Pink Ribbon Blues

How breast cancer culture undermines women's health

The Teal Before The Pink: Ovarian Cancer Awareness Month

In the race for a cause, breast cancer has consistently won the gold.

Photo Credit: Kevin Lamarque / Reuters
http://www.csmonitor.com/USA/Latest-News-Wires/2010/1015/Pink-White-House-greets-visitors-on-Thursday
“Before September is even over, stores are filled with pink merchandise. Magazines fill editorial pages, poignant survivor stories and photo spreads with breast cancer awareness. We’re swept off the surface of the earth by the waves of pink…Aside from pinkwashing consumer products and Walks For Whomever being pretty lousy ways to drum up funds for research; aside from the ubiquitous ribbons fooling people into thinking they’re doing some good in the “War On Cancer” that’s been failing miserably for forty years; aside from it distracting attention from preventing cancer by forcing corporations and governments to clean up toxic chemicals and environmental hazards, Pinktober overlooks the fact that there are other, deadlier forms of cancer in the world that could use some of the Pink Juggernaut’s P.R. clout and donation dollars.”

-- from a compelling essay by Sarah Sadtler Feather, The Carcinista (1971-2011).

Although September is National Ovarian Cancer Awareness Month you won’t see the White House lighted in teal, store shelves lined with teal-colored fundraising products, or many schools attempting to raise awareness of ovarian cancer. Pink has been the color of choice when it comes to cause support, so much so that some people don’t even know disease-specific ribbons besides the pink ones exist.

Nan Hart wrote on a discussion board of the Ovarian Cancer National Alliance (OCNA) that after her daughter got a teal ribbon tattoo, a coworker asked why her breast cancer ribbon wasn’t pink? The assumption that one ribbon, the pink ribbon, the mother of all ribbons is the baseline of social support for cancer is a huge assumption. In the coworker’s defense, it just shows how well pink marketing has worked to create the association. Millions of people buy, display, consume, and think pink.

An article in Marie Claire on the “Big Business of Breast Cancer” pointed out that “some $6 billion a year is committed to breast cancer research and awareness campaigns,” making it a “gold mine for pink profiteers and old-fashioned hucksters.” For those who are working to provide information, support, and resources for other types of diseases this isn’t really news.

Another woman posted on the OCNA discussion board that when she went into a Bed Bath and Beyond during Ovarian Cancer Awareness Month the first thing she saw was a pink display of breast cancer “awareness” products. “Where the education or awareness was,” she said, “I don’t know, but they’re certainly making a lot of money.” Another commenter contacted media outlets to encourage reporting about ovarian cancer during September, but apparently they “seemed uninterested.”

Pink publicity on the other hand, is a year-round activity. The related products? Many of them are around all year too.

Is the heightened attention to breast cancer just a matter of numbers?

The total number of people living with cancer (i.e., cancer prevalence) was estimated in 2007 to be 6.4 million. Of these, 2.6 million women were living with a breast cancer diagnosis and 177,000 were living with a diagnosis of ovarian cancer. However, cancer prevalence is affected by both the incidence and how long people normally live with the disease. On average, those with ovarian cancer tend not to live as long after diagnosis compared to those with breast cancer.

The National Cancer Institute reports that the incidence rate for ovarian cancer has declined since the mid-1980s but it remains the fifth leading cause of cancer-related death among women in the U.S. The Centers for Disease Control reported that 19,959 women were diagnosed with ovarian cancer in 2010, and 14,572 had died from the disease. With such a high death rate, it’s hard to find enough “survivors” to advocate for the cause. The same could be said of metastatic breast cancer, which is responsible for 40 thousand or more breast cancer deaths each year.

With so many women diagnosed with breast cancer (stage zero and invasive types included) the advocacy and consumer bases for breast cancer are huge. Compared to the 1500 or so non-profit programs and organizations dedicated to breast cancer, there are just about 150 dedicated to ovarian cancer. That’s ten times the advocacy/education/visibility. What's more, with all those pink-ribboned events in cities across America from pub crawls, to races, to yoga classes, to you name it — all designed to demand attention, raise funds, engage political leaders, shape research, saturate the culture, and sell a plethora of breast-cancer-themed products and services – how could smaller constituencies stand a chance?

What about the research?

In a “No Holds Barred” interview with OCNA Dr. Elise Kohn of the National Cancer Institute said there is “no question ovarian cancer is under funded and under represented in the scientific and medical communities.” The National Cancer Institute’s investment in ovarian cancer research increased to $110.1 million in FY 2009, up from $97.7 million in fiscal year FY 2005. The institute also supported $16.2 million in ovarian cancer research in FY 2009 using funding from the American Recovery and Reinvestment Act. In comparison, the National Institutes of Health spent $800 million in FY 2012 on breast cancer research compared to $147 million on ovarian cancer the same year. In addition, the Department of Defense Breast Cancer Research Program has allocated about $2.5 billion to peer-reviewed research since 1992 to fund innovative, high-impact research.

Variations in research allocations within and across different types (and subtypes) of cancers may indeed reflect differences in levels of advocacy, awareness, and political will. Yet Dr. Kohn argues that the last decade has still witnessed “exponential and explosive growth in knowledge and treatment benefits for ovarian cancer.” In addition, basic science has the potential to make impacts across diseases. The genetic mutation p53 has implications in lung, breast, colon and prostate cancers, and leukemia. Triple-negative breast and ovarian cancers also have links at the molecular level, and drugs used to inhibit an enzyme called PARP (i.e., Poly (ADP-ribose) polymerase) seem to disrupt chemotherapy resistance in some breast or ovarian cancers that involve mutations in the BRCA1 or BRCA2 genes.

Dr. Otis Brawley of the American Cancer Society sees such advances as part of a more integrated future for cancer research.

“Basic scientific research … has given us so much insight into cancer that we can actually see a day in the very near future in which it doesn’t even matter where the cancer started. In other words, the clinician is not going to be interested in whether it’s lung cancer or breast cancer or colon cancer. The significant questions for treatment will be: Which genes are mutated? Which genes are turned on? Which genes are turned off? Which genes are amplified?”

Win-win, if it works. The University of Texas MD Anderson Cancer Center’s Moon Shots Program is using such a model. Designed to accelerate the pace of converting scientific discoveries into clinical advances that reduce cancer deaths, the program is initially targeting eight cancers: acute myeloid leukemia/myelodysplastic syndrome, chronic lymphocytic leukemia, melanoma, lung cancer, prostate cancer, and triple-negative breast and ovarian cancers together. The Breast and Ovarian Moonshot is currently focusing on genetic testing, identifying new genetic markers and mutations, and the development of new biomarkers to find these cancers when they are more treatable.

Rather than a “Disease Olympics” approach in which one type of cancer beats out another in terms of research agendas, attention and funding, the idea of working with scientific knowledge across disciplines and the cancer care continuum has the potential to shape the direction of detection, treatment, and care across cancer types and subtypes. Unfortunately, the overwhelming festivity surrounding breast cancer and the pink ribbon has created a situation in which the torch for the Disease Olympics has already been lit. In the race for a cause, breast cancer has consistently won the gold while everyone else struggles not just for a place on the podium, but to be heard all.

Dr. Gayle Sulik is the author of Pink Ribbon Blues: How Breast Cancer Culture Undermines Women's Health. More information is available on her website.

© 2014 Gayle Sulik, PhD ♦ Pink Ribbon Blues on Psychology Today

See Gayle Sulik's Related Essays on Psychology Today:

 

Gayle A. Sulik MA, Ph.D. is research associate at the University at Albany (SUNY) and founder of the Breast Cancer Consortium. more...

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