Thank god Breast Cancer Awareness Month is almost over.
There. I’ve said it: the unspeakable, the cynical, the curmudgeonly. It feels like a betrayal of my gender and of all of the truly well-meaning and kind hearted folks who have swathed themselves in pink, run in 5ks, donated time and money; not to mention those who have survived, held the hands of their sisters and friends and mothers as they endured treatment, or, god forbid, died.
But I hate it. For all kinds of reasons.
Believe me, I don’t need the calendar to remind me to be aware of breast cancer. Six years ago this month, my sister was diagnosed. Two weeks ago I had my fourth mammogram and second ultrasound in six months. A screening mammo in February led to a diagnostic mammogram and ultrasound, which led to a biopsy. All told, from screening to (thank god) all clear was just under a month. A month of waiting for the doctor to prescribe, for the scheduler to arrange, for the pathologist to find that “it” was a fibroadenoma, completely benign and, incidentally, not even palpable, even after I knew it was there. In fact, the mass that had to be biopsied was not the spot on the mammogram that triggered the diagnostic imaging to begin with. That, as it turned out, was nothing...a thickening where some tissue was compressed in an unusual way during the screening mammogram. Lost track? Me, too.
“And please come back in six months for another mammogram and ultrasound, because there’s this other thing over here that may or may not be something.”
And so I did. Because my sister was diagnosed at 47 (my age). Because that’s what you do, and what I have done every year since I turned 40 (total number of mammos in that time: 12; total number of ultrasounds: 5; total cost: don’t ask). I have been relentlessly squeezed, stabbed, and prodded at the local “Breast Evaluation Center” in what seems like an endless wild goose chase, but still I go. Because it’s breast cancer awareness month and everyone knows that early detection saves lives. Doesn’t it?
In the months since my false alarm last March, I’ve read a lot about overdiagnosis and overtreatment of early stage breast cancers. Yes, we have made advancements in treatment in the last several decades, and yes, more women survive their diagnoses. But as it turns out, a significant number of women still die of metastatic breast cancer, and that number is not decreasing fast enough. If early diagnosis were saving as many lives as we’d like to think, then there should be a proportional decline in metastatic disease. There’s not. In fact, recent studies suggest that many of these early cancers may not actually present a long term danger. And yet women are enduring expensive, invasive, and stressful treatments for them. Just in case.
And there’s the rub. What is the line between vigilance and paranoia? Between denial and reasonably questioning the necessity of these interventions? And why aren’t more women asking these important questions of their doctors or of the charities they are donating to?
I blame pinkwashing. It would be simple to say that since breast cancer is bad, awareness and fundraising are good: pink goalposts at NFL games, pink boxes of toaster waffles, pink ribbons at car dealerships, high school kids cheering their football teams wearing pink instead of their school colors to “support” breast cancer. To question exactly where this money is going, what it’s doing, or in any way going against the pink cultural tidal wave seems blasphemous.
Where’s the harm, you might ask. Awareness and fundraising can’t be bad things, can they?
Well, that depends. Yesterday at Kroger, I was confronted with a wall of pink Campbell’s soup cans promising to donate portions of their sale to the Susan G. Komen Foundation. Pink cans sell, and the payoff for the corporation is big even after the donation (about 3.5 cents a can) is made. Who cares that many of their cans are lined with BPA, a chemical that has been linked in several studies to breast cancer?
But even if the pink product itself is benign, do you know where your money is going and how much? The Susan G. Komen Foundation, probably the best-known and most visible breast cancer charity, has not only defunded Planned Parenthood (and then reneged when the backlash hurt too much) but has also initiated legal action against other charities using the phrase “for the cure.” They have even tried to prevent other charities using their signature hue. Perhaps most disturbingly, only 15% of Komen’s revenue goes towards research. Eighteen percent is spent on fundraising and administration. Read the labels on your pink products to see what proportion of that money is going to breast cancer research; you might be surprised at what you find out. By all means, donate money, but do your homework first.
It also seems that the flurry of activism and fundraising around breast cancer obfuscates some other important realities. I wonder how many people know that the leading cause of cancer deaths among women (and men) is lung cancer. In fact, lung cancer kills more people than prostate, breast, and colon cancer combined. Do you know what color that ribbon is, or what month it’s celebrated? (Spoilers: white; November.) Lung cancer research is woefully underfunded, probably due to the widely held belief that victims have brought it on themselves. Tell that to my close friend Sara, Stage IV at diagnosis, who has never put a cigarette to her lips. But that’s another rant.
I was lucky that my most recent trip to the mammo/ultrasound rodeo ended happily: with many new pictures of cysts and lumps and fibrous tissues, but nothing that is likely to kill me in the short term. I don’t take my good fortune for granted, nor do I dismiss the suffering wrought by breast cancer as unworthy of our attention or charity. But I do wish we could have more nuanced conversations about what will lead to fewer deaths from cancers of all kinds: namely research and prevention, not just awareness and screening. And let’s have those conversations all year round, not just in October.
