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Breast Cancer Isn’t Just Pink

The documentary Pink Ribbons, Inc. casts a skeptical look at all those pink-branded efforts to raise awareness

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Participants at the 2010 Revlon Walk/Run for Women, New York City, from Pink Ribbons, Inc. (Leá Pool, © 2010 National Film Board of Canada)
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A pink-striped sports car cruises down the highway. A female voice-over says enthusiastically, “When I was diagnosed with breast cancer, all I wanted to do was get into a Ford Mustang and go!”

The desire to flee, that I understand. I’m just not sure I’d complete the thought with “… in a muscle car that looks like Malibu Barbie’s.”

But as that television commercial for the special-edition “Warriors in Pink” Mustang illustrates, breast-cancer awareness is now big business, with the unnerving perkiness that seems permanently attached to any mention of the disease now firmly tied to any number of commercial products. There’s the pink KitchenAid “Cook for the Cure” collection (pink blenders, mixers, food processors, and mini-choppers), Glamor Glints pink rhinestones, ribbon-shaped fingernail appliqués, breast-cancer awareness alcoholic lemonade, and of course a pink Smith & Wesson handgun.

There’s even a “Buckets for a Cure” tub of KFC fried chicken. As the watchdog organization Breast Cancer Action’s site Think Before You Pink succinctly asks (about the pink chicken bucket, but hey, it’s a relevant question for all these products): “What the Cluck?”

The new documentary Pink Ribbons, Inc., which opened in New York and Los Angeles on June 1 and begins a national rollout on June 8, tries to answer that question. What’s the deal with the whole pink ribbon movement, and the related commercialized effort to “raise awareness” about breast cancer—a disease that’s of particular relevance to Ashkenazi Jews, who are disproportionately susceptible to it? Pink ribbons have garnered lots of attention and raised millions of dollars, but to what end?

The movie isn’t perfect, but it raises important points about how the pink-ification of breast cancer has come at a cost. It asks whether the vast sums raised are being used effectively; whether all those races and walks “for the cure” create an unrealistic portrait of breast cancer, waste money, and trivialize the disease; and whether companies capitalize on pink-ribbon culture to lure consumers while distracting attention from their own corporate sins.

***

Pink Ribbons, Inc. is based on a very smart book of the same title, in which Samantha King, a professor of gender studies and health at Queens University in Ontario, looks at the business of pink-tinted, P.R.-oriented, corporate, breast-cancer fundraising.

Unfortunately, the documentary meanders away from the book’s central issue into a thicket of related issues: the potential environmental causes of breast cancer; how little we really know about the disease or how to cure it; where the money raised by various organizations actually goes. Then the filmmakers devote time to the toxic sins committed by purportedly breast-cancer-friendly car manufacturers (use of plastics, promotion of a bad-for-the-environment product), cosmetics companies (stuffing lead into lipstick, petroleum into moisturizer, and formaldehyde into nail polish), yogurt companies (using milk with bovine growth hormones), pharmaceutical companies (producing not only cancer drugs, but also pesticides that cause cancer). To call this approach diffuse is charitable.

The film also addresses the tone of the campaigns to raise awareness, arguing that the go-team-fight chipperness of the pink movement insults women with Stage IV cancer (“There is no Stage V,” the main character of Margaret Edson’s play Wit says drily) who have failed, in the happy language of the pink-pimpers, to “win the fight against breast cancer” and “be a survivor!”

I appreciate the way the movie wrestles with so many complicated issues. But as with the movie Bully, good intentions only go so far.

The movie is most effective when it sticks to examples of pink opportunism. For instance, the yogurt company Yoplait has long run a promotion called “Save Lids, Save Lives,” in which you send in yogurt lids (but only the pink ones, and only during specific periods, and no, you can’t save your pink lids until the next period because Yoplait tracks the codes on them), and Yoplait donates 10 cents per lid to the Susan G. Komen For the Cure foundation. Which sounds great, except that a stamp costs 45 cents. Why wouldn’t you donate your 45 cents directly to charity instead of going through the creamy yogurt middleman? Furthermore, as King’s book points out, if you ate three pink-lidded yogurts a day for four months, you’d wind up donating a whopping $36. Or you could just write a check to the women’s health organization of your choice. Maybe even Planned Parenthood!

(And speaking of Planned Parenthood: Unfortunately for the filmmakers, the documentary was made before the poop hit the fan about Komen pulling its support from that organization. Fortunately for the filmmakers, Komen’s president Nancy Brinker appears in the movie and still comes off as a fine villain, exuding money, privilege, and unnerving agelessness as the chant “There’s not enough pink! There’s not enough pink!” emanates from her hypnotically glossy pink lips.)

It would have been nice for the film to spell out how Komen spends its vast money: Since its founding in 1982, it’s raised nearly $2 billion; yet as Komen’s revenues have climbed, it has spent less and less on research. (According to Komen’s own figures, today it spends about 21 percent of its budget on research.) There are other strange gaps in the film, such as the fact that it glosses over whether breast cancer is more deadly or more prevalent than it was in the past. We’re told that around the world, someone dies of breast cancer every 69 seconds, and in North America over 59,000 women die from breast cancer every year—but how have those numbers changed over time? The movie doesn’t say.

