cultural connection between each individual's physical fitness
Physical fitness
Physical fitness comprises two related concepts: general fitness , and specific fitness...
and moral fitness
Morality
Morality is the differentiation among intentions, decisions, and actions between those that are good and bad . A moral code is a system of morality and a moral is any one practice or teaching within a moral code...
(King 2006, pages 46–49). Typically, one-quarter to one-third of the money donated is spent on advertising and organizing the event itself (Ehrenreich 2001).
Various landmark
Landmark
This is a list of landmarks around the world.Landmarks may be split into two categories - natural phenomena and man-made features, like buildings, bridges, statues, public squares and so forth...
s are illuminated in pink lights as a visible reminder of breast cancer, and public events, such as American football games, may use pink equipment or supplies. In 2010, all King Features Syndicate
King Features Syndicate
King Features Syndicate, a print syndication company owned by The Hearst Corporation, distributes about 150 comic strips, newspaper columns, editorial cartoons, puzzles and games to nearly 5000 newspapers worldwide...
comic strips on one Sunday were printed in shades of red and pink, with a pink ribbon logo appearing prominently in one panel.
Private companies may arrange a "pink day", in which employees wear pink clothes in support of breast cancer patients, or pay for the privilege of a relaxed dress code, such as Lee National Denim Day
Lee National Denim Day
Lee National Denim Day is a fundraiser created by Lee Jeans to support the Women's cancer programs of the Entertainment Industry Foundation. Every year, people are asked to donate the money they'd spend on a pair of jeans to support breast cancer research and wellness programs...
(Ehrenreich 2001).
Some events are directed at people in specific communities, such as the Global Pink Hijab Day
Global Pink Hijab Day
Global Pink Hijab Day is an initiative that began as an experiment by founder, Hend El-Buri and a group of high school students in Columbia, Missouri...
, which was started in America to encourage appropriate medical care and reduce the stigma of breast cancer among Muslim women, and Male Breast Cancer Awareness Week, which some organizations highlight during the third week of October.
Most events are well-received, but some, like the unauthorized painting of the Pink Bridge
Pink bridge
The Pink Bridge of Huntington, West Virginia is a concrete arch bridge spanning Four Pole Creek at 8th Street that was painted pink during late October to mid November 2006 to raise awareness of breast cancer...
in Huntington, West Virginia
Huntington, West Virginia
Huntington is a city in Cabell and Wayne counties in the U.S. state of West Virginia, along the Ohio River. Most of the city is in Cabell County, for which it is the county seat. A small portion of the city, mainly the neighborhood of Westmoreland, is in Wayne County. Its population was 49,138 at...
, are controversial.
These symbolic actions do not prevent cancer, improve treatments, or save lives. However, they are effective forms of promoting the pink ribbon culture: fear of breast cancer, the hope for a scientific breakthrough, and the goodness of the people who support the cause. These supporters may feel socially compelled to participate, in a type of "obligatory voluntarism" that critics say is "exploitative" (Sulik 2010, page 250, 308).
Pink ribbon
Pink ribbon
The pink ribbon is an international symbol of breast cancer awareness. Pink ribbons, and the color pink in general, identify the wearer or promoter with the breast cancer brand and express moral support for women with breast cancer....
is a symbol of breast cancer awareness. It may be worn to honor those who have been diagnosed with breast cancer, or to identify products that the manufacturer would like to sell to consumers that are interested in breast cancer. Pink ribbons, which can be made inexpensively, are sometimes sold as fundraisers, much like poppies on Remembrance Day.
The pink ribbon is associated with individual generosity, faith in scientific progress, and a "can-do" attitude. It encourages consumers to focus on the emotionally appealing ultimate vision of a cure for breast cancer, rather than on the fraught path between current knowledge and any future cures (Sulik 2010, pages 359–361).
Promotion of the pink ribbon as a symbol for breast cancer has not been credited with saving any lives. Wearing or displaying a pink ribbon has been denounced as a kind of slacktivism
Slacktivism
Slacktivism is a portmanteau formed out of the words slacker and activism. The word is usually considered a pejorative term that describes "feel-good" measures, in support of an issue or social cause, that have little or no practical effect other than to make the person doing it feel satisfaction...
, because it has no practical positive effect (Landeman 2008). Critics say that the feel-good nature of pink ribbons and pink consumption distracts society from the lack of progress (Sulik 2010, pages 365–366). It is also criticized for reinforcing gender stereotypes and objectifying women and their breasts (Sulik 2010, pages 372–374).
Shopping for the cure
Thousands of breast cancer-themed products are developed and sold each year (Ave 2006). Some of these, like pink ribbons and awareness bracelets, have no purpose other than as a type of status symbolStatus symbol
A status symbol is a perceived visible, external denotation of one's social position and perceived indicator of economic or social status. Many luxury goods are often considered status symbols...
that displays the wearer's interest in breast cancer. Others are everyday products that have been repackaged or repositioned to take advantage of cause-related marketing, such as teddy bears, clothing, jewelry, candles, and coffee mugs (Ehrenreich 2001). These blended value
Blended value
Blended value refers to a business model that combines a revenue-generating business with a component which generates social-value. The term is usually attributed to Jed Emerson, and sometimes used interchangeably with triple bottom line and social enterprise...
objects offer consumers an opportunity to simultaneously buy an object and make a tiny donation to a breast cancer organization.
Typically, a manufacturer will produce a product with a pink label or pink ribbon logo, and promise to donate a sum of money to support the cause (Levine 2005). The donation is typically capped, so that it is reached after a low level of sales, although in some cases, the company is providing only free advertising for a selected charity. Although advertising costs are rarely disclosed, companies often spend far more money advertising "pink products" and tie-ins than they donate to charitable organizations supporting research or patients. For example, in 2005, 3M
3M
3M Company , formerly known as the Minnesota Mining and Manufacturing Company, is an American multinational conglomerate corporation based in Maplewood, Minnesota, United States....
spent US $500,000 advertising post-it notes printed with a pink ribbon logo. Sales were nearly double what the company expected, but the campaign resulted in only a $300,000 donation (Levine 2005).
Some of these products are produced or sold by breast cancer survivors or charities for fundraising purposes (Ehrenreich 2001).
The first breast cancer awareness stamp in the U.S., featuring a pink ribbon, was issued 1996. As it did not sell well, a semi-postal stamp without a pink ribbon, the breast cancer research stamp
Breast cancer research stamp
The Breast Cancer Research Stamp is a semi-postal non-denominated postage stamp issued by the United States Postal Service, priced in 2010 as eleven cents higher than the standard first-class letter rate...
