Less 'sexy' cancers: A rather sickly pink
We're in the middle of Breast Cancer Awareness Month (as if you hadn't noticed). We must not let celebrities and stunts distract us from more deadly but less 'sexy' cancers, argues Chris Hiley
Wednesday 20 October 2010
It's that time of the year again. Throughout October our high streets are awash with pink products, the White House has even been lit up in the hue and there are hundreds of parties, dinners and events all in aid of Breast Cancer Awareness Month. No-one would disagree that there are too many women dying of breast cancer. But the way the story is told just now doesn't suit the problem.
Breast Cancer Awareness Month is selective, subjective, partial and ageist. There is so much missing from a designated 30-day awareness programme and – more than that – I question the whole idea of a "Month".
I speak with some authority – I have a good grasp of many medical areas, as well as a keen interest in the policy agenda in cancer. After training as a nurse I returned to education, gaining an MA in biological anthropology and a Ph.D. in cot death from Cambridge, before going on to receive a MSc in Science Communication from Imperial College, London. I then worked for many years in policy and research at The Prostate Cancer Charity. Cancer, its causes, treatment and the way it is perceived by the wider public is of great interest.
Every October we are bombarded with news and images of various celebrities hosting parties for Breast Cancer (in itself, a slightly odd concept). Last Thursday, Diddy – the rapper turned fashion mogul – held his first-ever pink party for breast cancer at a nightclub in Long Island. He usually has a white party, but wanted to show solidarity, which stopped just short of actually wearing pink himself. Liz Hurley, meanwhile – in her role as a spokeswoman for Estée Lauder, the company instrumental in launching the pink ribbon campaign – has been busy making appearances at department stores all over the world and lighting various buildings up pink. Glossy magazines are full of features about women who have survived breast cancer or women whose lives have been touched by the disease, alongside a shopping guide of all the pink products you can buy to raise money.
Awareness is fantastic, but this enormous blaze of publicity around breast cancer stops people thinking about women with other cancers and other diseases. They don't seem to be considered as important as women with breast cancer and I don't really understand why.
Across the population, breast cancer makes up four per cent of deaths in women. Therefore 96 per cent of women do not die of breast cancer, but will die of something else. Are we absolutely sure we have the balance right by having this whole month for breast cancer and the endless coverage it receives? The constant campaigns are also encouraging women to consider their breasts as an extreme source of danger, which is a bit bizarre when actually there are many other potential risks facing them.
I realise that Breast Cancer Awareness Month brings in a hell of a lot of money. Although it's difficult to put out an accurate figure because so many different charities and organisations work separately under the BCAM umbrella, one of the leading charities, Breakthrough Breast Cancer (and this is only one of a number) raises about £4million during Breast Cancer Awareness Month, nearly a quarter of their total fundraising income for the year and, while I appreciate it goes towards support, research and information, I still question whether this is the most appropriate model.
When I worked at the prostate cancer charity, trying to share messages of prostate cancer, we were always told to look towards the breast cancer lobby as a model of what we should aim for. As time went on I began to be concerned that breast cancer had such a significance. It should be remembered that breast cancer is not a solved problem, but it's become the template for how to try to raise money. The charities do not want to rank the disease they are raising money for against other diseases that women might get; it doesn't give an accurate portrayal of health risks and it ends up very unbalanced.
It doesn't strike me as a useful or helpful model for people who are trying to manage their health with any sense of rational proportion to be bombarded with information and marketing devices for one aspect of this disease. It's about trying to turn the volume down on the breast cancer issue to get some grip on how it all fits together in a more reasoned fashion.
Who exactly is Breast Cancer Awareness Month for? Is it for women who have the disease; to get involved in the month as a wonderful way to channel something good out of a terrible experience? If it's an awareness campaign, surely it should be directed at women who don't have breast cancer.
But then, women who don't have breast cancer also don't have lots of other cancers and lots of other health issues, so there is the danger of scaremongering with this wall-to-wall coverage of mastectomies, lumpectomies and so on.
It's to do with a complete lack of proportion. It's worth looking here at the salient facts.
Twelve thousand women die of breast cancer every year, yet lung cancer kills 15,000 women a year, but that receives a microscopic proportion of the attention. It seems to suggest that women with breast cancer are innocent victims, while women with lung cancer are blameworthy, because it carries with it the connection to smoking, with the unsaid idea that they might have brought it on themselves.
