Thursday, October 3, 2013

Cancer is Not Sexy

This is a guest post by friend of the blog, Maria, who you might remember from long discussions about Magic MikeShe excels at looking skeptical, if not mildly irritated at all times.  She loves history, feminism, and judging people. She can see Sarah Palin from her house.

It’s Breast Cancer Awareness month. With all the sweet shopping options out there, you probably already knew.

More than any other cancer, Breast Cancer comes with a built in feel-good campaign; with “save the ta-tas” bracelets and Thinking Pink and survivor walks, ways of coping that make us feel better in the face of an illness we still can’t control.

But let’s consider whether those ways of coping are doing us more harm in the long run, and distracting us from more effective ways of dealing with cancer. Is the way that we understand and treat cancer when it impacts females the best way we can do so?

For some time, the Susan G. Komen foundation has dominated the cultural conversation around breast cancer, and been the very successful face of “breast cancer awareness.” Lately, however, more and more people have been asking what “awareness” really means. It definitely can’t be said our culture is not already aware of breasts, or that they are not emphasized constantly in the media as a central part of what it means to be a woman. What do campaigns like “save our boobs” or covering every surface with Indigestion Barbie Pink really do, aside from reinforce the central importance that breasts play in traditional femininity? Being a woman with cancer means dealing with all kinds of challenges to what we are told it means to be a woman, from hair loss to infertility. Is attempting to make breast cancer prevention sexy (see: for one example) really the way to deal with the struggle for self-esteem and self-worth that cancer often brings?  The last thing someone who has undergone a mastectomy needs is another message telling her how central being sexually appealing is to her value in society.

Cancer is not sexy. Your hair and eyelashes falling out from chemotherapy is not sexy. Becoming infertile because of treatment, and not getting any information or support on how to preserve your eggs prior to treatment is not sexy.  Having your breast cut off is not sexy.  And that’s okay. Not every god damn thing has to be sexy.

Breast Cancer Awareness allows us to feel good, and empowered, while not actually dealing with the complexity and horror of breast cancer. It also owes its popularity to being uncontroversial and non-threatening (even people who otherwise ignore or work against women’s health are all for Breast Cancer Awareness, eager to support women when it asks nothing of them but slapping on a ribbon.) As Barbara Ehrenreich says, “In the post-feminist United States, issues like rape, domestic violence, and unwanted pregnancy seem to be too edgy for much public discussion, but breast cancer is all apple pie.”

When you, with good intentions, buy that pink kitchen aid or plastic water bottle with the pink ribbon symbol, what have you done, really? First of all, having good intentions doesn’t mean you are not inadvertently contributing to the problem. The American Cancer Society, for instance, holds “Look Good Feel Better” classes that give away makeup to help women deal with the impact of cancer on their femininity. But the makeup itself? It’s the kind you can buy at any Walgreens or department store today, which is another way of saying it contains known carcinogens.

Of your pink-hued purchase, 5% will go to Susan G. Komen, and out of the millions Komen raises every year, around 15% of that will go to research. By far the largest portion of Komen's budget (43%*) goes to "education and awareness."

So what are we being made aware of? Chiefly, the importance of early-detection in saving lives. But before we get to that, let’s talk about what kind of awareness is forced out of the all-pink conversation. When we make Breast Cancer Awareness the face of women’s cancer, we ignore all the other cancers that don’t just impact women, but do impact millions of women. If you are a woman with a non-female-specific cancer, you are going to find that there is less support available to you. There are (thankfully) no Save-The-Bile-Ducts bracelets, few Lymphoma Awareness t-shirts, and although you are a woman suffering from cancer, many resources and programs for women with cancer are only available to you if it’s in your breast.

And what about the men who are pushed out when breast cancer is exclusively feminized? Why doesn’t Komen use their influence to raise awareness of the fact that because black women have less access to healthcare generally, they are far more likely to die of breast cancer than white women?

And all of that doesn’t even cover the giant, flaming pink elephant in the room: whether or not early detection of breast cancer actually does anything at all to save lives.
[Image text: a Susan G. Komen ad that reads, "What's the key to surviving breast cancer? YOU. Get screened now."]

