Turn on an NFL game this month and you’re likely to see linebackers sporting pink cleats and gloves. Buy groceries and you’ll have your choice of products–from yogurt to mushrooms–in pink packaging. There’s a pink KitchenAid “cook for the cure” mixer, pink office supplies, and a Smith & Wesson handgun with a pink grip, all tied to fundraising for breast cancer awareness or research.

Plenty of diseases and conditions have their own awareness campaigns, with dedicated months and colors. But none have been as ubiquitous in recent years as the breast cancer awareness movement, signified by the color pink and focused on the month of October.

pink stuff

Pink products: A KitchenAid mixer, a Jets cap, and a Smith and Wesson 9mm handgun with an awareness ribbon on the barrel

Why have breast cancer awareness messages become so common? The disease is among the most common forms of cancer and kills about 40,000 people a year in the U.S. But why have breast cancer awareness efforts become more prominent than those for heart disease, the leading cause of death for women and men? Or lung cancer, the deadliest cancer for both sexes?

“Pinktober,” as some have dubbed this month, evokes strong responses. Some see it as a welcome chance to educate women about a disease that was once rarely discussed, to support survivors and spread what they say are critical messages about screening.

“Almost everyone knows someone or has been touched by the disease in some way,” said Anne Morris, executive director of the Connecticut affiliate of Susan G. Komen for the Cure, a national breast cancer advocacy organization that focuses on education, screening, treatment and research. “If it’s not their grandmother, it’s their next door neighbor, or someone they grew up with.”

Others take a different view, seeing the proliferation of pink items as a way for companies to market to women in an appealing demographic group. Some see the messages associated with the campaigns as driven by industries that benefit from breast cancer screenings, delivering what they consider to be questionable messages about the value of screening while failing to make progress on curing the disease or preventing it in the first place.

“There’s a huge industry around breast cancer. Breast cancer is big business,” said Laura Nikolaides, director of research for the National Breast Cancer Coalition. “And unfortunately, from our position, all of the awareness and all of the resources that have gone into breast cancer have not gotten us a lot of success.”

“A unique impact”

Breast cancer is the most common cancer among women, and the third leading cause of cancer deaths in the U.S., after lung and prostate cancers. The National Cancer Institute estimates that 1 in 8 women will be diagnosed with breast cancer during their lifetimes.

And unlike some cancers, it has many survivors; in 2007, more than 2.5 million people who had been diagnosed with breast cancer were alive in the U.S., the most of any cancer. That includes more than a handful of celebrities who have raised the disease’s profile, and many woman who have gotten involved in raising awareness.

“I’ve been a volunteer for the American Cancer Society for 30 years, and I would say women with a breast cancer history have gotten involved in that organization in greater numbers and over a longer period of time than men and others with other diseases have,” said Dr. Andrew Salner, director of the Helen and Harry Gray Cancer Center at Hartford Hospital.

Salner said he’s been amazed this year by how many products have pink ribbons on them or labels indicating the company would donate money to breast cancer causes. He thinks the campaigns have caught on so strongly in part because breast cancer awareness efforts began earlier than those for other cancers, and because the disease has what he called a “unique impact.” Compared to other common cancers, breast cancer is more likely to occur at an earlier age, often in women who have multiple responsibilities–in the workplace, with their kids, in their communities–and whose diagnoses affect many people.

Among the other major cancers, lung cancer has fewer survivors–370,617 in 2007–and, Salner noted, carries a stigma, since it’s highly linked to tobacco use. Prostate cancer has had a growing advocacy effort, although it tends to affect older men. Colorectal cancer has gotten attention–Katie Couric famously had a colonoscopy on national television–but nothing like what breast cancer receives.

“There’s a little bit of reluctance to talk about colorectal cancer and early detection, just because it’s sort of an uncomfortable topic for people to talk about,” Salner said.

