In 2002, when I started working in the breast cancer screening department of what was then the Alberta Cancer Board, one of the recurring agenda items in staff meetings was what to do with the world’s longest pink ribbon. Stapled with intense resolve by Calgary staff and volunteers, many of the 24,000 ribbons inscribed with names of loved ones, it was carefully laid out on the hill behind CFRN TV in Calgary, jubilantly measured at 6,765 feet, certified by the Guinness World Records people and, shortly after, stuffed into large cardboard boxes. We thought a big Plexiglas square might be a striking means of display, and someone got estimates, but someone else thought such a box would have coffin associations. Eventually we stopped talking about pink ribbons, although it seems no one else has.
Pink Ribbon Culture, as Gayle Sulik calls it in her 2011 book, Pink Ribbon Blues, is a study in philanthropic trends, cause-related marketing, and the branding of disease. Within a decade, breast cancer has evolved from a stigmatized disease into the dream cause of dozens of corporations that compete to “gain ownership over the issue,” as an Avon spokesperson once put it. In 2008, by way of example, the Susan G. Komen Breast Cancer Foundation had ninety-four corporate sponsors and their Race for the Cure raised over $170 million in 2009. Yet Sulik is one among many critics who claim the six billion dollar Pink Ribbon industry does not benefit women diagnosed with the disease as much as it does corporations, large non-profits, and especially pharmaceutical companies.
Pink Ribbon Culture has become pathological, according to Sulik, “inadvertently help[ing] to maintain a war on breast cancer that has little chance of ending in the near future.” Samantha King made similar points in her 2011 book, Breast Cancer, Inc., where she focused on “the philanthropic arm” of breast cancer culture to show how “corporate marketing strategies, government policies, and the agendas of large nonprofits serve to reinforce one another in the social production of the disease.” Certainly there’s nothing subtle about the recent branding of breast cancer: A pink-lit Taj Mahal? The “crawl for the cause” lifelike baby doll? Critiques of the “vast pink sea of the breast-cancer crusade,” as Barbara Ehrenreich has called it, are plentiful and anti pink-ribbon activism (such as the Think Before You Pink campaign) has become increasingly widespread.
But then, what kind of mean-spirited crank complains about the billions of fundraised dollars for cancer research over the last decade? As Jian Gomeshi asked Samantha King in a CBC interview in October 2010, “Where’s the harm?” Isn’t increased awareness a good thing? After all, breast cancer awareness is now a huge global movement, marked last October by the illumination of thirty-nine historic landmarks within twenty-four hours. The Komen Foundation’s “global mission” to bring breast cancer awareness to women in places like Bosnia and North Africa likely benefits women too, as does Avon’s Breast Cancer Crusade, a worldwide campaign on the importance of early detection.
Like many missionary efforts, however, breast cancer awareness involves the export of cultural values under the mantle of charity, the “awareness” message remaining constant in every environment. In King’s analysis, Avon’s “crusade,” has far more to do with establishing brand identity than improving women’s health. Avon’s success appears to rely on Asian, Latin American and Eastern European markets—their crusaders are the 3.9 million sales reps worldwide who hand out information on breast cancer whenever they sell a pink-ribbon brooch. “Awareness” in breast cancer culture means the importance of early detection, but these global awareness crusades ignore multiple factors. As a Ghanaian activist pointed out at the 2002 World Conference on Breast Cancer, “The greatest risk factor facing women living in third world countries [is] living in third world countries.”
In Canada, what, exactly, should we be aware of when Estée Lauder lights up the parliament buildings? Under that pink glow last October, were people suddenly aware of the disparity in funding for “good” diseases like breast cancer versus “bad” health problems related to poverty and violence? Did we collectively realize that, despite the billions devoted to breast cancer research over the years, barely a dent has been made in incidence or mortality rates? Why does most of the research money focus on early detection and treatment instead of prevention?
At the same time, there’s no question that widespread breast health awareness and certain concrete goals have been achieved under the pink umbrella. The importance of reaching “underserved” women, for instance, has meant funds have been granted for many breast-health awareness projects in which more pressing corollary goals—such as creating a peer-support network, or improving access to healthcare services—were also met. In Edmonton a few years ago, an inner-city breast-health project meant that several women living on the street received one-to-one support on general health and personal safety issues along with the brochure on mammography.
When I was giving workshops on breast cancer, I witnessed, over and over again, how misleading the culture of “awareness” can be. Most women overestimated their risk, having frequently read that one in eight Canadian women will be diagnosed with breast cancer. The context for this statistic—should all women live to be eighty-five—is often missing.
Because “awareness” overemphasizes heredity, genetics are widely, and incorrectly, believed to account for far more than the five to ten per cent of breast cancer cases which they do. Many women believe they are at high risk even though their mother or grandmother had the disease post-menopausally and there was no other family history. Most egregious are the “awareness” messages for girls, training them to, in effect, view their developing breasts as potential cancer vehicles.