, was designed in 1998. Products like these emphasize the relationship between being a consumer and supporting women with breast cancer (King 2006, pages 61–79).
In Canada, the Royal Canadian Mint produced 30 million 25-cent coins with pink ribbons during 2006 for normal circulation (Royal Canadian Mint 2006). Designed by the mint's director of engraving, Cosme Saffioti (reverse), and Susanna Blunt (obverse), this colored coin is the second in history to be put into regular circulation (Royal Canadian Mint 2006).
Business marketing campaigns, particularly sales promotions for products that increase pollution or that encourage the development of breast cancer, such as high-fat foods, alcohol, pesticides, or the parabens
Parabens
Parabens are a class of chemicals widely used as preservatives in the cosmetic and pharmaceutical industries. Parabens are effective preservatives in many types of formulas. These compounds, and their salts, are used primarily for their bactericidal and fungicidal properties...
and phthalates
Phthalates
Phthalates , or phthalate esters, are esters of phthalic acid and are mainly used as plasticizers . They are used primarily to soften polyvinyl chloride...
used by most cosmetic companies, have been condemned as pinkwashing (a portmanteau of pink ribbon and whitewash
Whitewash (censorship)
To whitewash is a metaphor meaning to gloss over or cover up vices, crimes or scandals or to exonerate by means of a perfunctory investigation or through biased presentation of data. It is especially used in the context of corporations, governments or other organizations.- Etymology :Its first...
) (Mulholland 2010). Such promotions generally result in a token donation to a breast cancer-related charity, while exploiting the consumers' fear of cancer and grief for people who have died to drive sales (Landeman 2008). Critics say that these promotions, which net more than US $30 million each year just for fundraising powerhouse Susan G. Komen for the Cure
Susan G. Komen for the Cure
Susan G. Komen for the Cure, formerly known as The Susan G. Komen Breast Cancer Foundation, often referred to as simply Komen, is the most widely known, largest and best-funded breast cancer organization in the US....
, do little more than support the marketing machines that produce them (Stukin 2006).
Pink products have also been condemned as promoting consumerism
Consumerism
Consumerism is a social and economic order that is based on the systematic creation and fostering of a desire to purchase goods and services in ever greater amounts. The term is often associated with criticisms of consumption starting with Thorstein Veblen...
, materialism
Materialism
In philosophy, the theory of materialism holds that the only thing that exists is matter; that all things are composed of material and all phenomena are the result of material interactions. In other words, matter is the only substance...
, and environmental degradation. Critics are also concerned that the ubiquity of pink products may mislead people into thinking that significant progress has been made, and that small, individual actions, like buying a breast cancer-themed product, are sufficient (Stukin 2006).
Two significant campaigns against pink consumption are the National Breast Cancer Coalition
National Breast Cancer Coalition
On September 20, 2010, the National Breast Cancer Coalition , a grassroots advocacy organization that seeks to improve public policies surrounding breast cancer research, diagnosis and treatment, launched Breast Cancer Deadline 2020, a call to action for policymakers, researchers, breast cancer...
's "Not Just Ribbons" campaign, and Breast Cancer Action
Breast Cancer Action
Breast Cancer Action is a national grassroots education and advocacy organization dedicated to supporting people living with breast cancer and creating system-wide change that will end the breast cancer epidemic. It was founded in 1990 by Elenore Pred, Susan Claymon, and Linda Reyes...
's "Think Before You Pink" campaign. NBCC's "Not Just Ribbons" which opposed the hypocrisy of people and businesses who use pink ribbons to promote their products or themselves, but ignore or oppose substantive issues, such as genetic discrimination
Genetic discrimination
Genetic discrimination occurs when people are treated differently by their employer or insurance company because they have a gene mutation that causes or increases the risk of an inherited disorder. People who undergo genetic testing may be at risk for genetic discrimination.The results of a...
, access to medical care, patient rights, and anti-pollution legislation (Sulik 2010, pages 366–368). "Think Before You Pink" encouraged consumers to ask questions about pink products, e.g., to find out how much of a donation was being made (Sulik 2010, pages 369–372).
Advertisements
Many corporate and charitable organizations run advertisements related to breast cancer, especially during National Breast Cancer Awareness Month, in the hope of increasing sales by aligning themselves with a positive, helpful message (King 2006). In addition to selling pink products, corporate advertisements may promote the company's progressive policies, or may provide free advertisingGifts in kind
Gifts in kind is a kind of charitable giving in which, instead of giving money to buy needed goods and services, the goods and services themselves are given. The motivations for GIK vary, but include:...
for a chosen charity. Medical institutions may run advertisements for mammogram or other breast-related services. Non-profit organizations often benefit from public service announcement
Public service announcement
A public service announcement or public service ad is a type of advertisement featured on television, radio, print or other media...
s, which are free advertisements provided by newspapers, radio and television stations, and other media.
Some marketing blurs the line between advertisements and events, such as flash mob
Flash mob
A flash mob is a group of people who assemble suddenly in a public place, perform an unusual and sometimes seemingly pointless act for a brief time, then disperse, often for the purposes of entertainment, satire, artistic expression...
s as a form of guerrilla marketing
Guerrilla marketing
Guerrilla warfare is about waging small intermittent attacks on different territories of the opponent with the aim of harassing and demoralising the opponent and eventually securing permanent footholds....
. Advertising campaigns on Facebook
Facebook
Facebook is a social networking service and website launched in February 2004, operated and privately owned by Facebook, Inc. , Facebook has more than 800 million active users. Users must register before using the site, after which they may create a personal profile, add other users as...
have encouraged users to use sexual innuendo and double entendres in their status updates to remind readers about breast cancer. In 2009, the campaign asked women to post the color of their brassieres, and in 2010, the campaign asked women to post where they keep their purses, resulting in status messages such as "I like it on the floor" (Kingston 2010). These campaigns have been criticized as sexualizing the disease (Kingston 2010).
The typical participant in the breast cancer movement, and therefore the advertisers' target audience
Target audience
In marketing and advertising, a target audience, is a specific group of people within the target market at which the marketing message is aimed .....
, is a white, middle-aged, middle-class, well-educated woman (King 2006, pages 110–111).
Some corporate sponsors are criticized for having a conflict of interest
Conflict of interest
A conflict of interest occurs when an individual or organization is involved in multiple interests, one of which could possibly corrupt the motivation for an act in the other....