Lung cancer has a complete lack of public profile and the amount of research effort that goes in to tackling it is worrying low. Seven thousand women die of bowel cancer every year. It's not an insignificant figure, but where is the coverage of bowel cancer? Quite apart from the inherent perceived ugliness of bowels, lungs and other internal organs and the possibility that many of us don't quite understand what these organs do or how they function, there isn't an emotional pull towards the lung or the bladder like there is to the breast. Breasts are attractive and they are nurturing.
So everybody's terribly interested in them, but I suspect if a woman is told she has terminal cancer, is she really going to care whether it's breast cancer or liver cancer or bladder cancer? Why would it get more notice, except that we understand breasts in a very particular way; they are the symbol of femininity.
If you were to ask women: which do you fear more – breast cancer or heart disease – the majority would answer breast cancer, regardless of the fact that three times as many women die of heart disease than die of breast cancer each year in the UK. You would think there would be a bit more of an emotional attachment to the heart, which might translate into awareness drives and funds raised, but that isn't the case which, I suspect, is because women primarily think of it as a man's disease, even though it affects men and women very similarly.
Raised awareness beyond what is proportional brings another risk. Women over 50 are encouraged to go for breast screenings but recent research has questioned how much women benefit from these screenings. Obviously early detection can save lives, but there are some women whose lives may well be adversely affected because they'll have a medical procedure (be it lumpectomy or mastectomy) where perhaps they didn't need to have one. There is also a great deal of ambiguity around what is picked up in screening, particularly in the earlier stages – as scanning techniques become more sophisticated, they pick up rogue cells which may never develop into full cancer, or which are so slow-growing the patient may die of something else – even old age – before they become significant. Experts are concerned that mastectomies are often suggested when they are not totally necessary and this over-treatment can be dangerous.
Back with the pink brigade, I have to take issue with much of the media coverage, which I believe is ageist. The normal age distribution across cancer – in the most general sense – is that it is a disease of older people. That's ignoring the slightly unusual cancers which affect young people; those are a minority. Incidence begins to pick up in the early fifties and then is probably at its highest at around the age of 75. With breast cancer, the rise in incidence occurs slightly before other cancers, so it begins to go up at around 35 onwards. Still, the standard stat is that 80 per cent of women who develop breast cancer are over the age of 50.
Not that you'd realise this from the coverage, though. If you go through glossy magazine and newspaper features you will find they are full of young women telling their story and experiences of breast cancer. But surely the use of sexiness and youth to add value to a women's health issue is counter-productive.
Often, the celebrity supporters are girls in their 20s and 30s like Holly Willoughby and Martine McCutcheon, but these "role models" are nowhere near the likely age of people to get breast cancer.
The charities must use the resources available to them to get the media interested if this "Awareness Month" really is such a money-spinner, but why aren't they doing something radical and showing us the real victims of this disease?
Case studies are extremely important to communicate awareness, but if all we see are young women, we'll end up with this rather bizarre idea of where the weight of suffering is with breast cancer. I don't mean that these women are irrelevant, but what about the older women, who, as evidence suggests, don't recognise that they are at risk of breast cancer because it is viewed as a young woman's disease? It's as if once you're past child-bearing age, you begin to not count; you become invisible.
Then there are all these pink products on sale, which to the onlooker could be construed as a way to make cancer 'fun'. Cancer and glitter: it's absurd. Products as diverse as chocolate, batteries, lingerie and sunglasses are all sold to raise money for Breast Cancer Awareness Month and it results in positive PR for any number of individuals and companies who link their reputations or products to the cause.
Varying amounts go to the breast cancer charities, anything from five per cent of the profit to all of it. Organisation like Fashion Targets Breast Cancer claims to raise awareness, but what is awareness?
Awareness is risk reduction, symptom definition and knowing the numbers. How much of that is conveyed amongst all the glitter?
Next April is going to be the first Sceptics' Cancer Awareness Month, which has risen from the fact that I don't believe that the general public understand enough about cancer awareness.
My aim is to put realistic complexity back into awareness, along with educating older people at risk of cancers which don't benefit from being labelled as 'sexy'.
Of course, having an awareness of any health risk in hugely important and women should be as informed as they possibly can.
I just worry that for women, "breast cancer" has almost come to mean "cancer" and so loud is the volume coming from the breast cancer lobby that other potential health risks are not heard about.
I might get breast cancer. Or I might get heart disease. Or dementia.
But I've got no way of knowing that and nor does anyone else, so why is it that all I seem to hear about is breast cancer?
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