There are many ironies in our abiding cultural fascination with breast cancer – not least how we manage to be saturated with information about it, and yet still so ignorant of the knowledge we need to reduce our risk.
I’m probably fairly typical of an adult woman with, happily, no direct experience of the illness. Before Angelina Jolie’s calm revelations about her mastectomy last week, there were a few things I knew about breast cancer, and very many things I didn’t. I knew there was a breast cancer gene, but I didn’t know how to find out if I had it. I had never heard of ‘nipple delay’. I didn’t know that having a mastectomy could take three months, or that you could have one if you weren’t even ill.
Embarrassingly, I may have learned more in those 945 words by a Hollywood actor and all the surrounding commentary than I had in my previous three-odd decades – and at the end of it, I’m still not convinced I know how to check my breasts properly. (One study estimates one woman in three never examines her breasts – and that even those who do may not be doing it properly.)
It can hardly be that we don’t talk about it enough. Every October, the world is awash with pink. Online, you can buy pink ribbon teddy bears, perfume, curling tongs and Tic Tacs. In the US, you can even buy a breast cancer gun – a Smith and Wesson M&P9 JG, engraved with a pink ribbon on the slide and packaged with two pink grip inserts.
In 2010, in a move so rich with irony you’d need an antacid just thinking about it, Kentucky Fried Chicken launched its own special range of “Buckets for the Cure”, deep-fried chicken sold in themed pink buckets. If you’re so inclined, you can bake pink ribbon biscuits, fly a pink ribbon kite and even donate to the breast cancer cause while downloading pornography.
Now, when a corporation wants to declare itself to be pro-woman, it stamps a pink ribbon on its products, and proclaims that some, often minuscule, portion of the profits will go to breast cancer research – a process some activists call “pinkwashing”.
It wasn’t always like this. Twenty years ago, the pink ribbon was launched as a symbol of solidarity, and the activists who set out to raise awareness did so with two goals in mind. They wanted to increase funding for research, treatment and support, and they wanted women who had breast cancer to stop feeling embarrassed of having an illness that, until then, had been spoken about only in whispers.
In many respects, they succeeded. Breast cancer is no longer mired in shame, and many more cases are being detected and treated early. But somewhere over the last two decades, that little ribbon became repurposed for other, more nakedly commercial ends, as some of the world’s biggest commercial enterprises twigged that there is a ready market for anything emblazoned with it.
Today, despite the ubiquity of the pink ribbon and the best efforts of well-meaning organisations like the Irish Cancer Society to educate us, confusion about the disease still reigns. Many of us are happy to assume that if there's no breast cancer in our family, we're safe, when in reality only 5 to 10 per cent of cases are genetic. Few of us realise that even moderate activity can reduce your risk by 18 per cent, or that having babies younger offers protection. Fewer still appreciate that even one alcoholic drink a day increases our risk.
On one level, even commercially-driven awareness about breast cancer is better than no awareness at all. Awareness leads to increased early detection, although one Swedish study suggests screening may lead to “overdiagnosis”, especially in older women, picking up abnormalities which meet the definition of cancer, but will never progress in their lifetime. But awareness can help to reduce stigma and make those affected feel supported.
However, when it exists in a pink bubble, surrounded by euphemisms and feelgood slogans instead of facts, it can make people unnecessarily afraid. Several studies show that healthy women are likely to overestimate their risk of getting breast cancer by as much as eight times their actual risk. The average woman has about a 12 per cent lifetime risk of developing it. An American oncologist, Todd Tuttle, recently told the New York Times he believes we have reached the stage where there is too much awareness. “I’ve called it breast-cancer over-awareness. It’s everywhere. There are pink garbage trucks. Women are petrified.”
Double-edged sword
It can be a double-edged sword for those who have cancer, too. The pink ribbon industry is predicated on positivity, but faced with the reality of the disease, not everybody is able to be positive. The courageous Kerry teenager Donal Walsh was remarkable for his ability to remain upbeat in the face of devastating cancer diagnoses. But not all cancer sufferers are capable of that – nor should they feel obliged to be. Anger, sadness and fear are surely also valid and natural responses.
In her book, Smile or Die, Barbra Ehrenreich describes how alienated she felt by constant reminders to think positive after her diagnosis, and by the infantilising nature of so much breast cancer merchandise – all those pink teddy bears, balloons and lip glosses. She notes that recent studies have questioned the belief that a positive mental attitude can help your immune system fight cancer.
Angelina Jolie is right when she states that women should not be fearful so long as they have choices. Undoubtedly, faced with an 87 per cent risk, she made the right choice for her. But the rest of us should try to keep it in perspective – she was not a typical case.
With her revelation about her preventive mastectomy, Jolie has started a much-needed conversation that is thankfully free of the fuzzy euphemisms and bumper-sticker wisdom that characterise so much of the discussion. We should use this opportunity to have a grown-up, teddy bear-free, conversation about cancer.