However, in keeping with the excellent “what’s everyone’s agenda here” aspect of the film, it does tell us that Breast Cancer Awareness Month was invented in the early 1980s by a P.R. guy at what’s now AstraZeneca, then the American arm of the largest chemical company in the world. The goal: Promoting mammograms and not-so-incidentally increasing the profit potential of the company, which not-so-incidentally, makes breast cancer drugs. But again, that begs the question: Is breast cancer on the rise, or is it just more frequently diagnosed thanks to the push of people making money off it? The movie does point out that early diagnosis doesn’t always lead to increased survival rates. Breast cancer manifests itself differently in different people—sometimes, early detection finds a cancer that never would have become life-threatening, which can lead to overtreatment and panic; other times, a cancer detected early (especially in younger women) still leads inexorably toward an unhappy outcome. These facts don’t fit with the happy-happy-joy-joy messaging of the pink ribbon brigade. But to me, these facts say that money is still needed for both research and treatment. If we don’t understand something, how do we fight it? The movie implies that funds are being misspent but doesn’t tell us exactly how.

What is clear is that in the United States (and Canada, where the documentary hails from) breast cancer is deadlier in both young women and in the African-American community. That’s partially why Komen cutting funding to Planned Parenthood was so infuriating; the five-year survival rate for breast cancer diagnosed in African-American women is 78 percent, compared to 90 percent among white women, and Planned Parenthood provides health care for those women who are less likely to have access to prompt, high-quality treatment.

The upshot: While the gaps in the film and its scattershot approach are irksome, Pink Ribbons, Inc. still gives us a lot to ponder. It’s up to us to take the issues it raises and make our own decisions about our purchasing power, donations, approach to health care, and activism.

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Breast cancer brings up particularly knotty questions for us as Jews. Just ask Rochelle Shoretz, a former law clerk to United States Supreme Court Justice Ruth Bader Ginsburg. She was diagnosed with breast cancer at 28 and founded Sharsheret (Hebrew for “chain”), a nonprofit that supports young Jewish women with breast and ovarian cancers.

“Ashkenazi Jews carry an increased genetic risk for breast and ovarian cancers, because one in 40 Jews carries a mutation in the BRCA1 or BRCA2 gene that can trigger these cancers,” Shoretz explained to me in an interview. “That’s why our community has to pay attention to screening and to family history. This is a Jewish family issue, a Jewish community issue—and that’s where Sharsheret focuses our energy. So much of our family health history was destroyed in the Holocaust; we have to give our children a legacy of health information that they can use to be proactive.”

The fact that we Jews may have a genetic propensity toward the disease is proof that there shouldn’t be a one-size-fits-all approach to breast cancer. But that also means there shouldn’t be a one-size-fits-all approach to cancer awareness. When I watched the movie Bully, I was uncomfortable with all the balloon-releasing “yay, let’s end bullying!” rallies—they don’t offer kids the practical tools for becoming allies rather than bystanders, and they don’t change the culture of schools (in fact, research shows that the zero-tolerance policies the film’s website advocates do more harm than good). But my heart went out to the kids and adults whose intentions are clearly lovely. So it is with all the pink-clad participants in the Komen Races for the Cure and the Avon Walks for Breast Cancer. The film spends a lot of time visually snarking at all the women screaming “whoo!” and dancing to Kool and the Gang’s “Celebration” and acting as unwitting shriek-y shills for the companies giving out plastic-bottled tea beverages. But these women mean well … just as the filmmakers do. People are drawn to the idea of doing something, even if it’s not the most effective something. The Avon Walks for Breast Cancer have raised over $150 million; Susan G. Komen’s Races for the Cure raised over $120 million in 2010 alone. Yes, as with the yogurt lids, there are valid questions about whether the money is well spent. Barbara Ehrenreich, in her brilliant essay “Welcome to Cancerland,” points out that Avon spends more than a third of the money it raises on overhead and advertising, and Komen’s numbers are similar. And yes, it’s a valid question whether these events marginalize those who “fail” at being “survivors.” As Ehrenreich says in the film, “We found sisterhood from other women and looking critically at what was going on with our healthcare. The sisterhood of now is supposed to be supplied by the runs and races … the effect of the whole pink ribbon culture was to drain and deflect the kind of militancy we had as women who were appalled to have a disease that is epidemic and that we don’t even know the cause of.” Wearing a ribbon and tarting up the Empire State Building, Niagara Falls, and Canadian Parliament in pink lights won’t change that.

