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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