. For example, some of the prominent sponsors of these advertisements include businesses that sell the expensive equipment needed to perform screening mammography; an increase in the number of women seeking mammograms means an increase in their sales. Their sponsorship is thus not a voluntary act of charity, but an effort to increase their sales (King 2006, page 37). The regulated drug and medical device industry uses the color pink, positive images, and other themes of the pink ribbon culture in direct-to-consumer advertising
Direct-to-consumer advertising
Direct-to-consumer advertising usually refers to the marketing of pharmaceutical products but can apply in other areas as well. This form of advertising is directed toward patients, rather than healthcare professionals. The Food and Drug Administration holds responsibility of regulating DTC...
to associate their breast cancer products with the fear, hope, and wholesome goodness of the breast cancer movement (Sulik 2010, page 206–208). This is particularly evident in advertisements designed to sell screening mammograms.
Despite having been determined to be ineffective in low-risk and average-risk women, many charities still advertise breast self-examination
Breast self-examination
Breast self-examination is a screening method used in an attempt to detect early breast cancer. The method involves the woman herself looking at and feeling each breast for possible lumps, distortions or swelling....
s as a means of simultaneously raising awareness, encouraging early detection, and increasing the visibility of their organizations. Other organizations' advertisements now advocate breast awareness, which is paying attention to any changes in the breast that may require medical attention.
Media
Although more women die from lung cancerLung cancer
Lung cancer is a disease characterized by uncontrolled cell growth in tissues of the lung. If left untreated, this growth can spread beyond the lung in a process called metastasis into nearby tissue and, eventually, into other parts of the body. Most cancers that start in lung, known as primary...
, breast cancer receives far more attention in women's magazines than any other cancer. Until the mid-1990s, nearly all of these stories were written from the perspective of the expert, who doled out advice. Since then, the illness narrative, describing the personal experiences of individual patients, has become prominent. (Sulik 2010, page 133).
Embedded marketing, branded content
Branded content
Branded content is a relatively new form of advertising medium that blurs conventional distinctions between what constitutes advertising and what constitutes entertainment. Branded content is essentially a fusion of the two into one product intended to be distributed as entertainment content,...
, and frequent feature stories amount to free advertising for the breast cancer brand and for the organizations that support it.
Breast cancer as a brand
Breast cancer advocacy uses a the pink ribbonPink ribbon
The pink ribbon is an international symbol of breast cancer awareness. Pink ribbons, and the color pink in general, identify the wearer or promoter with the breast cancer brand and express moral support for women with breast cancer....
and the color pink
Pink
Pink is a mixture of red and white. Commonly used for Valentine's Day and Easter, pink is sometimes referred to as "the color of love." The use of the word for the color known today as pink was first recorded in the late 17th century....
as a concept brand to raise money and increase screening. The breast cancer brand is strong: People who support the "pink brand" identify themselves as members of the socially aware niche market
Niche market
A niche market is the subset of the market on which a specific product is focusing; therefore the market niche defines the specific product features aimed at satisfying specific market needs, as well as the price range, production quality and the demographics that is intended to impact...
, who are in favor of women's health, screening mammography, positive thinking, and willing submission to the current mainstream medical opinion (Sulik 2010, page 22).
The brand ties together fear of cancer, hope for early identification and successful treatment, and the moral goodness of women with breast cancer and anyone who visibly identifies themselves with breast cancer patients. This brand permits and even encourages people to substitute conscientious consumption and individual symbolic actions, like buying or wearing a pink ribbon, for concrete, practical results, especially collective political action
Collective action
Collective action is the pursuit of a goal or set of goals by more than one person. It is a term which has formulations and theories in many areas of the social sciences.-In sociology:...
aimed at discovering non-genetic causes of breast cancer (Sulik 2010, pages 133–146).
The establishment of the brand and the entrenchment of the breast cancer movement has been uniquely successful, because no countermovement
Countermovement
By definition, a countermovement in sociology means a social movement opposed to another social movement. Whenever one social movement starts up, another group establishes themselves to undermine the previous group. Many social movements start out as an affect of political activism towards issues...
opposes the breast cancer movement or believes breast cancer to be desirable (King 2006, page 111).
Social role of the woman with breast cancer
The marketing of breast cancer awareness allows people to choose support for awareness as a personal identityIdentity (social science)
Identity is a term used to describe a person's conception and expression of their individuality or group affiliations . The term is used more specifically in psychology and sociology, and is given a great deal of attention in social psychology...
or lifestyle. Socially aware, pro-woman people, businesses, politicians, and organizations use pink ribbons and other trappings of breast cancer awareness to signal their support for women, health, and mainstream medicine.
The she-ro
The "she-ro"Hero
A hero , in Greek mythology and folklore, was originally a demigod, their cult being one of the most distinctive features of ancient Greek religion...
of breast cancer is the woman who publicly maintains a pleasant personal appearance and optimism while aggressively fighting breast cancer through compliance with mainstream medical advice. The ideal survivor is always diagnosed early because of her unswerving obedience to the aggressive screening mammography standards put forward by American (but not European or Asian) breast cancer organizations. She is educated as a medical consumer and firmly believes that modern science can cure breast cancer. She is always brave, always victorious, and never dies (Sulik 2010, page 158, 243).
The careful presentation of feminine qualities, such as emphasizing a feminine appearance and concern for others, restores the woman to her proper gender role
Gender role
Gender roles refer to the set of social and behavioral norms that are considered to be socially appropriate for individuals of a specific sex in the context of a specific culture, which differ widely between cultures and over time...
by balancing the masculine qualities the women display in responding to breast cancer, such as taking an active role in decision-making, being "selfish" by putting their immediate needs before others', and bravely "fighting" cancer. The military metaphors are particularly masculine: the woman must fight, must persevere, must do her duty (by following medical advice), must be strong, must be victorious, and must conquer the enemy (Sulik 2010, pages 78–89). She regains her femininity by using breast reconstruction
Breast reconstruction
Breast reconstruction is the rebuilding of a breast, usually in women. It involves using autologous tissue or prosthetic material to construct a natural-looking breast. Often this includes the reformation of a natural-looking areola and nipple...
, prosthetic devices, wigs, cosmetics, and clothing to present an aesthetically appealing, upper-class, heterosexual feminine appearance and by cultivating relationships in which she can nurture other people (Sulik 2010, page 42, 374). Programs such as Reach to Recovery and Look Good, Feel Better educate breast cancer patients of this cultural standard and help them conform to it (Olson 2002, page 120; Sulik 2010, pages 37–38).
