A Brief History of Breast Cancer Awareness Month

National Breast Cancer Awareness Month (NBCAM): The month of October, designated to be an observed commemorative month to raise awareness of breast cancer. Established in 1985 as a partnership between the American Cancer Society and the pharmaceutical division of Imperial Chemical Industries (now part of AstraZeneca, a leading manufacturer of oncology drugs).

See also: Pinktober


Claiming to “fill the information void” about breast cancer, the early mission of National Breast Cancer Awareness Month (NBCAM) was to educate and empower women to “take charge of their breast health.” Well-known public figure and breast cancer survivor Betty Ford and her daughter helped to kick off the first week-long awareness event with an emotional televised appeal. It wasn’t long before NBCAM became a year-long series of educational and fundraising activities culminating in October.

NBCAM consists of “the creation and distribution of promotional materials, brochures, advertisements, public service spots, and other educational aids.” In addition to advertising, there is free exposure through word of mouth, clinical promotion, workplace and community initiatives, and political representatives. For years, the program encouraged routine self-breast exams and annual mammograms.

During the 1993 NBCAM, President Clinton proclaimed the third Friday in October to be “National Mammography Day” and urged companies, clinics, and radiologists to provide free or discounted screening on that special day. After mammography became incorporated into insurance coverage and state and federal programs, mammography screening virtually guaranteed ongoing investment in breast cancer awareness as a social cause and crucial public health issue. Indeed, NBCAM gave breast cancer awareness a regularly occurring timeline for cause promotion and has functioned as a platform for a variety of commercialized activities as well as pink-ribboned products and services.

A Brief Critique of NBCAM

There have been numerous critiques of NBCAM over the years. Among others, there is the reification of survivorship, the belief that screening mammograms are the ultimate answer to the breast cancer problem, the overt commercialization of the disease and more recently, the feminization of breast cancer through stereotyping, trivialization, and the objectification of women.

Survivorship

The cancer survivor is a label and an identity common in cancer culture. According to the National Cancer Institute Office of Cancer Survivorship, a person is considered a cancer survivor at the time of cancer diagnosis and remains so for the remainder of his or her life. Contrary to the everyday meaning of survival (i.e., to live), many “cancer survivors” do not actually survive cancer. People with cancer that has spread to distant organs face life-long treatment and a progressive disease that is, currently, incurable.

Data from the National Cancer Institute shows that the five-year survival rate for people diagnosed with metastatic breast cancer is still only about 20 percent, and the average prognosis is only two to four years. Nearly 41 thousand people die of metastatic breast cancer every year, a number that hasn’t budged in four decades despite an overall decline in the cancer death rate. Yet cancer awareness messaging focuses on living as a survivor even when facing a terminal disease, a message that isolates advocates like Beth Caldwell, founder of the nonprofit breast cancer advocacy group MetUp. Caldwell explains that for people with metastatic (stage 4) cancer,

“We might not die right away–we might suffer through treatments for a while, but eventually, nearly all of us will die of our disease, and 100% of us will die with our disease, because it is incurable. So, how can I be a survivor of cancer? How can you survive something that will eventually kill you?”

Focusing on survivorship, while well-intentioned, masks the suffering and hardship of cancer and treatment on individuals, families, and communities.

Screening Hype

Although NBCAM partner, the American Cancer Society, has acknowledged the limitations of screening mammography and no longer promotes breast self exam, the organization falls short when addressing the limits of mammography screening, instead casting it primarily as a personal choice. Individual proclivity aside, there is a body of evidence that can be used to make evidence based decisions about whether and when to screen. Although the ACS published a justification of its new guidelines in JAMA (2015), simple messaging such as the infographic below with its tentative (wish, can) language fails to give women adequate information about the pros and cons of routine mammograms.


Commercialization

Now with numerous collaborating partners, NBCAM has become a marketing platform and pink ribbon shop under the guise of fundraising and education. Cause marketing promotions are so ubiquitous in the pink ribbon marketplace that it is difficult to know which ones have merit. BCC advises consumers to consider mission match, company transparency, charity legitimacy, and impact. Read more here.

Feminization of Breast Cancer

NBCAM’s public service announcement in 2010 exemplified a key tenet of pink ribbon culture–feminine beauty. A claymation dancing pink ribbon with a smiling face, lipstick, and a get-up-and-go attitude was proof that a saucy woman could fight breast cancer and win. Not only does the dancing ribbon trivialize breast cancer and infantilize women, it distracts people from understanding the realities of cancer.

The American Cancer Society took the feminization of awareness to an extreme by intentionally objectifying women in a “Making Strides Against Breast Cancer” awareness video shot at chest-level. Supporting a social cause oriented to women while commercializing, stereotyping, objectifying, and undermining women and their status in society is counterproductive and glosses over the realities of a serious disease.

 

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