Does all the pink stuff really help fight breast cancer?

We're bombarded with fundraisers and retail products sporting pink ribbons to raise money to "fight breast cancer." Do pink ribbon campaigns do any good, or are they mainly a way for corporations to fleece consumers by leveraging fear and sympathy? Where is all the money raised by pink ribbon campaigns going? - Jill Gatwood, Albuquerque

A lot of people are starting to wonder about this. It's not so much that consumer products companies are exploiting concerns about breast cancer to sell more yogurt or lipstick, although that's part of it. The real issue is that we don't have much to show for all the ribbons, runs, and billions of dollars spent on research. Instead we've built a vast breast cancer industry that generates lots of jobs, profits, and awareness, but so far nothing that will prevent breast cancer, and nothing that will reliably stop it besides the knife.

To give the run-for-a-cure crowd some credit, pink ribbon campaigns have been remarkably successful in what they set out to do, namely increase breast cancer awareness and funding for research. The color pink and pink ribbons have been used as symbols since the 1980s, initially by what's now called Susan G. Komen for the Cure, perhaps the best-known advocacy group.

The idea got a boost in 1992, when the Estee Lauder cosmetics company teamed up with Self magazine to create an awareness campaign symbolized by pink ribbons. Things took off from there, leading to what critics call "pinkwashing" during Breast Cancer Awareness Month every October, in which pink-ribboned products, events, and publicity come at you from all sides.

If it all seems a little chaotic, that's because it is. No single entity is in charge of all the pink ribbon campaigns. In contrast to Canada, where the pink ribbon symbol is controlled by the Canadian Breast Cancer Foundation, in the U.S. anyone can slap a pink ribbon on anything.

None of these stunts is necessarily a scam, and no doubt many are well intended. But they often involve considerable effort for decidedly modest results.

One often-cited example is Yoplait's program, in which the company donates ten cents to the Komen group for each beribboned yogurt lid mailed in. That's nice, but think about it: If you save 120 over the four-month campaign, you'll have to store and ship them, the postal service will have to transport them and Yoplait will have to count them, for a total donation of $12. You'd save yourself and everyone else a lot of trouble if you just sent a check.

Laborious though they may be, such schemes have generated plenty of money for breast cancer research. The Komen foundation has awarded $450 million since 1982, the Avon Breast Cancer Crusade $640 million since 1992, the Breast Cancer Research Foundation $250 million since 1993.

Federal funding has also increased dramatically. In 1990 the National Cancer Institute allotted $81 million to breast cancer research. In five years that amount had nearly quadrupled to $309 million, and in 2009 was $685 million.

It's unfair to say all that expenditure accomplished nothing. The NBCC notes that breast cancer killed 44,000 Americans in 1991, compared with 40,000 now-seemingly only a slight improvement. But that's deceptive, since the population has grown. NCI data shows the breast cancer death rate has fallen by roughly a third since 1990.

What hasn't appreciably improved is breast cancer incidence-that is, the number of women who contract the disease. Despite some improvement in the past decade, it remains about 25 percent higher than it was 30 years ago.

This has led pink ribbon skeptics to hint darkly about a conspiracy involving fund-raising groups, manufacturers of carcinogenic products, and drug companies, who contrive to keep the research focus on detection and treatment rather than prevention. That keeps the lucrative cancer business humming while deflecting attention from the underlying causes, namely carcinogens released into the environment.

Paranoid? Maybe. Still, a woman's lifetime risk of breast cancer has increased from one in 20 in 1940 to one in eight now. I've seen 70 percent of that increase reasonably attributed to longer life and better early detection. What accounts for the remaining 30 percent? Nobody really knows.



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