The Science of Sustainability

Think Pink? I’d Rather Raise a Stink

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breast cancer awareness ribbon

Giant pink ribbon on the corner of 5th and Market, downtown Louisville, KY. (Jason Meredith)

Just a generation ago, October belonged to the colors of fall, when “every green thing loves to die in bright colors,” as Henry Ward Beecher said. (Growing up back East, you read a lot of odes to fall foliage in school.) For years after moving to the Bay Area from Pennsylvania, I felt a twinge of melancholy when October rolled around, knowing the once-demure woodlands would let loose in a fleeting blaze of brash reds and orange-tinged yellows without me.

Now, of course, October belongs to all things pink, as high-profile outfits from the NFL to Ace Hardware set aside 31 days to raise awareness and money for Breast Cancer Awareness Month. (National Breast Cancer Awareness Month was launched in 1985 by CancerCare, a nonprofit cancer support group, and cancer-drug maker AstraZeneca.)

But as women’s health advocate Dr. Susan Love says, awareness of the disease isn’t the issue. “When the NFL is wearing pink gloves, I think you can say we’re aware,” she said last year. “But the awareness isn’t enough.”

Even raising money isn’t enough. You have to ask where that money is going.

It’s a message that gets lost in an ocean of pink-ribbon products (from bagels and teddy bears to vodka and wine glasses), even though critics like the San Francisco-based nonprofit Breast Cancer Action have warned about “pinkwashing” for years, urging people to look behind the feel-good messages to see who’s really benefiting from the commercialization of cancer.

Breast Cancer Action’s Think Before You Pink—Raise a Stink! campaign encourages consumers to think critically about pink products and ask four simple questions to find out what proportion of proceeds go to breast cancer programs and whether the products sold are safe. The group has especially targeted cosmetics companies for marketing pink merchandise even as they sell products with toxic ingredients. (For more information, download the group’s 30-page “toolkit”.)

The group also urges companies to be more transparent and has long called out those it believes use a good cause to increase their bottom line.

Like Eureka, which donated a dollar for every vacuum cleaner sold in its “Clean for the Cure” campaign. Or American Express, which donated a penny per transaction in its “Charge for the Cure.” Both companies bowed out of the pink sweepstakes after Breast Cancer Action asked just how breast cancer patients were benefiting from the campaigns in a 2002 ad in the New York Times.

Breast Cancer Action ad

In October 2000, the San Francisco-based advocacy group Breast Cancer Action ran a full page ad in the New York Times West Coast Edition with text (not shown) inviting readers to participate in its ”Stop Cancer Where It Starts” Campaign. The campaign criticized breast cancer awareness campaigns for pushing early detection and mammograms (without acknowledging their limitations) while ignoring prevention. (Image: Courtesy Breast Cancer Action)

Others, like KFC with its 2010 “Buckets for the Cure” campaign, climb on the pink bandwagon to peddle decidedly unhealthy products. Stephen Colbert’s take on the “pink bucket dilemma” shows just how ludicrous cause marketing has become. (Forward to 1:13.)

But even when money goes to breast cancer programs and not corporate coffers, is it going to the right place? Love (and several advocacy groups) has said for years that we need to shift our focus from cures to causes—and prevention.

If we can develop a vaccine for cervical cancer, says Love, why not for breast cancer? Early results of a clinical trial show promising results for a vaccine designed to prevent recurrence of one form of breast cancer. (The data were presented at a meeting and have not yet gone through peer review.)

As I wrote in May, Love’s Research Foundation is looking for volunteers in her online Army of Women to identify potential causes in order to eradicate the disease. (Anyone can sign up.)

art.rage.us art and breast cancer

In the late 1990s, The Breast Cancer Fund, the American Cancer Society, and the Susan G. Komen Breast Cancer Foundation invited American artists and writers to submit work about their breast cancer experiences. The resulting exhibit (and book)—Art.Rage.Us.—opened in 1998 at San Francisco’s Main Library. At the time, project coordinator and Breast Cancer Action Co-founder Susan Claymon said, “Art.Rage.Us. presents deeply moving and beautiful expressions from women with breast cancer, along with intensely personal statements that provide a window into their hearts and minds.” Claymon died of breast cancer in 2000. She was 61.

Prevention is also a primary concern for the Athena Breast Health Network, a partnership of the five University of California medical centers that collects personalized data on breast cancer patients to optimize treatment and ultimately figure out how to stop cancer before it starts. The site also includes a comprehensive list of breast cancer risk factors.