The breast cancer she-ro closely follows the feeling rules
Feeling rules
Feeling rules are socially shared norms that influence how we want to try to feel emotions in given social relations. This concept was introduced by sociologist Arlie Russell Hochschild in 1979....
of the breast cancer culture, or tries to: She remains optimistic of a permanent, physical cure, and relentlessly cheerful in public. She is selfish—that is, she prioritizes her greater needs above others' lesser needs—and justifies this either as a short-term, rational coping strategy or as an inevitable, although guilt-inducing, situation. She also feels guilty: She may conceive of herself as an inadequate she-ro, or she may believe that her previous choices caused her breast cancer, or she may feel that she is doing too little to care for others, especially her family and other women with breast cancer (Sulik 2010, pages 225–272, 277).
A type of have-it-all superwoman
Superwoman (sociology)
In sociology the term superwoman has been used to describe a Western woman who works hard to manage multiple roles of a worker, a homemaker, a volunteer, a student etc...
, the she-ro tries to present a normal appearance and activity level and minimize the disruption that breast cancer causes to people around her. Women with breast cancer are often more comfortable caring for other people than being cared for. They may find it difficult or inappropriate to ask for help they need or want, and later feel bitter that their friends and family did not offer these services unbidden (Sulik 2010, pages 279–301). The success of their normalization efforts may paradoxically increase their dissatisfaction, as their apparent ability to handle it all discourages people from offering help (Sulik 2010, page 283, 286).
The effect of the she-ro model is to reduce the stigma of having breast cancer, and to increase the stigma of being overwhelmed, depressed, anxious, abrasive, or unattractive as a result of having breast cancer (Sulik 2010, page 45). The culture celebrates women who display the attitude deemed correct, and declares that their continued survival is due to this positive attitude and fighting spirit, even though cheerfulness, hope, and displaying a cosmetically enhanced appearance do not kill cancer cells (Sulik 2010, page 243–244).
Women who reject the she-ro model may find themselves socially isolated by the breast cancer support group
Support group
In a support group, members provide each other with various types of help, usually nonprofessional and nonmaterial, for a particular shared, usually burdensome, characteristic...
s that are nominally supposed to help them. Support from "the sisterhood" is reserved for the "passionately pink", rather than those whose response is deemed inappropriate because it is angry, unhappy, or afraid (Sulik 2010, page 274–277).
The breast cancer culture is also ill-equipped to deal with women who are dying or who have died (Sulik 2010, page 4). Despite occasional efforts at memorials, such as displaying the names of women who have died, these women's experiences are not validated and represented. They are, instead, ignored and shunned as failures and as hope-destroying examples of reality. Similarly, the culture is ill-equipped to deal with the news that a previously hyped treatment or screening procedure has been determined to be ineffective, with women demanding acceptance and promotion of useless activities and harmful drugs (Ehrenreich 2001; Olson 2002, pages 204–205; Sulik 2010, pages 200–203).
Breast cancer culture
Breast cancer culture, or pink ribbon culture, is the set of activities, attitudes, and values that surround and shape breast cancer in public. The dominant values are selflessness, cheerfulness, unity, and optimism. The she-ro uses the emotional trauma of being diagnosed with breast cancer and the suffering of extended treatment to transform herself into a stronger, happier and more sensitive person who is grateful for the opportunity to become a better person. In particular, she sees breast cancer as an opportunity to give herself permission for necessary personal growth—permission that she felt unable to give herself before, because of the restraints of her gender roleGender role
Gender roles refer to the set of social and behavioral norms that are considered to be socially appropriate for individuals of a specific sex in the context of a specific culture, which differ widely between cultures and over time...
(Sulik 2010, page 236). Breast cancer thereby becomes a rite of passage
Rite of passage
A rite of passage is a ritual event that marks a person's progress from one status to another. It is a universal phenomenon which can show anthropologists what social hierarchies, values and beliefs are important in specific cultures....
rather than a disease (Ehrenreich 2001; Sulik 2010, page 3).
The emphasis on cheerfulness allows society to blame women for developing breast cancer and to the limit their responses to culturally approved scripts. The requirement of cheerful optimism arises from a now-discredited idea that people who were diagnosed with cancer had a "cancer personality" that was depressed, repressed, and self-loathing. The cure for cancer was therefore psychotherapy
Psychotherapy
Psychotherapy is a general term referring to any form of therapeutic interaction or treatment contracted between a trained professional and a client or patient; family, couple or group...
to produce a cheerful, self-affirming identity (Olson 2002, pages 460–469; Sulik 2010, page 342).
Pink ribbon culture is pro-doctor, pro-medicine, and pro-mammogram. Health care professionals are sources of information, but the rightness of their advice is not to be seriously questioned. Patients are not encouraged to notice the absence of any meaningful method of prevention or treatments that are non-mutilating, non-debilitating, or noticeably more successful than what existed in the 1930s (Sulik 2010, pages 365–366).
Breast cancer culture values and honors suffering, selecting its she-roes by a "misery quotient" (Sulik 2010, page 319). Elizabeth Edwards
Elizabeth Edwards
Elizabeth Anania Edwards was an American attorney, a best-selling author and a health care activist. She was married to John Edwards, the former U.S...
, for example, personifies the breast cancer she-ro. Women whose treatment requires less suffering feel excluded and devalued. The suffering, particularly the extended suffering of months of chemotherapy and radiation treatment, forms a type of ordeal
Ordeal
Ordeal may refer to* The American title of What Happened to the Corbetts, a 1939 novel by Nevil Shute* Trial by ordeal, the judicial practice...
that initiates women into the inner circle of the breast cancer culture (Ehrenreich 2001).
Mainstream pink ribbon culture is also trivializing, silencing, and infantilizing (Sulik 2010, page 98). Women who choose not to conform to the culture feel excluded and isolated; those who cannot conform to the prescribed triumphant storyline feel unable to share their stories honestly. Anger, negativity and fatalism transgress the feeling rules, and women with breast cancer who express anger or negativity are corrected and disciplined by other women with breast cancer and members of the breast cancer support organizations (Ehrenreich 2001; Sulik 2010, page 240–242). Appearing unattractive—such as going out in public with a bare, bald head if treatment causes temporary hair loss—transgresses the approved, upper-class style of pink femininity and provokes shaming comments from strangers. Women with breast cancer are surrounded by sentimental kitsch and baby toys, such as pink teddy bears, when the equivalent for men, like a blue toy car, is unthinkable (Ehrenreich 2001).