But portraying women as dupes isn’t really helpful, either. Frivolousness and silliness do have a place in activism, right alongside anger. We need optimism. The trick is making sure it isn’t naïve, roped into the service of consumerism or (another issue the film doesn’t address) sexualization. The whole leering, youthful Save the Ta-Tas! and I Love Boobies! movement, which Peggy Orenstein addresses so well on her blog, is as unnerving as the middle-aged matrons shaking their pink sweatpants-clad booties to “We Are Family.” The “tyranny of cheerfulness” (as King puts it in the film) is cross-generational. But surely we can find a middle ground of pressuring the medical establishment for answers and treatment for all while also getting to dance. We have made strides in treating breast cancer—support groups are ubiquitous, research is advancing (albeit more slowly than we might like), and activists have pressured companies (yogurt companies!) into removing potentially cancer-causing hormones from their products. And as Shoretz puts it, “You cannot underestimate the benefits to those of us living with breast cancer of the attention the pink ribbon has garnered. Talk to anyone who has a cancer that’s not breast cancer and they wish they were part of a bigger cancer movement. The ‘how much is too pink’ debate will continue. But at the end of the day it’s important to recognize that there are benefits as well as costs to a pink campaign that has raised billions of dollars for breast cancer research.”

If Pink Ribbons, Inc. educates women into considering where they donate and whether they’re getting the most for their money, that’ll be a huge service.

***

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andreardr says:

Hello!  This is Andrea Rader at Komen and I wanted to just weigh in on some of the questions that you posed in your very thoughtful review of the Pink Ribbons, Inc. film.  You ask good questions, e.g., how are breast cancer organizations spending the money they raise and to what end?  On Komen’s end, 84 cents of every dollar we raise goes to our mission, which is research, support for women going through breast cancer, screening, education and outreach to low-resource women. We don’t spend a third of our funds on advertising, as the movie suggests – fundraising expenses are about 7 percent of our budget).  We’ve invested more in breast cancer research than any other nonprofit — $740 million to date, and our research investment averages 20-29 percent each year, with the rest going to the community health, advocacy and education programs that served more than 800,000 women last year with screenings, financial help, patient support – even groceries for their families. The result of our work and others?  Death rates from breast cancer have declined by 33 percent since 1990 in the U.S., and we now have 99 percent five-year survival rates for women diagnosed with early stage cancers (up from 74 percent when we started).  Of particular note to your readers is our work in research for the BRCA genetic mutations affecting Ashkenazi Jewish women and other minority groups (more information about our research on BRCA mutations is available here).  One final note: we partnered with KFC for six weeks in 2010, which helped us reach a lot of women with information about breast cancer.  Thanks for giving us some time here to answer your questions.

savtaro says:

It’s nice to talk about early detection and improved survival in breast cancer or any other cancer but we must always bear in mind the not so little anomaly which goes like this:  due to early detection (as in mammograms) a cancer is located before it would be found by palpation…..perhaps even a couple of years earlier.  This cancer is treated and the patient survives for, e.g. 7y,  and is in contrast to the patient who survives 5y after discovering a tumor by palpation.  Both have succumbed but the 7y survival and the 5y survival both result in death at the same time.  All statistics can be skewed but in cancer treatment this is especially true.  This is not to suggest that early detection is never worthwhile.  Of course it has saved many lives.  But the figures are not quite as dramatic as the studies may indicate.

Rebecca Lesses says:

And when will we see this kind of support for research on lung cancer and treatment for it – a kind of cancer that kills more women every year than breast cancer?

naomisa says:

I watched the film in Canada three months ago . I think it is an extremely important one. Fortunately women have a lot of power to change things if they do things together. Exposing the industrial/ corporate misleading and exploiting this power is the first and foremost importance of this movie, even if it does not convey all the important things King described in her book.
King’s book was published 5y ago and very few in the US read it.
I think that the movie’s message is very clear. Women’s good energy and money is misused. Research in the field has been concentrated on Diagnosis (but we are still using mammographies that creates a huge collateral damage and no better method was found for over 40 years) and on drugs for treatment (pharmaceutical companies), instead of preventive methods.
This movie , that took 3 months to pass the border (I wonder whether somebody had an interest to halt it?) and the newspaper stated that it is here “only for one week”, should get a much broader exposure.
It is time for the pink ribbon energy and money to be directed towards liberating women from mammographies’ harm and influencing the money that goes to research into the right direction.
There is no need for so much money to stream to commercial pockets.
I am a physician and an Ashkenazi Jew and I see in this movie a Universal potential, beyond the Jewish interests and I hope it won’t be taken off the screens quickly and perhaps will enable a small or bigger earthquake.
Naomi Smidt-Afek MD
New Jersey

doctordogood says:

Why did Komen given money to Planned Parenthood or anyplace else?  Why don’t they just give vouchers to women who need them?  (How many actually do?)  It’s part of their failure to actually “empower” women.  Why do women need a physician’s permission – in the form of a prescription – before they can get  mammograms?  Are they too infantile to make that choice alone?  People can go for all sorts of screening without having to take an intermediate step.  Why doesn’t Komen advocate removing that barrier to the mammograms they deem so worthwhile? 

 Why doesn’t Komen distribute information on the thinking about breast cancer and treatment – e.g. the thoughts and the reasoning on the frequency and ages at which women should get them; radiation and treatment options for women who do get breast cancer; perhaps evaluations from women on their experiences with diagnosis and treatment.   

It seems to me that Komen is a lot of hype and very little substance.  They seem to take a very simplistic view of women and breast cancer. 

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Breast Cancer Isn’t Just Pink

The documentary Pink Ribbons, Inc. casts a skeptical look at all those pink-branded efforts to raise awareness

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