A new breast cancer-awareness doc is too focused on conspiracies to grasp the real travesty of ‘pink think’.
What about my human rights, eh? I was the one who had to sit through a feature-length documentary, Pink Ribbons, Inc., at the Human Rights Watch Film Festival, a film which consisted mostly of wobbly women dressed in pink lycra catsuits jumping up and down and joyfully screaming ‘yee haw’. When they weren’t jumping about, the women were marching, jogging, skydiving or marketing cute teddy bears, balloons and that protean manifestation of breast-cancer awareness, the pink ribbon. Yes, folks, this is how they mark breast-cancer awareness month in North America and it’s not a pretty sight.
In the UK, it tends to be a little more restrained, genteel and dignified. But to me, breast-cancer awareness month has always been ‘Black October’. That’s the month when our breast clinics become overloaded with anxious young women who have been coerced into breast self-examination (BSE) and, as might be expected in women below the age of the menopause, have noticed some lumpiness in the top left-hand corner of their left breasts. BSE is a thoroughly bad idea and has long been condemned by the cognoscenti as causing more harm than good.
So who on Earth is responsible for this annual breast fest that Pink Ribbons, Inc. documents? Well, it is partly the cosmetic industry: Avon and Estée Lauder, aided and abetted by the foundation Susan G Komen for the Cure, or maybe the other way around. The centrepiece events are sponsored races for female runners dressed in pink t-shirts.
For the most part, the organisers are acting in good faith and the participants are well meaning, if naive. But golly gosh, Breast Cancer Awareness Month is an awfully good opportunity for product placement. At the merchandise booths around the start and finishing lines of the mini marathons or the ‘I’m walking backwards for breast cancer challenge’, you’ll find groceries, toys, fashion items, bling and even automobiles in shocking pink. The prices might be a little inflated, but the extra profit goes to breast-cancer research, so everyone is a winner, right? If you eat 12 cartons of some expensive, branded yoghurt and send the lids to somewhere, someone will donate a dime to the pink charity. If you shop using American Express during Breast Cancer Awareness Month, then a cent per item purchased will be donated to the cause. And what is that cause? Why, it’s the war against breast cancer.
Cut to the stage-four breast-cancer support groups, which we get to follow in Pink Ribbons, Inc. These scenes did contain genuine pathos. Here are groups of women getting together in the privacy of someone’s parlour because they have one thing in common: a diagnosis of stage-four disease. As one sufferer bitterly commented, ‘there ain’t no stage five’. All of them complained that they’d done everything right, had no family history of breast cancer, had checked and screened themselves with evangelical enthusiasm, ate five portions of fruit and veg a day, ran mini marathons, fought the good fight, and yet here they were knocking at death’s door.
Their anger and frustration were palpable and justified. They will not be one of the ‘survivors’, so somehow they will end up being judged and found wanting. So where, they ask, do the millions of pink dollars go to and why are women still dying of breast cancer?
Cut to talking heads. As a welcome break to the tyranny of pink joyfulness and optimism, Pink Ribbons, Inc. was punctuated by interviews with greyish, serious ‘experts’, including the odd apologist PR person from the cosmetic industry. All these grave faces, apart from the smooth Avon man, poured scorn on the failure of the pink-ribbon campaign and questioned how these millions of dollars were spent. I do, too. I can recall most of the important advances in the diagnosis and management of breast cancer in the past 40 years and they were mostly funded by the US National Cancer Institute and, more recently, the US Department of Defense, the UK Medical Research Council, Cancer Research UK and by the pharmaceutical industry worldwide. I cannot recall any examples of game-changing work being funded by the pink dollars. I could be wrong, though, and would be happy to stand corrected.
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The film should have stopped at this point. Instead, just as it was actually getting to the gist of the story, it offered us another conspiracy theory, another Michael Moore moment. There has been a 30 per cent increase in the incidence of breast cancer in the past 30 years and yet only five per cent of National Cancer Institute money goes to prevention research. The subject is certainly worthy of greater investigation but not for the reasons suggested in Pink Ribbons, Inc..
Apparently many cosmetic products contain carcinogens, so the whole affair, the film claims, is all about a cynical conspiracy of the hypocritical cosmetic industry to distract the gullible public from the real cause of the increase in incidence. I have little time for some of the claims made by the cosmetic industry, particularly for creams that are ‘clinically proven’ to increase the collagen content of the skin so that you stay looking younger for longer or, even worse, for those potions that supposedly get rid of ‘cellulite’. But to claim that cosmetics also cause breast cancer while tightening your booty is a bit too far fetched.
Cosmetics have always been with us, even from the time of Ancient Rome, so they can hardly account for the recent sudden surge in the incidence of breast cancer. We don’t have to look far for the real culprits; they are staring at us in the face. Now here we come to the delicious irony that from time to time makes life worth living: it’s Breast Cancer Awareness Campaigns themselves that are guilty of producing this pseudo-epidemic.
To ‘Think Pink’ means more screening mammograms at younger ages. More screening means more over-diagnosis and that means more mastectomies. Further data confirming this phenomenon, emerging from Harvard University, has just been published in the Annals of Internal Medicine and featured on the websites of the BBC and the Daily Telegraph.
If we stopped screening today, the incidence of breast cancer would fall at a stroke by about 25 per cent. That is the conspiracy.
I came across a report from the Wall Street Journal, published in January 2010. It states: ‘One of the largest breast-cancer awareness groups, Susan G Komen for the Cure…. turned to GE in October (Breast Cancer Awareness Month) when it lit the Great Pyramids pink to mark a major screening initiative in Egypt. Neither GE nor the Komen group would say how much the event cost. In 2007, GE sold limited-edition pink cameras to Home Shopping Network, which donated a portion of the sales to Komen. Imaging and film companies whose products go into mammography equipment have made pink DVD players, pink computer flash-drives and pink cellphones, a portion of whose sales raise money for Komen and other breast-cancer groups. In events at the Capitol, Komen for the Cure founder Nancy Brinker has praised GE’s digital mammography technology, and she received a public-service award from the company.’
Envoi: There is often a synchronicity of unrelated events in my life that add to my self-delusion that I am someone’s pawn in some grand eternal plan. At lunchtime on the same day of the premier of Pink Ribbons, Inc., I attended the first meeting of the panel given the task of rewriting the leaflet that will accompany future invitations for breast-cancer screening in the National Health Service. Amanda Ramirez, professor of liaison psychiatry at King’s College London, chairs this committee. It is independent of the one chaired by Professor Sir Michael Marmot that is currently reviewing the future of breast-cancer screening in the UK. Both will report to the Department of Health later this year.
If nothing else, our new information leaflet will describe the harms as well as benefits of screening in absolute rather than relative numbers. Faced with the knowledge that screening is associated with the over-diagnosis of cancer, many women will make the legitimate decision not to accept the invitation. I therefore prophesise that the incidence of breast cancer in this country will fall while that in the USA will continue to rise. To paraphrase the immortal words of Eartha Kitt: ‘A beauty spot may cost a lot, but pink I think is more expensive.’
Michael Baum worked for 30 years as a surgeon specialising in breast cancer, and is now professor emeritus of surgery at University College London. He is the author of Breast Beating: A Personal Odyssey in the Quest for an Understanding of Breast Cancer, the Meaning of Life and Other Easy Questions, published by Anshan. (Buy this book from Amazon(UK).)