Young Feminists — Beyond the Boundaries of National Breast Cancer Awareness Month

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September/October 2011

By Kira S. Jones

October is National Breast Cancer Awareness Month (NBCAM), which means the country will soon be buzzing with talk of the disease. News articles will explore the prevalence of breast cancer, some of which will comment on the disease’s possible causes, and others will outline why mammograms may or may not be the most effective detection method. A tidal wave of pink will consume and saturate common household products as cause-marketing campaigns take hold, turning countless items (like yogurt, blenders, and batteries) pink in an effort to generate money for breast cancer research.  Pink ribbons will abound. Awareness campaigns will encourage women to schedule an appointment for a mammogram and to help raise money for breast cancer research, even though critical breast cancer activists have made it quite clear that these mainstream approaches to addressing breast cancer have not done as much to save women’s lives and reduce the prevalence of breast cancer as we might think.

NBCAM has been framing breast cancer for us since 1985, when the awareness campaign was founded by CancerCare and Zeneca Pharma-ceuticals, a multinational pharmaceutical corporation and subsidiary of Imperial Chemical Industries. Over the years, NBCAM has helped to shift public opinion and shatter the silence and stigma that once surrounded breast cancer, as well as shape how women think about and cope with the disease. In other words, NBCAM has significantly influenced how we talk about breast cancer and what we talk about when we do. 


In some ways, this is a good thing. Yet, in other ways, NBCAM’s construction of breast cancer is a real problem. The campaign’s narrative noticeably lacks important messages that might threaten to complicate the ultra-feminine, perky, corporate-driven and consumer-oriented discourse of NBCAM. For starters, the discourse consistently presents women with the fact that breast cancer knows no boundaries of race, ethnicity, or social class. What is frequently omitted from this message, however, is the fact that breast cancer does not affect every woman in exactly the same way.

Factors like race, class, and access to care are critical in how a woman experiences breast cancer and to her survival. According to Breast Cancer Action (BCA), disparities “in breast cancer incidence and mortality between and among different racial and ethnic groups are well documented.”1 In other words, social, political, and economic inequities are more than abstract concepts; they are contributing factors in the development of breast cancer.

For example, breast cancer incidence and mortality rates differ significantly among African American and White women. According to the National Cancer Institute (NCI), White women have a slightly greater chance of developing breast cancer than African American women (at a rate of 127.3 per 100,000 women vs. 119.9 per 100,000 women). But, African American women are more likely to die from breast cancer, with 32.4 deaths per 100,000 women, compared to an average of 23.4 deaths per 100,000 U.S. women.2   Asian, Hispanic and Native American women, on the other hand, have lower risks of both developing and dying from breast cancer than White and African American women. 

According to the Black Women’s Health Imperative, there are “many environmental, political and economic factors that place black women at increased risk of dying from breast cancer.”3 Low-income African American women lack access to quality and appropriate mammography screening and, even when they are insured, African American women receive unequal treatment and care. 

Not only does NBCAM lack a narrative about the ways breast cancer affects groups of women differently, it also avoids the message that there is more than one type of breast cancer.  According to the National Breast Cancer Coalition’s (NBCC) 2011 Baseline Status Report, there are a number of subtypes that “behave differently, are associated with different populations of women and different risk factors, and may have different causes.”4 Yet, the media and popular awareness campaigns rarely acknowledge these kinds of nuances in their discussion of breast cancer during NBCAM. Of course, this information complicates our understanding of the disease, but it’s important information that needs to be included during a month dedicated to “awareness.” 

African American women are twice as likely as White women to develop “triple negative” breast cancer, which is a subtype of the disease.5  Triple negative breast cancer is a type of aggressive breast cancer that primarily affects young African American women. It’s called triple negative breast cancer because it tests negative for estrogen receptors (ER), progesterone receptors (PR), and the HER-2 gene. It’s also very difficult to treat. Women with triple negative breast cancer don’t benefit from the most common treatments, such as tamoxifen or Herceptin, which are designed to affect cancers driven by estrogen, progesterone, or the protein called human epidermal growth factor receptor 2.

This means that chemotherapy is the only treatment option currently available for women with triple negative breast cancer.  But, chemo’s effectiveness is highly dependent on detecting triple negative breast cancer early — which is complicated by African American women’s reduced access to both health care and insurance coverage. There is an upside, though.  A recent study found “advances in chemotherapy have lessened the survival differences between ER-positive patients who receive hormonal therapy and ER-negative patients.”6 According to Dr. Susan Love, this means that “women with early stage ER-negative tumors now have a prognosis nearly as good as that of women with ER-positive tumors.7

Breast cancer is a complex disease that, despite the years of awareness campaigns and discussions that occur each October, we still don’t fully understand. We don’t know how to prevent breast cancer and we don’t know how to prevent women from dying from it. We don’t need any more month-long conversations about pink ribbons and mammograms.  Our “awareness” of such things has been raised. We need a discourse that calls attention to the ways the larger context of environmental exposure, reproductive patterns, and economic realities might influence the pathology of breast cancer and the disease’s genetic markers.

Groups like BCA and NBCC are injecting these messages into NBCAM, working to call attention to all aspects of breast cancer and pointing to solutions and messages that benefit the lives of all women. They’re working to provide women with a more nuanced, critical, and complete breast cancer commentary.  It’s important work and I believe it’s helping to fray the ends of those cute pink ribbons that weave themselves around us during NBCAM. I recognize that complexity and real social problems are not as appealing as pink positivity, but as breast cancer advocates, we have a responsibility to continue pulling on the frayed ends of the pink ribbon to create a more complete conversation about the disease and the ways it affects women.
 
References

1. Breast Cancer Action, “Cancer Policy Perspective,” San Francisco, CA:  Breast Cancer Action, 2011.  Retrieved July 19, 2011 from http://bcaction.org/cancer-policy-perspective/

2. The National Cancer Institute, “SEER Stat Fact Sheets: Breast,” Bethesda, MD:  The National Cancer Institute, 2011.  Retrieved July 19, 2011 from http://seer.cancer.gov/statfacts/html/breast.html#incidence-mortality

3. Black Women’s Health Imperative, Moving Beyond Pink to End Breast Cancer Disparities:  Issue Brief, Washington, DC:  Black Women’s Health Imperative, 2010, p. 3.

4. National Breast Cancer Coalition, “Ending Breast Cancer: A Baseline Status Report,” Washington, DC: National Breast Cancer Coalition, 2011, p. 18.  Retrieved July 19, 2011from http://www.breastcancerdeadline2020.org/2020/assets/pdfs/2011-progress-report.pdf

5. Black Women’s Health Imperative, Moving Beyond Pink to End Breast Cancer Disparities:  Issue Brief, Washington, DC:  Black Women’s Health Imperative, 2010, p. 2.

6. Dr. Susan Love Research Foundation, “Populations of Interest / Triple Negative,” Santa Monica, CA:  Dr. Susan Love Research Foundation, no date. Retrieved July 19, 2011 from http://www.dslrf.org/endingbc/content.asp?L2=1&L3=1&SID=381

7. Dr. Susan Love Research Foundation, “Populations of Interest / Triple Negative,” Santa Monica, CA:  Dr. Susan Love Research Foundation, no date. Retrieved July 19, 2011 from http://www.dslrf.org/endingbc/content.asp?L2=1&L3=1&SID=381

Kira S. Jones was a NWHN intern in the spring of 2011. For the past five years, she has studied the breast cancer movement and worked with women’s health organizations across the country.  Her Master’s thesis, entitled, “In The Pink: The (Un)Healthy Complexion of National Breast Cancer Awareness Month,” was on breast cancer.