Since the beginning of the 21st century, breast cancer culture has become more sexualized, and many awareness campaigns now reflect the old advertising truism that sex sells. The "booby campaigns", such as "Save the Tatas"
Save the tatas
Save the tatas, also written as save the ta-tas, refers to both a non-profit breast cancer awareness foundation and a for-profit company founded in 2004 by Julia Fikse and currently has 12 employees. Their motto is that laughter heals. Founder Julia Fikse, attributes her idea to seeing people...
and the "I ♥ Boobies" gel bracelets, rely on a cultural obsession with breasts and a market that is already highly aware of breast cancer (Kingston 2010). This message reflects a belief that breast cancer is important not because it kills women prematurely, but because cancer and its treatment makes women feel less sexually desirable and interferes with men's sexual access to women's breasts (Sulik 2010, page 347). These campaigns tend to attract a younger audience than traditional campaigns (Kingston 2010).
Breast cancer culture tends to overlook men with breast cancer
Male breast cancer
Male breast cancer is a relatively rare cancer in men that originates from the breast. As it presents a similar pathology as female breast cancer, assessment and treatment relies on experiences and guidelines that have been developed in female patients. The optimal treatment is currently not...
and women who do not fit the white, middle-class archetype. African-Americans involved with breast cancer organizations often feel like their role is to be the token minority (Sulik 2010, pages 308–309).
The primary purposes or goals of breast cancer culture are to maintain breast cancer's dominance as the preëminent women's health issue, to promote the appearance that society is "doing something" effective about breast cancer, and to sustain and expand the social, political, and financial power of breast cancer activists (Sulik 2010, page 57).
The breast cancer culture tells women with breast cancer that their participation in fundraising, social support other women with breast cancer, and appearance at public events are critical activities that promote their own emotional recovery. Women begin to believe that refusing to raise money for breast cancer organizations or to become mentors for newly diagnosed women with breast cancer is an unhealthy response to breast cancer (Sulik 2010, pages 305–311).
Feminism and the breast cancer wars
Advocates have said that breast cancer is special because society's response to it is an ongoing proof of the status of women and the existence of sexismSexism
Sexism, also known as gender discrimination or sex discrimination, is the application of the belief or attitude that there are characteristics implicit to one's gender that indirectly affect one's abilities in unrelated areas...
(Olson 2002, pages 195–202; Soffa 1994, page 208). Before the feminist movement, women with breast cancer were often treated as passive, dependent objects
Objectification
Objectification is the process by which an abstract concept is made as objective as possible in the purest sense of the term. It is also treated as if it is a concrete thing or physical object...
, incapable of making appropriate choices, whose role was to accept whatever treatment was decreed by the physicians, surgeons, or husbands, who held all of the power (Ehrenreich 2001). Because of sexism in education, few women were trained to be surgeons, and until the 1990s, when Susan Love
Susan Love
Dr. Susan Love is an American surgeon, a prominent advocate of preventative breast cancer research, and author.She is the president of the Dr. Susan Love Research Foundation, a non-profit organization that promotes and funds breast cancer intraductal research, and has a close involvement with the...
of the UCLA Breast Center published Dr. Susan Love's Breast Book, the physicians who provided breast cancer treatments were generally men. Love said that some male physicians tended to impose their own values on women, such as recommending mastectomy to older women because, being past the age of child bearing and breastfeeding, they no longer "needed" their breasts (Olson 2002, page 198). The women's health movement promoted mutual aid, self-help, networking
Social network
A social network is a social structure made up of individuals called "nodes", which are tied by one or more specific types of interdependency, such as friendship, kinship, common interest, financial exchange, dislike, sexual relationships, or relationships of beliefs, knowledge or prestige.Social...
, and an active, informed role in the patient's health care (Ehrenreich 2001).
The breast cancer wars were a series of conflicts between advocates and others about the causes, treatments, and societal responses to breast cancer (Olson 2002, pages 192–220). Women in the late 1980s and 1990s followed the successful approach used by ACT-UP and other AIDS awareness groups, of staging media-friendly protests to increase political pressure. Prominent women who made the "wrong" choice were publicly excoriated, as when Nancy Reagan
Nancy Reagan
Nancy Davis Reagan is the widow of former United States President Ronald Reagan and was First Lady of the United States from 1981 to 1989....
chose mastectomy over lumpectomy followed by six weeks of
radiation therapy
Radiation therapy
Radiation therapy , radiation oncology, or radiotherapy , sometimes abbreviated to XRT or DXT, is the medical use of ionizing radiation, generally as part of cancer treatment to control malignant cells.Radiation therapy is commonly applied to the cancerous tumor because of its ability to control...
. The abortion–breast cancer hypothesis was formulated when an early study showed a connection between voluntary abortion
Abortion
Abortion is defined as the termination of pregnancy by the removal or expulsion from the uterus of a fetus or embryo prior to viability. An abortion can occur spontaneously, in which case it is usually called a miscarriage, or it can be purposely induced...
s and the development of breast cancer in premenopausal women, which pitted breast cancer advocates against abortion rights advocates (Olson 2002, pages 192–220).
Since the end of the breast cancer wars, feminists have again objected to the breast cancer culture's treatment of women with breast cancer as little girls who need to be obedient to authority figures, cooperative, pleasant and pretty (Ehrenreich 2001).
Achievements of the breast cancer movement
Breast cancer has been known to educated women and caregivers throughout history, but modesty and horror at the consequences of a largely untreatable disease made it a tabooTaboo
A taboo is a strong social prohibition relating to any area of human activity or social custom that is sacred and or forbidden based on moral judgment, religious beliefs and or scientific consensus. Breaking the taboo is usually considered objectionable or abhorrent by society...
subject. The breast cancer movement, which developed in the 1980s and 1990s out of 20th century feminist movements and the women's health movement, has mostly remove those taboos through its modern advocacy and awareness campaigns (Sulik 2010, page 4).