As it turns out, breast cancer is a lot more complicated than scientists used to think. They now believe there are at least 5 distinct kinds of breast cancer, all with different rates of growth and levels of aggression. The most aggressive kinds often will have spread long before they are visible on a mammogram, meaning more frequent screenings at earlier ages are not saving those women’s lives. According to the LA Times, “One of the reasons that mammography is a less effective tool in young women is that they have a higher rate of these aggressive tumors. Younger women also have breast tissue that is more sensitive to the carcinogenic effects of low-dose radiation. Calculations by a research team in Britain published in the British Journal of Cancer in 2005 suggest that it is possible for women to develop cancer because of the cumulative radiation from yearly mammograms starting at 40 or younger.”

According to Peggy Orenstein, also writing in the New York Times, “Mammograms, it turns out, are not so great at detecting the most lethal forms of disease — like triple negative — at a treatable phase. Aggressive tumors progress too quickly, often cropping up between mammograms. Even catching them ‘early,’ while they are still small, can be too late: they have already metastasized. That may explain why there has been no decrease in the incidence of metastatic cancer since the introduction of screening.”

At the same time, the increase in screenings at ever earlier ages means doctors are finding tumors that are in all likelihood very slow growing or may not even have the ability to spread, so there is little benefit from finding them early. Doctors are debating whether some of the diseases being found and aggressively treated should even be called cancer. Many doctors and scientists are concerned that the overdiagnosis of breast cancer is causing breast cancer patients to go through extremely painful treatment that would have turned out to be unnecessary if not found. The problem is scientists still have no way of knowing which cancers will turn out to be invasive and life-threatening, so they treat any detected cancer as a deadly one.

As Peggy Orenstein writes, “In one survey of randomized clinical trials involving 600,000 women around the world, for every 2,000 women screened annually over 10 years, one life is prolonged but 10 healthy women are given diagnoses of breast cancer and unnecessarily treated, often with therapies that themselves have life-threatening side effects. These therapies include radiation, chemotherapy, surgery, and hormones which can themselves cause cancer, as well as many other health issues.

Overall, according to the New York Times, a recent study found that “mammograms, combined with modern treatment, reduced the death rate by 10 percent, but the study data indicated that the effect of mammograms alone could be as low as 2 percent or even zero.”

Doctors and scientists are not saying that mammograms are useless, only that patients deserve to know the truth of the cost and benefits of mammograms. Instead of a blanket recommendation of mammograms for all women starting at 40 or earlier, mammograms should to be targeted toward those who are highest risk. Sloganeering that “early detection saves lives” and making breast cancer screenings the centerpiece of the war against breast cancer, as Komen does, is neither helpful nor honest. If Komen truly wants to help patients, they’ll raise awareness of how complicated breast cancer really is, instead of unfairly and impossibly placing the responsibility of surviving on women themselves. It is not pleasant to realize that we still don’t know what causes breast cancer, and that the best tool we have to combat it isn’t really that great. But breast cancer itself isn’t pleasant, and we need to stop pretending it is.

Komen and other breast cancer charities currently devote millions to ineffective “awareness-raising”, to softening and sexualizing breast cancer, but we’d all be better off if they’d instead funnel that money into research. If the priority is saving lives, then as unsexy as it is, we should be focusing on how to more effectively treat metastatic breast cancer, and figuring out how to prevent breast cancer in the first place.

Related Reading:
Angelina Jolie and the Patriarchal View on Breast Cancer

*This percentage was originally listed as 85% but has been updated with the corrected figure.

1 comment:

  1. You make so many good points. The whole 'think pink' juggernaut reached the UK some time ago. And I have to say that I feel so depressed whenever I go into my local Asda (Walmart) and am faced with stacks of biological soap powder, air freshener, cleaning preparations and so on - all tied up with the pink ribbon, because - as you say - a lot of these items contain known carcinogens. I would love to see them doing special promotions on cabbage and other natural foodstuffs known for their cancer-busting properties!


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