It’s October – the leaves are turning yellow, porch ornaments are coming up pumpkin orange, the first frost is sparkling silver, and everywhere I turn the sight of pink ribbons assaults my eyes and affronts my sensibilities. The annual pink ribbon extravaganza, surely one of the most successful marketing campaigns in history, has millions of Americans walking, running, racing and selling merchandise “for the cure.” Having spent the first half of my career studying religious rituals, I can’t help but think that many of the ribbon bearers see their little scraps of pink as an amulet or a charm, a means of warding off an enemy over whom one feels impotent. If we just wear or sell enough pink ribbons during the month of October, we hope or we bargain with the cancer gods, then maybe we’ll be safe from breast cancer for the coming year.
Maybe I’m a cynic, or an agnostic, but as a means of averting breast cancer I’d rather put my money on cleaning up toxic chemicals from the environment than on adding a bunch of pink ribbons to our November trash piles or on painting pink ribbons on football fields while the NFL allows known rapists and batterers to play in the league.
Winners and Losers
When my mother became ill with and eventually died of breast cancer in 1971, no one talked about it – not even her close friends were present to offer aid or comfort. Yet, today, as we paint the town pink, I am concerned that we have come to see breast cancer as a relatively normal part of the female life course: puberty, pregnancy and childbirth, followed by menopause and breast cancer. Pushing against this cultural tide, I feel a need to yell: Breast cancer is not normal; nor is it pinkly feminine or cute. The rise in rates of breast cancer over the past century is a palpable sign that something is wrong with our world.
America loves winners, and we have come to regard women who are diagnosed with but do not die from breast cancer as heroic battlers. Those women who die are hidden, lying somewhere outside of the victory circle, “victims” in a culture that at best pities and at worst blames victims for their own misfortunes. It feels absurd to have to say this, but it needs to be said: Breast cancer can’t be cured by the optimism or will power or athleticism or fighting spirits or strength of character of women who are afflicted with the disease. Breast cancer should not be treated as a challenge or as a measure of one’s moral fiber.
And it should never, ever be treated as a commodity.
Gayle A. Sulik draws attention to some disturbing implications of the ubiquitous pink ribbon. First, pink ribbon marketing, like all “cause marketing,” primarily benefits the company, not the charity or cause. Second, as a result of cause marketing, people actually give less to charities. And third, pink ribbon and other cause marketing can mask conflicts of interest, like when companies promote the idea of cancer research but also manufacture, disseminate, or sell products that contain toxic or carcinogenic ingredients.
Over the past few years the failure of the pink ribbon movement was brought home to many of us when the Susan G. Komen for the Cure foundation, the most visible promoter of pink racing for the cure, announced that it would no longer fund breast cancer screenings at Planned Parenthood, the health care home for millions of young and low-wage women. This decision, believed to reflect the Komen’s Foundations’ capitulation to anti-choice advocates, was reversed when donations to the organization plummeted in response.
Where is the Evidence?
Victory laps in races for the cure, together with the ubiquitous pink ribbons, may lead people to believe that far greater strides have been made in preventing and treating breast cancer than have actually been made. In a 2014 article published in the New England Journal of Medicine, Nikola Biller-Andorno, M.D., Ph.D. and Peter Jüni, M.D. report that data show no evidence that routine mammography screening of women at average risk saves lives. A high-quality study made public by the Swiss Medical Board, “acknowledged that systematic mammography screening might prevent about one death attributed to breast cancer for every 1000 women screened, even though there was no evidence to suggest that overall mortality was affected.”
The NEJM article also cites research showing that many American women overestimate their personal risk of breast cancer and the benefits of mammograms. In a study of U.S. women’s perceptions, “717 of 1003 women (71.5%) said they believed that mammography reduced the risk of breast-cancer deaths by at least half.” Exacerbating the dangers, as a major Canadian study discovered, 21.9% of breast cancers found through mammography screening represented over-diagnoses. In other words, thousands of women each year undergo surgery, radiation and chemotherapy for non-life threatening cancers.
Breast Cancer Action, a national non-profit organization calling for transparency in breast cancer research, treatment and education, has these harsh words to say: “While corporations [such as manufacturers of mammography equipment] have made billions off the disease, progress in breast cancer treatment, prevention, survival, and inequities has not been forthcoming. Three million women in the U.S. are living with breast cancer. Up to one-third of all breast cancers will metastasize, even when found in the early stages. Black women are still 40% more likely to die of breast cancer than white women. And each year, 40,000 women die of breast cancer.”
We Can Do Better
While spending on breast cancer detection and treatment continues to increase, funding for prevention – for learning about the causes of breast cancer – is far less marketable. This year, in my home state, the Massachusetts legislature failed to fund research on potential carcinogenic impacts of chemical exposure despite clear findings that there are specific communities in Massachusetts with particularly high rates of breast cancer. According to reports, “The Massachusetts Senate  budget … did not include a $500,000 request to fund water quality and public health research by Silent Spring Institute. The Massachusetts Breast Cancer Coalition requested this funding on behalf of its sister organization, Silent Spring Institute to study exposure to toxic chemicals in drinking water and homes in Central Massachusetts and on Cape Cod. Earlier this month, the House of Representatives failed to approve funding for Silent Spring Institute in the FY 2015 House budget. This is the second year in a row that budget requests for important water quality research in both the House and Senate have been excluded.”
Today, when I walked past the Massachusetts State House on my way to work and saw pink ribbons everywhere, women’s health pioneer Barbara Ehrenreich’s words came to mind. Writing about her own experiences with breast cancer, Ehrenreich wrote, “What sustained me through the ‘treatments’ is a purifying rage, a resolve, framed in the sleepless nights of chemotherapy, to see the last polluter, along with say, the last smug health insurance operator, strangled with the last pink ribbon.”
In honor and memory of my mother, Bernice C. Starr, let me say “Amen.”