Educated, empowered patients
At the beginning and middle of the 20th century, breast cancer was usually discussed in hushed tones, as if it were shameful (Sulik 2010, page 113). Later, however, several celebrities publicly disclosed their own health challenges, and the resulting publicity reduced the stigma (Olson 2002, pages 124–144). One of the first was Shirley Temple Black, the former child star, who announced her diagnosis in 1972. In October 1974, Betty Ford, the wife of the then-President of the United States, openly discussed her breast cancer diagnosis and mastectomy. Two weeks later, the wife of the then-Vice President also had a mastectomy for breast cancer. The next year, journalist Rose KushnerRose Kushner
Rose Rehert Kushner was an American journalist and pioneering advocate for breast cancer patients. She wrote the 1975 book Why Me? What Every Woman Should Know About Breast Cancer to Save Her Life.- Early life and career :...
published her book, Breast Cancer: A Personal History and Investigative Report, which she had written while recovering from a modified radical mastectomy. The media reported these women's health and their treatment choices, and even invited some to appear on talk show
Talk show
A talk show or chat show is a television program or radio program where one person discuss various topics put forth by a talk show host....
s to discuss breast cancer frankly (Olson 2002, pages 124–144).
The breast cancer movement has resulted in widespread acceptance of second opinion
Second opinion
A second opinion is a consultation with an additional physician for an alternative point of view.Second opinion may also refer to:* Second Opinion , an American medical program...
s, the development of less invasive surgical procedures, the spread of support group
Support group
In a support group, members provide each other with various types of help, usually nonprofessional and nonmaterial, for a particular shared, usually burdensome, characteristic...
s, and other advances in patient care (Olson 2002, pages 121, 171–220). The movement successfully separated diagnostic biopsy from mastectomy surgery; before about 1980, it was common to perform the biopsy and, if a quick review of tissues indicated a probable need, a mastectomy in the same surgery (Ehrenreich 2001; Olson 2002, pages 168–191). The one-step surgery prevented women from seeking different opinions about their treatment, and sent them into the surgery without knowing whether their breasts would be removed that day. In response to women's concerns over lymphedema
Lymphedema
Lymphedema , also known as lymphatic obstruction, is a condition of localized fluid retention and tissue swelling caused by a compromised lymphatic system....
after routine removal of lymph nodes during mastectomy, the more limited approach of sentinel node biopsy was developed. Advocacy efforts also led to the formal recommendation against the routine use of the Halsted radical mastectomy in favor of simple mastectomies and lumpectomies (Olson 2002, pages 176, 185–186, 250).
The breast cancer movement has supported practical, educational, emotional, and financial care for women with breast cancer. Support groups, individual counseling opportunities, and other resources are made available to patients.
Increased resources for treatment and research
Supporting breast cancer was seen as a distinctively pro-woman stance for public officials to take, without any of the political risks associated with supporting other feminist goals, such as abortion rights or lesbian rights (Olson 2002, page 202). This has resulted in better access to care. For example, in much of the United States, low-income women with breast cancer may qualify for taxpayer-funded health care benefits, such as screening mammography, biopsies, or treatment, while women with the same income, but another form of cancer or a medical condition other than cancer, do not.Breast cancer advocates have successfully increased the amount of public money being spent on cancer research and shifted the research focus away from other diseases and towards breast cancer. Most breast cancer research is funded by government agencies (Mulholland 2010). Breast cancer advocates also raise millions of dollars for research into cures each year, although most of the funds they raise is spent on screening programs, education and treatment.
The high level of awareness and organized political lobbying has resulted in a disproportionate level of funding and resources given to breast cancer research and care. Favoring breast cancer with disproportionate research may have the unintended consequence
Unintended consequence
In the social sciences, unintended consequences are outcomes that are not the outcomes intended by a purposeful action. The concept has long existed but was named and popularised in the 20th century by American sociologist Robert K. Merton...
of costing lives elsewhere (Browne 2001). In 2001 UK MP Ian Gibson
Ian Gibson
Ian Gibson may refer to:*Ian Gibson , British artist of comic books*Ian Gibson , historian and hispanist*Ian Gibson , former director of Northern Rock, chairman of Trinity Mirror...
said, "The treatment has been skewed by the lobbying, there is no doubt about that. Breast cancer sufferers get better treatment in terms of bed spaces, facilities and doctors and nurses" (Browne 2001).
Risks of too much awareness
Because breast cancer is a highly visible disease, most women significantly overestimate their personal risk of dying from it. Misleading statistics, such as the claim that one in eight women will be diagnosed with breast cancer during their lives—a claim that depends on the patently unrealistic assumption that no woman will die of any other disease before the age of 95 (Olson 2002, pages 199–200)—obscure the reality, which is that about ten times as many women will die from heart disease
Heart disease
Heart disease, cardiac disease or cardiopathy is an umbrella term for a variety of diseases affecting the heart. , it is the leading cause of death in the United States, England, Canada and Wales, accounting for 25.4% of the total deaths in the United States.-Types:-Coronary heart disease:Coronary...
or stroke
Stroke
A stroke, previously known medically as a cerebrovascular accident , is the rapidly developing loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia caused by blockage , or a hemorrhage...
than from breast cancer (Ave 2006).
Awareness has also led to increased anxiety for women. Early detection efforts result in overdiagnosis of precancerous and cancerous tumors that would never risk the woman's life (about one-third of breast cancers), and result in her being subjected to invasive and sometimes dangerous radiological and surgical procedures (Aschwanden 2009).
The breast cancer culture has also promoted an expansive definition of breast cancer, which includes non-invasive, non-cancerous conditions like lobular carcinoma in situ
Lobular carcinoma in situ
Lobular carcinoma in situ is a condition caused by unusual cells in the lobules of the breast.It is usually not considered cancer, but it can indicate an increased risk of future cancer...
(LCIS) and pre-cancerous or "stage 0" conditions like ductal carcinoma in situ (DCIS). Despite the now-regretted decision to use the word carcinoma in these relatively common conditions (almost a quarter of "breast cancer" diagnoses in the USA), they are not life-threatening cancer
Cancer
Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...
s (Sulik 2010, page 165–171). Women with these conditions are promoted as breast cancer survivors due to the fear they experienced before they became educated about their condition, rather than in respect of any real threat to their lives. This effectively increases the market size for breast cancer organizations, medical establishments, pharmaceutical manufacturers, and the makers of mammography equipment (Sulik 2010, page 170–171).
An emphasis on educating women about lifestyle changes that may have a small impact on preventing breast cancer often makes women feel guilty if they do develop breast cancer. Some women decide that their own cancer resulted from poor diet, lack of exercise, or other modifiable lifestyle factor, even though most cases of breast cancer are due to non-controllable factors, like genetics or naturally occurring background radiation. Adopting such a belief may increase their sense of being in control
Locus of control
Locus of control is a theory in personality psychology referring to the extent to which individuals believe that they can control events that affect them. Understanding of the concept was developed by Julian B...
of their fate. Increased awareness inadvertently increases victim blaming
Victim blaming
Victim blaming occurs when the victim of a crime, an accident, or any type of abusive maltreatment are held entirely or partially responsible for the transgressions committed against them. Blaming the victim has traditionally emerged especially in racist and sexist forms...
