Friday, November 23, 2012

Singapore - Breast Cancer Awareness: Staying In The Pink Of Health

David Tan takes a look at the annual Pink Ribbon campaign that aims to increase breast cancer awareness and raise funds for cancer research.

Unless you are a hermit living far from civilization, you would surely have come across a pink ribbon or two this past October.

As the pink glow of October’s breast cancer awareness campaign recedes, pundits are starting to assess the benefit of the pink movement.

The Breast Cancer Awareness Month campaign began in 1985 and the pink ribbon that now symbolizes the cause was first given out at a New York City race for breast cancer survivors in 1991. Since then, the trickle of pink into the public consciousness has grown into a flood each October.

At first glance, large-scale breast cancer awareness campaigns appear to be hitting all the right targets.

After all, they have brought the issue to the fore, helping remove the stigma associated with cancer, as well as encouraging women to practice self-examination and attend regular check-ups. Campaigns also have significant psychological impact in offering support to breast cancer sufferers.

Show me the money

However, not everyone is convinced of the overall benefit. For starters, some critics feel the breast cancer awareness movement has grown to such a staggering scale that most of the funds raised are used to sustain the campaigns themselves instead of going toward cancer research.

For example, the Susan G. Komen foundation that initiated the pink ribbon movement in the first place, has recently come into the spotlight for only spending 15 percent or US$63 million of the money it raised in 2011 on research. The rest was spent on education, screening, and treatment, which while useful, divert resources from those trying to find solutions.

Others feel that the well-intentioned movement has been hijacked by companies seeking new opportunities. Indiscriminate use of the color pink or the pink ribbon to associate products with the breast cancer awareness campaign for commercial gain has become more widespread of late. So much so that Breast Cancer Action described the blatant profiteering as “pinkwashing, ” a portmanteau of “pink ribbon” and “whitewash.”

To screen or not to screen

One hotly debated topic surrounds the benefit of breast cancer screening. In focusing on early detection as prevention, the Susan G. Komen foundation has been criticized for overselling mammograms and under-representing the risks.

Writing in the British Medical Journal in August this year, Dr. Steven Woloshin and Dr. Lisa Schwartz argued that the survival statistics used in advertising campaigns by the foundation were unreliable and made screening appear more beneficial than it actually was. According to them, “For every life saved by mammography, around two to ten women are overdiagnosed.”

Some say screening tends to identify tumor types that are indolent and cause no harm. Before the BMJ report, a study in the New England Journal of Medicine in 2010 found that while screening mammograms saved lives, there was five to fifteen times the number of women who were unnecessarily diagnosed and treated for cancers that turned out to be harmless.

In late October this year, an independent UK panel investigating the benefit of breast cancer screening found that while screening extends lives, it also led to overdiagnosis. Publishing in the medical journal, The Lancet, the panel found that for every breast cancer death prevented, there were three overdiagnosed cases identified and treated.

And just this week, another report in the New England Journal of Medicine by two MDs, Archie Bleyer and H. Gilbert Welch, presented more data collected over three decades in the US. They found evidence for “substantial overdiagnosis accounting for nearly a third of all newly diagnosed breast cancers, and that screening is having, at best, only a small effect on the rate of death from breast cancer.”

Giving pink some street cred

Another bugbear of critics is how the language of breast cancer campaigns has recently changed to appeal to the younger generation. Some campaigns have veered into risqué territory with slogans such as “Feel your Boobies” and “Save the Ta-Tas,” in the name of standing out from the crowd. Critics have responded with accusations that they do more harm than good by sexualizing the disease.
“It sexually objectifies women, trivializes breast cancer… and uses the objectified woman as window dressing for the profit-making machine,” explains writer Gayle Sulik in an interview with USA Today.
Others feel that such campaigns simply reinforce the image of breasts being a woman’s most prized possessions, which magnifies the psychological pain endured by women who have had mastectomies.

What say the researchers?

A key area that lacks attention from current campaigns is information on the results of breast cancer research. Charities should take the lead in explaining these so the public can begin to understand the nature of this highly complex disease.

Recently, an international consortium of scientists published the most comprehensive analysis yet of breast cancer. Looking at 825 breast tumor samples, they found that the cancers could be divided into four main classes that are better treated as separate diseases to determine the optimal treatment.

As Dr. Matthew Ellis, Chair of Oncology at Washington University and co-leader of the study, explains:
“With this study, we’re one giant step closer to understanding the genetic origins of the four major subtypes of breast cancer. Now, we can investigate which drugs work best for patients based on the genetic profiles of their tumors.”

Clearly, breast cancer comes in many shapes and sizes and no single magic bullet cure can be developed to treat it. In fact, it is more helpful to think of breast cancer as a family of different diseases with their own characteristics, which influence the type of treatment needed.

This is exactly the type of information that needs to be broadcast to update the public about how research is advancing our knowledge of the disease and how to treat it. Better understanding of the disease itself would make expectations easier to manage.

Dr. H. Gilbert Welch, who co-authored the recent NEJM study confirming the trend of overdiagnosis, believes that healthcare providers should focus on treatment options.

“They can look less hard for tiny cancers and pre-cancers and put more effort into differentiating between consequential and inconsequential cancers,” he wrote in a New York Times editorial.

Despite being mired in doubt about their benefit, money raised through breast cancer awareness campaigns that filter through to cancer research has led to improvement in treatments as well as our understanding of the disease.

And so, distractions aside, I still bought a pink ribbon this year.

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