Breast Cancer Awareness. More harm than good?

     Perhaps lost amid all the controversy of Susan B. Komen defunding Planned Parenthood and their subsequent about face, is a re-evaluation of the organization’s effectiveness and message. Susan G. Komen for the Cure was founded in 1982 by Nancy Goodman Brinker shortly after her sister and namesake of the organization died of breast cancer. Its mission? To find a cure and eradicate breast cancer. As of 2010, the organization has contributed “nearly $1.5 billion for research, treatment, health and education services.” For fiscal year 2009-2010 alone, Komen devoted $140.8 million to public health education, $46.9 million for health screening services, and $20.1 million for  treatment services. Not to be overlooked, Komen also invested $75.4 million for research illustrating the importance of non-profit organizations in plugging in federal research funding shortfalls. Komen’s presence is felt worldwide and breast cancer awareness has benefited as exemplified by the ubiquitousness of the Pink Ribbon. It’s hard to argue with success.

Komen’s narrative can lead to over-diagnosis

     Or is it? Komen’s main strategy is to advocate for early detection of breast cancer as a means to prevent death. This is accomplished through self-breast exams, universal screening mammography as well as other methods for diagnosis. Critics, however, point out that universal screening is indiscriminate and that ignoring the varying degree of risk that women have in developing breast cancer leads to over-diagnosis. Consequently, the resulting treatment, whether it be surgery, radiation, or chemotherapy could cause more harm since some cancers can regress on their own or develop so slowly that they would not impact a woman’s life. As Christie Aschwanden writes on The Last Word On Nothing blog, “the notion that breast cancer is a uniformly progressive disease that starts small and only grows and spreads if you don’t stop it in time is flat out wrong. I call it breast cancer’s false narrative, and it’s a fairy tale that Komen has relentlessly perpetuated…Years of research have led scientists to discover that breast tumors are not all alike. Some are fast moving and aggressive, others are never fated to metastasize. The problem is that right now we don’t have a surefire way to predict in advance whether a cancer will spread or how aggressive it might become.”

     Aschwanden points out three possible outcomes in early screening mammography: 1) a potentially non-life threatening tumor is found and removed, in which case a woman is labelled a breast cancer survivor, 2) a life-threatening tumor is found and the patient dies despite detection, or 3) a life-threatening tumor is found and the patient is successfully treated. She later concedes that, “Right now mammography is the best tool we have…Komen isn’t wrong to encourage women to consider mammography. But they’re dead wrong to imply that “the key to surviving breast cancer” is “you” and the difference between a 98% survival rate and a 23% one is vigilance on the part of the victim. This message flies in the face of basic cancer biology.” These concerns are reminiscent of the controversy surrounding prostate specific antigen (PSA) screening used routinely for the detection of prostate cancer. In October 2011, United States Preventive Services Task Force (USPSTF) advised against PSA screening for healthy men, stating that the risks of overdiagnosis and overtreatment outweighed the potential rewards. Coincidently, 2 years prior to their PSA screening recommendation, the task force also recommended that women in their 40s should no longer get routine mammograms.

Pinkwashing

     Komen also engages in cause marketing to increase awareness and raise funds. Over $35 million a year is raised through corporate partnerships. Cause marketing is a form of fundraising whereby brands can associate their product with Komen. This is beneficial for both parties as Komen simultaneously raises funds and increases awareness through entering the consciousness of consumers (think of all the products that display the Pink Ribbon) and brands can associate their products with a good cause. However, this practice has also come under fire over the years as products that do not promote or are inconsistent with a healthy lifestyle have been allowed to use breast cancer awareness and the Pink Ribbon in their marketing campaigns. This has been referred to as “pinkwashing.” Products ranging from KFC’s “Buckets for a Cure” to Smith & Wesson’s Awareness Gun have adorned Komen’s signature ribbons.

Shoot For The Cause

Eat For The Cause

                                                                                                                                                                                                                                                                                                                                                                                                                                      

     Last October, the NPR program “All Things Considered” examined whether the saturation of Pink is undermining effective breast cancer treatment. As Komen founder Nancy Brinker explains, “”[Breast cancer] is the second leading cancer killer of women in this country. As long as a woman, or even a man, dies every 74 seconds from this disease, there’s not enough pink.” In response to criticisms of pinkwashing, Brinker responds, “At Susan G. Komen, we have a very strong code with our cause-related marketing partners and a very strong agreement that these programs must be upheld. There’s a strict guideline for what a partner must do to be able to use our Pink Ribbon but there are of course people who are going to abuse anything that seems to be working well.” However, Gayle Sulik, author of Pink Ribbon Blues: How Breast Cancer Culture Undermines Women’s Health, says, “there’s often a misconception that anything with a pink ribbon on it is supporting and funding research for a cure…the branding has probably oversimplified the disease, its detection and treatment in people’s minds.”

Did you know that February is American Heart Month?

    Don’t feel bad, neither did I (and I know someone with a history of heart disease…Amasian Dad). In my opinion, perhaps the most significant unintended consequences of Komen’s success in raising breast cancer awareness is how it overshadows the impact of other health problems. Heart disease is the leading cause of death for women (and men) in the US. The CDC figures for 2007, show that heart disease accounts for 25.1% of deaths in females. Cancer (all forms) comes in at second (22..1%). After lung cancer, breast cancer is the 2nd leading cause of death among cancers in women. For perspective, in 2007, 40,598 women in the United States died from breast cancer whereas 306,246 women died from heart disease. This, of course, is not meant to minimize or dismiss the impact of breast cancer on the lives of patients and families (believe me, Amasian Mom was successfully treated for breast cancer only a few years ago–and I am very grateful). I also can respect how this particular cancer resonates with women as it affects a part of the body that is often attached to the identity of a woman (oh for my sake I hope I phrased that properly). But having said that, the awareness and attention that breast cancer garners compared to heart disease in women is disproportionate. This often leads to misconceptions about what poses the greatest risk to a woman’s health. In a 2010 study published in Circulation: Cardiovascular Quality and Outcomes, 54% of women that were surveyed correctly identified heart disease as the leading cause of death, an improvement over the 30% of women that correctly identified heart disease in 1997. Despite this improvement, however, 28% of respondents identified breast cancer as their “perceived” greatest health problem versus 16% who identified heart disease as the greatest threat to their health. Whereas 1 in 8 women will develop breast cancer at some point in their life, 1 in 3 will develop heart disease.

     Breast cancer awareness is not the only kid on the block. In 2004, the American Heart Association created the Go Red For Women campaign to bring attention to the fact that heart disease was the leading cause of death in woman. According to their website, “In 2003, the National Heart, Lung and Blood Institute (NHLBI), the American Heart Association and other organizations committed to women’s health joined together to raise awareness of women and heart disease. The NHLBI introduced the red dress as a national symbol for women and heart disease awareness and the American Heart Association adopted this symbol to create synergy among all organizations committed to fighting this cause.” Interestingly, the campaign also uses cause marketing. Let’s hope that “redwashing” does not become a problem for them.

February is also Black History Month. Please read Black History Month: Celebrating Blacks in Science, Promoting Diversity in STEM by DNLee.

Mosca, L., Mochari-Greenberger, H., Dolor, R. J., Newby, L. K. & Robb, K. J. Twelve-Year Follow-Up of American Women’s Awareness of Cardiovascular Disease Risk and Barriers to Heart Health. Circulation: Cardiovascular Quality and Outcomes (2010).doi:10.1161/CIRCOUTCOMES.109.915538

One response to “Breast Cancer Awareness. More harm than good?

  1. Pingback: Rethinking the War on Cancer 4.11.12 « Amasian Science·

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