Meanwhile, mass participation in the fight against breast cancer has become highly visible through walks, runs and various “-athons.” Marketing guru Dan Palotta invented the AIDS ride, then the Avon breast cancer three-day walk, after recognizing, as he put it, a “deep hunger on the part of people with AIDS and breast cancer and the people who care about them to do something heroic.” Avon eventually fired Palotta in response to public concern about his forty per cent administrative costs, among other issues. The Komen Foundation hired him to orchestrate their walk, which now raises approximately $40 million a year. In his 2008 book Uncharitable: How Restraints on Nonprofits Undermine Their Potential, Palotta claims that altruism is never selfless. “It’s a taste, stronger than our taste for music and art.” Why not capitalize on that taste? Samantha King notes that fundraising walks and races help in “shaping a social context that views America’s survival as depending on personal acts of generosity mediated through consumer culture.” The difficult trick for consumers, however, is “discerning activities that bring social change from those that reproduce the status quo.”
Former employees of Palotta Teamworks applied the sixty-kilometre walk formula in Canada by deploying their new company, CauseForce, to produce the Weekend to End Breast Cancer (WEBC), for which I volunteered. Except for staffing the giant colon in West Edmonton Mall, working at theWEBC’s registration day was my least favourite job assignment. CauseForce applied their formula of big production values: blaring inspirational music, slick promo video on a massive screen, an army of pink-clad volunteers, and, in the middle, a store of commemorative trinkets, t-shirts and baseball caps. My job as a representative of the Alberta Cancer Board was to hand out pink breast-health wheels. Although the atmosphere was not conducive to critical thought, many womenapproached me with questions. They asked if their money really was going to good use, and why, as one woman put it, there has to be “so much effing pink.” Many refused the brochures and breast health wheels, citing environmental concerns.
Despite my difficulty with the loud, pink stimuli at the WEBC, I was always moved by the deep commitment many of the walkers had for each other and those they were walking for. While it seemed, on one hand, that this human concern was being exploited, it was clear that the walks gave people a way to fulfill their strong and urgent need to help. Yes, the walk is a commodity (for which, as Palotta says, walkers must raise at least $2,000 for the “privilege” of participating). But it is also a place where people can match intense feeling—love, fear, gratitude—with rigorous action.
The optimism of the WEBC was so strong, it was easy to forget that the disease caused suffering. In the Pink Ribbon Culture’s “tyranny of cheerfulness,” as Ehrenreich calls it, breast cancer is a battle regularly won by thousands of plucky, reflective, and sometimes kick-ass heroines who are then feted as “survivors.” In her 2006 graphic memoir, Cancer Made Me a Shallower Person, Miriam Engelberg wonders what the term “survivor” really means. “Is it just a statement of fact?” Engelberg asks, her cartoon self pointing at a coffin and saying, “I’m alive. She’s not. Na na na na na.”
In her 1980 book, The Cancer Journals, Audre Lorde created a model for the politically-engaged breast cancer memoir and seemed to foresee its replacement: “Like superficial spirituality, looking on the bright side of things is a euphemism used for obscuring certain realities of life…” Forty years later, breast cancer memoirs have become a genre of bright-siding in which cancer is experienced as a personal journey from which a truer self can emerge. As Ehrenreich points out, dissent amongst all this cheer amounts to a kind of treason. While Pink Ribbon Culture may have succeeded in reducing the stigma of getting breast cancer, it has at the same time stigmatized or disregarded many of the ways in which women might experience the disease—anger and despondency being especially unacceptable.
Much of my job at the Alberta Cancer Board involved giving breast-health talks in which the main message was: “Get a mammo if you’re over fifty.” The main visual aid was the breast model. Smooth and gummy and embedded with hard round lumps ranging in size from small to large tapioca, women poked at it with gleeful dread. In every group, in every corner of the province, the conversation was the same: “Oh God! There’s one.” “Oh my God, that’s huge!” “Is that what they really feel like?”
Perhaps the model allowed us to transfer our fear of breast-cancer away from our own breasts, or perhaps it had an intrinsic squishy appeal, but certainly the breast model provided a simple, necessary reassurance—something like a stressball—in the absence of concrete information. As the expert, I could clear up “awareness” misconceptions, but I had nothing to offer in terms of prevention, given that early detection, a poor alternative to start with, is hardly straightforward. While mammography for women fifty and over appears to remain the best method of early detection, the American Cancer Society publicly admitted in 2009 that the benefits of breast cancer screening have been exaggerated. In 2001, a Canadian task force on preventative health care declared breast self-examination ineffective. Breast-health brochures now say, “Stay aware of your breasts,” something women age fifty and over can hardly avoid, many of us sensing our social capital sag as they do.
Awareness takes many forms, of course, from staying “aware of your breasts” to staying aware of who is actually benefiting from the culture of the Pink Ribbon and in what ways; and there is a growing literature devoted to this kind of awareness. Speaking of which, I’m not aware of what became of that world record-breaking pink ribbon we didn’t know what to do with back in 2001. Most likely it was quietly destroyed. Pink Ribbon Culture is all about optics, after all, and if you’re stuck with a giant pink ribbon that you can’t deploy to bright-side someone’s heroic struggle—or, at the very least, use as a motivational tool to convince someone to buy a pink blender—then what good is it?