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PINK RIBBON FATIGUE-THE NEW YORK TIMES

October 11, 2010, 11:00 am

Pink Ribbon Fatigue

By BARRON H. LERNER, M.D.
Scott Boehm/Getty Images

Another Breast Cancer Awareness Month is upon us, which will mean lots of pink ribbons.

The pink ribbon has been a spectacular success in terms of bringing recognition and funding to the breast cancer cause. But now there is a growing impatience about what some critics have termed “pink ribbon culture.” Medical sociologist Gayle A. Sulik, author of the new book “Pink Ribbon Blues: How Breast Cancer Culture Undermines Women’s Health” (Oxford University Press), calls it “the rise of pink October.”

“Pink ribbon paraphernalia saturate shopping malls, billboards, magazines, television and other entertainment venues,” she writes on her Web site. “The pervasiveness of the pink ribbon campaign leads many people to believe that the fight against breast cancer is progressing, when in truth it’s barely begun.”

The National Breast Cancer Coalition, a highly visible activist group based in Washington, D.C., has also taken a swipe at pink culture as it tries to reconfigure breast cancer activism through a highly ambitious plan to eradicate the disease by 2020. “Peel back the pink,” the group urges its advocates, “and go beyond awareness into action to end breast cancer.”

So what’s a breast cancer survivor, or an interested citizen, supposed to think when encountering the ubiquitous pink ribbons on everything from yogurt to bathrobes? It helps to know a little of the history of breast cancer activism.

The first breast cancer activists were a series of women in the early and mid-1970s who challenged the routine use of the radical mastectomy, a highly disfiguring operation that involved removal of both the affected breast and the nearby chest wall muscles, for treating breast cancer. Building on the work of a few renegade surgeons plus the era’s feminism, these women gradually got the medical profession to rethink radical surgery. Data eventually showed that smaller operations, such as lumpectomies, accompanied by local radiation were equally effective.

Among the most persistent and effective activists was Rose Kushner, a breast cancer survivor who took on not only the radical mastectomy but also the practice in which doctors decided whether or not to remove cancerous breasts while women were under anesthesia, effectively silenced.

But even Ms. Kushner knew the next steps in breast cancer activism would be even harder. Beginning in the 1980s, she forged alliances with prominent physician-researchers in the field, such as Bernard Fisher. She also informally reviewed grant applications for the National Cancer Institute, a momentous acknowledgment by a scientific organization about the value of lay opinion. Ms. Kushner, who had taken the anti-estrogen drug tamoxifen to treat her breast cancer but who ultimately died of the disease in 1990, even forged a working relationship with Imperial Chemical Industries, the manufacturer of the drug. The company would later merge with the Zeneca Group to form a huge drug conglomerate, AstraZeneca.

This latter connection is particularly telling, as the AstraZeneca Healthcare Foundation is now the major sponsor of the annual Breast Cancer Awareness Month. Pink activities are hardly restricted to October, but they are particularly prominent during the month: billboards promoting breast cancer awareness; media coverage of the latest advances in breast cancer detection and treatment; and races, walks, climbs and other events for breast cancer survivors that provide emotional uplift, a sense of community and an opportunity to raise money for the cause.

So how can the pink ribbon be objectionable? Among the first salvos against the pink ribbon was a 2001 article in Harper’s magazine entitled “Welcome to Cancerland,” written by the well-known feminist author Barbara Ehrenreich. Herself a breast cancer patient, Ms. Ehrenreich delivered a scathing attack on the kitsch and sentimentality that she believed pervaded breast cancer activism.

Others added to Ms. Ehrenreich’s arguments, notably the San Francisco-based group Breast Cancer Action, which in 2002 initiated a “Think Before You Pink” campaign. The organization’s main concern was that pharmaceutical companies that manufactured breast cancer treatments, plus other industries that promoted the pink ribbon for publicity purposes, produced toxic waste that poisoned the earth — and actually promoted breast cancer. Rather than being used to study the causes of breast cancer and how to prevent the disease, a large proportion of pink money, the group argued, has been used to pay for local screening and treatment programs and research into new, expensive biological agents that have had little impact on women’s survival from breast cancer.

The head of the National Breast Cancer Coalition, Fran Visco, in a recent e-mail to her membership, called for a “solution,” such as the development of a breast cancer vaccine, rather than just more hope. “We have to stop celebrating breast cancer awareness months and begin pushing for the end,” she wrote.

In “Pink Ribbon Blues,” Ms. Sulik offers three main objections to the pink ribbon. First, she worries that pink ribbon campaigns impose a model of optimism and uplift on women with breast cancer, although many such women actually feel cynicism, anger and similar emotions.

And like Ms. Ehrenreich, Ms. Sulik worries that the color pink reinforces stereotypical notions of gender — for example, that recovery from breast cancer necessarily entails having breast reconstruction, wearing makeup and “restoring the feminine body.”

Finally, Ms. Sulik closely examines what she calls the “financial incentives that keep the war on breast cancer profitable.” She reports that the Susan G. Komen Foundation, which annually sponsors over 125 annual Races for the Cure and more than a dozen three-day, 60-mile walks, has close to 200 corporate partners, including many drug companies. These associations, she warns, are a potential conflict of interest.

So should women start boycotting these very corporate events, which Ms. Sulik admits raise billions of dollars each year, and in which participants receive make-up and other pink-ribbon products in honor of their achievements? I’m not so sure. It is hard not be moved by these types of gatherings, in which survivors demonstrate their perseverance, altruism and endurance.

But one does hope that books like “Pink Ribbon Blues” and campaigns like Breast Cancer 2020 encourage all of us to examine the facts anew. Over 40,000 women still die from breast cancer annually in the United States, and strategies for preventing the disease have received inadequate attention and funding.

It is great to celebrate one’s survivorship from breast cancer, but it would be better not to have to be a survivor in the first place.

Barron H. Lerner, a physician and medical historian at Columbia University Medical Center, is the author of “The Breast Cancer Wars: Hope, Fear and the Pursuit of a Cure in Twentieth-Century America.”

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