(Olson 2002, pages 240–242, Sulik 2010, page 74, 263). Women who resist screening mammography or breast self-exams are subjected to social pressure, scare tactics, guilt, and threats from some physicians to terminate the relationship with the patient
Doctor-patient relationship
The doctor-patient relationship is central to the practice of healthcare and is essential for the delivery of high-quality health care in the diagnosis and treatment of disease. The doctor-patient relationship forms one of the foundations of contemporary medical ethics...
(Welch 2010). Similarly, the emphasis on early detection results in women blaming themselves if their cancer is not detected at an early stage.
The promotion of research to make screening programs find ever more cancers is also criticized. One-third of diagnosed breast cancers might recede on their own (Aschwanden 2009). Screening mammography efficiently finds non-life-threatening, asymptomatic breast cancers and pre-cancers, even while overlooking serious cancers. According to H. Gilbert Welch of the Dartmouth Institute for Health Policy and Clinical Practice, research on screening mammography has taken the "brain-dead approach that says the best test is the one that finds the most cancers" rather than the one that finds dangerous cancers (Aschwanden 2009).
Independence of breast cancer organizations
Some critics say that breast cancer awareness has transformed the disease into a market-driven industry of survivorship and corporate sales pitches (Ave 2006; King 2006). Corporate marketing machines promote early detection of breast cancer, while also opposing public health efforts, such as stricter environmental legislation, that might prevent the disease entirely. These critics believe that some of the breast cancer organizations, particularly the highly visible Susan G. Komen for the Cure, have become captive companies that support and provide social capitalSocial capital
Social capital is a sociological concept, which refers to connections within and between social networks. The concept of social capital highlights the value of social relations and the role of cooperation and confidence to get collective or economic results. The term social capital is frequently...
to the breast cancer industry, including big pharma, mammography equipment manufacturers, and pollution-causing industries, as well as large corporations, creating or exacerbating other problems.
For example, Ford Motor Company
Ford Motor Company
Ford Motor Company is an American multinational automaker based in Dearborn, Michigan, a suburb of Detroit. The automaker was founded by Henry Ford and incorporated on June 16, 1903. In addition to the Ford and Lincoln brands, Ford also owns a small stake in Mazda in Japan and Aston Martin in the UK...
ran a "Warriors in Pink" promotion on their Ford Mustang
Ford Mustang
The Ford Mustang is an automobile manufactured by the Ford Motor Company. It was initially based on the second generation North American Ford Falcon, a compact car. Introduced early on April 17, 1964, as a "1964½" model, the 1965 Mustang was the automaker's most successful launch since the Model A...
sports car, which critics say was intended to sell cars and counter the bad publicity the company received by reducing its workforce by tens of thousands of people, causing many of them to lose their health insurance
Health insurance
Health insurance is insurance against the risk of incurring medical expenses among individuals. By estimating the overall risk of health care expenses among a targeted group, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to ensure that money is...
, rather than to prevent or cure breast cancer (Sulik 2010, page 130-135).
However, the primary sponsors are part of the breast cancer industry, particularly cancer drug makers like AstraZeneca, Bristol-Myers Squibb, and Novartis. Because the national breast cancer organizations are dependent on corporate sponsorships for survival, this situation may represent a conflict of interest
Conflict of interest
A conflict of interest occurs when an individual or organization is involved in multiple interests, one of which could possibly corrupt the motivation for an act in the other....
that prevents these organizations from representing the needs of current and future people with breast cancer when those needs conflict with the profit-making motives of the corporate sponsors. To avoid offending sponsors or to woo new ones, breast cancer organizations may self-censor their message and oversell options like screening mammography and new chemotherapeutic agents (Sulik 2010, page 209–210).
The structure of the breast cancer movement may allow large organizations to claim to be the voice of women with breast cancer, while simultaneously ignoring their desires (Sulik 2010, page 376).
Some breast cancer organizations, such as Breast Cancer Action
Breast Cancer Action
Breast Cancer Action is a national grassroots education and advocacy organization dedicated to supporting people living with breast cancer and creating system-wide change that will end the breast cancer epidemic. It was founded in 1990 by Elenore Pred, Susan Claymon, and Linda Reyes...
, refuse to accept funds from medical or other companies they disapprove of.
Environmental breast cancer movement
Most of the money raised by advocates is spent on advertising, increased awareness, cancer screeningCancer screening
Cancer screening aims to detect cancer before symptoms appear. This may involve blood tests, urine tests, other tests, or medical imaging. The benefits of screening in terms of cancer prevention, early detection and subsequent treatment must be weighed against any harms.Universal screening, mass...
, and existing treatments (Ave 2006). Only a small fraction of the funds is spent on research, and most of that funding is spent on research to improve diagnosis and treatment of breast cancer. To the dismay of advocates like Breast Cancer Action
Breast Cancer Action
Breast Cancer Action is a national grassroots education and advocacy organization dedicated to supporting people living with breast cancer and creating system-wide change that will end the breast cancer epidemic. It was founded in 1990 by Elenore Pred, Susan Claymon, and Linda Reyes...
and women's health issues scholar Samantha King, relatively little money or attention is devoted to identifying the non-genetic causes of breast cancer or taking steps to prevent breast cancer from occurring (Ave 2006). The mainstream breast cancer culture is focused on a cure for existing breast cancer cases, rather than on preventing future cases.
As a result, screening mammography is promoted by the breast cancer industry as the sole possible approach to public health
Public health
Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals" . It is concerned with threats to health based on population health...
for breast cancer (Sulik 2010, page 204). Alternatives, such as pollution prevention, are largely ignored.
As the majority of women with breast cancer have no risk factors other than sex and age, the environmental breast cancer movement suspects pollution as a significant cause, possibly from pesticides, plastics, or petroleum products (Ehrenreich 2001). The largest organizations, particularly Susan G. Komen for the Cure and the American Cancer Society, are not part of the environmental breast cancer movement (Ehrenreich 2001). These organizations benefit the most from corporate sponsorships that critics deride as pinkwashing, e.g., polluting industries trying to buy public goodwill by publishing advertisements emblazoned with pink ribbons, rather than stopping their pollution under the precautionary principle
Precautionary principle
The precautionary principle or precautionary approach states that if an action or policy has a suspected risk of causing harm to the public or to the environment, in the absence of scientific consensus that the action or policy is harmful, the burden of proof that it is not harmful falls on those...