Morris noted that breast cancer was rarely spoken of 30 years ago. Campaigns since then have made people more comfortable doing so. “Some of the other diseases perhaps are still not there yet, and they should be,” she said, adding that men might not be as comfortable talking about prostate cancer.

But don’t expect breast cancer to continue to stand out among disease awareness campaigns for long, said Gary Schwitzer, publisher of the online HealthNewsReview.org.

“This has become a marketing person’s dream to wrap yourself in pink. It’s better than wrapping yourself in mom, apple pie and the flag because you are reaching a key demographic, women,” he said, adding that campaigns focused on screening and prevention presumably target healthy women.

Schwitzer expects other disease advocacy groups to catch on. Already, he noted, the American Heart Association has a campaign targeted at females, called “Go Red for Women,” and recently released a short film starring the actress Elizabeth Banks as a woman having a heart attack, even though a woman her age is likely at low risk for one.

“The other groups have admired the advocacy efforts and probably a lot of the pinkwashing that many people don’t find very admirable about breast cancer,” he said.

Enthusiasm, caution about screenings

At the heart of the disagreements between those who applaud the ubiquity of pink this month and those who are wary of it are differing views about screenings.

Unlike many conditions, breast cancer can be found early through mammograms, before a person develops symptoms.

“You actually can make a difference,” said Patrice Bedrosian, director of communications for the American Cancer Society’s New England Division.

Many of the major campaigns this month urge women to get screened, including the NFL’s “A Crucial Catch,” which began in 2009. Anna Isaacson, the NFL’s director of community affairs, noted that breast cancer has affected owners, players, coaches and fans; the idea for players to wear pink cleats came from running back DeAngelo Williams, whose mother had breast cancer.

The league wanted a targeted campaign that could make an impact, and worked with the American Cancer Society to develop it. “They really talked to us about early detection and the fact that women over 40 really weren’t getting the mammograms that they needed to get,” Isaacson said.

But in the push to get women screened, others see a problematic connection to industries that benefit from screening, and campaigns that ignore important cautions. They say women should be aware that screenings don’t always catch fast-moving cancers, and can pick up cancers that would never have been lethal, leading patients to get treatments with sometimes significant side effects.

Advocates for breast cancer screening–which can detect cancer before a person experiences symptoms–point to high five-year survival rates for women who get screened and diagnosed with early-stage breast cancer. That rate refers to people who live at least five years from the time the disease is found.

Critics point to mortality rates, which they say haven’t budged enough.

Nikolaides is among those who want the messages that go along with awareness efforts to change. The National Breast Cancer Coalition, where she works, advocates for research funding for the disease and set a deadline of Jan. 1, 2020 for ending breast cancer. It’s part of an effort to change the conversation, from what advocates say is too much of a focus on screening to preventing the disease and keeping it from metastasizing.

Nikolaides is grateful for the early stages of the breast cancer awareness movement, when women like Betty Ford spoke about a disease that was often hidden.

“I’ve heard people, their mother died of breast cancer and they didn’t know it was breast cancer for 20 years because people couldn’t talk about it,” she said. “When I had breast cancer four years ago, my kids could be very open and talk about it at school. They weren’t ashamed, and so I’m very thankful.”

The early campaigns also made women more likely to see a doctor if they noticed something different in their breasts.

“But I think back then, the message that went along with it was, ‘OK, we need to talk about breast cancer and you need to go get screened,’” Nikolaides said. “Now we know breast cancers aren’t all the same. You can’t find them all with a mammogram, and you find a lot of things that turn out not to have been lethal breast cancers.”

Arielle Levin Becker covered health care for The Connecticut Mirror. She previously worked for The Hartford Courant, most recently as its health reporter, and has also covered small towns, courts and education in Connecticut and New Jersey. She was a finalist in 2009 for the prestigious Livingston Award for Young Journalists, a recipient of a Knight Science Journalism Fellowship and the third-place winner in 2013 for an in-depth piece on caregivers from the National Association of Health Journalists. She is a 2004 graduate of Yale University.

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