Recent research suggests that the biology behind one of the listed risk factors, dense breast tissue, may be more complicated than previously thought. Earlier studies found that women with dense breasts had a higher risk of developing breast cancer. (And this finding led to the “right to know” legislation that Gov. Brown recently signed, requiring doctors to tell women if their mammograms show they have dense breasts.) But a recent study in the Journal of the National Cancer Institute suggests that women with denser breasts are not more likely to die of breast cancer. The greatest risk was found for women who had the fattiest breast tissue, a condition linked to obesity. This suggests that if you have dense breast tissue, you may be more likely to get cancer—but not die of it. Love’s blog explained the significance of the findings:

The recent study on breast density showed us, yet again, that women who are obese when they are diagnosed with breast cancer are more likely to die of breast cancer than women who are not obese. Doctors need to do more than tell women about their breast density or remind them to get a mammogram. They need to be teaching women the importance of exercising, losing weight (if necessary) and eating a well-balanced diet—both before and after a breast cancer diagnosis.

breast cancer in Rubens

A 2001 paper in the journal Breast Cancer Research and Treatment, argues that several paintings by the Baroque painter Peter Paul Rubens, including The Three Graces, Diana and Her Nymphs Pursued by Satyrs, and Orpheus and Euridice, show signs of breast cancer. In The Three Graces (above), the authors argue, “the model on the right has an open ulcer with reddening of the skin, nipple retraction, reduction of breast volume as well as axilar lymph nodes. This is a visual aspect of a locally advanced breast cancer.”

As companies outdo each other trying to hitch their products to breast cancer, it’s worth remembering that more women die of heart disease than breast cancer. (And more women die of lung cancer than of breast cancer.)

It’s also worth remembering when you see all those pink ribbons that there’s a difference between being a “survivor” and being cured. If you’re alive five years after a diagnosis, you’re considered a survivor. It’s a useful time frame for clinicians to compare the effectiveness of different therapies. But that doesn’t mean you’re cured. And as a 2000 JAMA study points out, when five-year-survival rates increase, it might be because more cases are being diagnosed, not because treatments are saving more lives.

Breast cancer death rates in the United States have declined over the past 20 years, though African American women still face a greater risk of death than any other group. It’s still the most common cancer among women. It’s still one of the leading causes of cancer death among women. And it’s still the disease women fear most.

Close to 40,000 women are expected to die of breast cancer this year, about 3,000 fewer than died in 1991—the year my mom got her diagnosis.

She wore a little pink ribbon pin for a while. But after about five years, she grew weary of the pink propaganda. And though she’d never say so, she also grew weary of the seemingly endless rounds of tests, procedures, surgeries, and chemo. I know she grew tired of the pain. Ten years ago—a little more than five years after she was officially a “survivor”—she died of breast cancer.

Now, when October rolls around, I feel no wistful melancholy for spectacles missed. I’ve got a much deeper loss to consider. And it makes me angry. I’m sick of the pink ribbons and the suggestion that bright colors can bathe cancer in a cheery, comforting glow. There’s nothing cheery about breast cancer. There’s a lot of pain, suffering, and fear.

When pink stands for taking real action against breast cancer, I might start to see October in a whole new light.

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Resources/Further Reading

Athena Breast Health Network

Breast Cancer Action. Its latest campaign (“It’s an Epidemic, Stupid!”) calls on elected officials to develop a series of actions against breast cancer, including developing tougher regulations on potential carcinogens and supporting research into root causes as well as less toxic therapies.

Breast Cancer Symptoms You’re Most Likely to Ignore

Welcome to Cancerland, author and journalist Barbara Ehrenreich’s devastating account of her experience with breast cancer and the breast cancer “marketplace.”

Pink Ribbons, Inc. a feature documentary on breast cancer marketing campaigns.

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Category: Biology, Blog, Health

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Liza Gross

About the Author ()

Liza Gross, a freelance science writer and senior editor at the biomedical journal PLOS Biology, channeled an early love of wildlife into a lifelong exploration of the numerous ways diverse species, including humans, interact in the natural world. She writes mostly about wildlife, conservation, and environmental health. Her stories reflect a deep curiosity about natural and social interactions and often highlight evolutionary relationships that remind humans of their place in, and responsibility to conserve, nature. Her article "Don't Jump!" published in Slate, won an ASJA award in the op-ed category. She's a visiting scholar at NYU, a 2013 recipient of NYU Reporting Award funding and a Dennis Hunt health journalism fellow. Read her previous contributions to QUEST, a project dedicated to exploring the Science of Sustainability.
  • AJACs

    There are HIV survivors that have the same opinion about red ribbons, expressing their dissatisfaction by wearing t-shirts during pride parades declaring "Ribbons are for gifts". Oft times stated with more colorful language.

  • Alex

    It is also important to see where money goes that is sent to the American Cancer Society. They spend more money on fundraising (20-25%) than they do on researrch (~14%). When people contribute to the ACS, they assume it is going to research. As noted, 85% is not. Pick your charities wisely and do some research on charities and charity ratings (ACS gets a C+ only).

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