(King 2006, pages 1–2).
Samantha King says that prevention research is minimized by the breast cancer industry because there is no way to make money off of cases of breast cancer that do not happen, whereas a mammography imaging system that finds more possible cancers, or a "magic bullet" that kills confirmed cancers, would be highly profitable (King 2006, page 38). This prejudice applies equally to breast cancer organizations, because a reliable form of prevention would deplete their future supply of dedicated volunteers.
Dissent through art
While the pink ribbon culture is dominant, cracks in the façade of unity show through. The environmental breast cancer movement is one type of dissent. Another is the rejection of compliant optimism, aesthetic normalization, and social pleasingness that the pink ribbon culture promotes (Sulik 2010, pages 229–377).In 1998, the Art.Rage.Us art collective published a book that collected some of the art work from their traveling collection. This included art that was shocking, painful and realistic rather than beautiful, such as several self-portraits that showed mastectomy scars (Sulik 2010, pages 326–332).
Another art form has a wider range: the illness narrative has become a staple of breast cancer literature. This may take the form of a restitution or cure narrative (the protagonist seeks a physical or spiritual return to a pre-diagnosis life), a quest narrative (the protagonist must meet a goal before dying), or a chaos narrative (the situation inexorably goes from bad to worse). The cure and quest narratives fit neatly with the breast cancer culture. Chaos narratives, rarer with breast cancer, oppose it (Sulik 2010, pages 321–326).
History
Breast cancer has been known and feared since ancient times. With no reliable treatments, and with surgical outcomes often fatal, women tended to conceal the possibility of breast cancer as long as possible. With the dramatic improvement in survival rates at the end of the 19th century—the radical mastectomy promoted by William Stewart Halsted raised long-term survival rates from 10% to 50%—efforts to educate women about the importance of early detection and prompt action were begun (Olson 2002, page 1; King 2006, page xix).Early campaigns included the "Women's Field Army", run by the American Society for the Control of Cancer (the forerunner of the American Cancer Society
American Cancer Society
The American Cancer Society is the "nationwide community-based voluntary health organization" dedicated, in their own words, "to eliminating cancer as a major health problem by preventing cancer, saving lives, and diminishing suffering from cancer, through research, education, advocacy, and...
) during the 1930s and 1940s. Explicitly using a military metaphor, they promoted early detection and prompt medical intervention as every woman's duty in the war on cancer. In 1952, the first peer-to-peer support group, called "Reach to Recovery", was formed. Later taken over by the American Cancer Society, it provided post-mastectomy, in-hospital visits from women who had survived breast cancer, who shared their own experiences, practical advice, and emotional support, but never medical information. This was the first program designed to promote restoration of a feminine appearance, e.g., through providing breast prostheses, as a goal (Sulik 2010, pages 37–38).
Organizations
A wide variety of charitable organizations are involved in breast cancer awareness and support. These organizations do everything from providing practical support, to educating the public, to dispensing millions of dollars for research and treatment. Thousands of small breast cancer organizations exist. The most largest and prominent are:- Susan G. Komen for the CureSusan G. Komen for the CureSusan G. Komen for the Cure, formerly known as The Susan G. Komen Breast Cancer Foundation, often referred to as simply Komen, is the most widely known, largest and best-funded breast cancer organization in the US....
: Komen is the largest and best funded organization, with highly visible fundraisers. They represent the good, hopeful, happy, unified survivors who have embraced pink ribbon culture. - National Breast Cancer CoalitionNational Breast Cancer CoalitionOn September 20, 2010, the National Breast Cancer Coalition , a grassroots advocacy organization that seeks to improve public policies surrounding breast cancer research, diagnosis and treatment, launched Breast Cancer Deadline 2020, a call to action for policymakers, researchers, breast cancer...
: This large umbrella organization played key roles in several prominent pieces of American legislation, such as the creation of the United States Department of DefenseUnited States Department of DefenseThe United States Department of Defense is the U.S...
's Breast Cancer Research Program, genetic non-discrimination laws, and the patients' bill of rights. They are committed to evidence-based medicineEvidence-based medicineEvidence-based medicine or evidence-based practice aims to apply the best available evidence gained from the scientific method to clinical decision making. It seeks to assess the strength of evidence of the risks and benefits of treatments and diagnostic tests...
. - Breast Cancer ActionBreast Cancer ActionBreast Cancer Action is a national grassroots education and advocacy organization dedicated to supporting people living with breast cancer and creating system-wide change that will end the breast cancer epidemic. It was founded in 1990 by Elenore Pred, Susan Claymon, and Linda Reyes...
: Famous for its "Think Before You Pink" campaign against pinkwashing, BCA emphasizes the need for research into pollution as a cause of breast cancer. Like the National Women's Health NetworkNational Women's Health NetworkThe National Women's Health Network is a non-profit women's health advocacy organization located in Washington, D.C.. It was founded in 1975 by Barbara Seaman, Alice Wolfson, Belita Cowan, Mary Howell, M.D., and Phyllis Chesler, Ph.D. The stated mission of the organization is to give women a...
, they refuse funding from any group that may have a conflict of interestConflict of interestA conflict of interest occurs when an individual or organization is involved in multiple interests, one of which could possibly corrupt the motivation for an act in the other....
, such as pharmaceutical companies, medical imaging companies, or pollution-causing industries. - National Breast Cancer Organization: Closed in 2004. A dissenter to the notion of mandatory public unity, it provided case managementCase managementCase management is a managed care technique within the health care coverage system of the United States.- Case management in health care :The Case Management Society of America, a non-profit association dedicated to the support and development of the profession of case management through...
and other services. - New York State Breast Cancer Support and Education Network (US): An association of groups in New York that are not affiliated with Komen, they are committed to evidence-based medicine rather than conventional wisdom.
- Breast Cancer Fund: Like Breast Cancer Action, they are a key player in the environmental breast cancer movement.
While the large organizations dominate the media, most of the practical, day-to-day support for women with breast cancer is provided by small, local groups. While providing the bulk of unglamorous, practical assistance, like driving women to and from medical appointments, these organizations typically struggle for funding in the shadow of the large groups (Sulik 2010, page 53).