Is it time to rethink the pink?

October is Breast Cancer Awareness Month, and to the credit of those behind its promotion, it would be next to impossible not to have noticed. Pink is everywhere.

The National Cancer Institute spends more money on breast cancer research than on any other cancer, by a wide margin. On average, about $562 million goes towards breast cancer annually; at a distant second is prostate cancer, with $302 million.

Even my favorite minor league hockey team, the Texas Stars (affiliate of the Dallas Stars) will don pink jerseys for a game in October, then auction them off to benefit the movement.

The hype that goes into Breast Cancer Awareness Month and the federal money spent on research into the disease leads any rational person to ask some basic questions.

Is breast cancer the most commonly diagnosed cancer?

No. According to the most recent SEER statistics (used throughout this entry) more lung and prostate cancers are diagnosed each year in the US, although not by much:

• Lung cancer: 222,520
• Prostate cancer: 217,730
• Breast cancer: 207,090

Is it the most deadly of all cancers?

Using 5-year survival figures for advanced, metastatic disease as a measuring stick, the answer is No. Not even close:

• 5 year survival for metastatic pancreatic cancer: 1.9%
• 5 year survival for metastatic liver cancer: 2.5%
• 5 year survival for metastatic lung cancer: 3.5%
• 5 year survival for metastatic breast cancer: 23.4%
• 5 year survival for metastatic prostate cancer: 30.2%

[Meanwhile, on the other end of the spectrum is the poster boy for the potential success of cancer research, Hodgkins lymphoma, with a 5 year survival of 74.2%]

So breast cancer is not the most commonly diagnosed nor the deadliest of cancers. Still, it's estimated that about 40,000 women will die of breast cancer each year, compared to about 32,000 deaths from prostate cancer. However, prostate cancer has a higher rate of incidence. While 12% or 1 in 8 women will get the breast cancer diagnosis in their lifetime, 16% or about 1 in 6 men will get the prostate cancer diagnosis in theirs.

Are other cancers nationally recognized like breast cancer?

Yeah, kind of. But the campaigns pale in comparison. For instance, how many know when National Prostate Cancer Awareness Month is? The answer, thanks to a very recent presidential proclamation is September, which it shares, unofficially, with ovarian cancer, childhood cancers, leukemia, and lymphoma. It's odd that so many cancers are crammed into September. Breast cancer flies pretty much solo in October; the same goes for colorectal cancer (official) in March; lung and pancreatic cancers (both unofficial) share November, but the remaining months are fairly cancer-free. They have plenty of other disorders, for sure, but cancer, not so much.

Is breast cancer treatment tougher than other cancers?

That's subjective. However, surgery for prostate cancer often leaves men impotent and unable to have children. They also tend to suffer from temporary incontinence. Of course neither of these unfortunate treatment effects are visually evident; the same cannot be said about a mastectomy.

Are other cancers color-coded like breast cancer?

We know breast cancer's official color is pink.
What is the official color of prostate cancer? Blue, what else.
Pancreatic cancer uses Purple.
Lung cancer uses either pearl, white or 'clear'.
Liver cancer gets graphic by using Yellow
But colorectal cancer outdoes everyone by using Brown.

Then what's with the hype?

The essential question is why does breast cancer get so much more money than other cancers? Why is the month of October so co-opted by the color pink that some companies are guilty of 'pinkwashing'? If it's not the deadliest, or the most common, why?

I have a guess. It's a crude one. I think the reason breast cancer awareness has blown up into the biggest anti-cancer campaign in the country is simple:

We love boobs.

Men and women, all of us, we understand them, we glorify them, we remake them into a variety of cultural symbols. They have panache; they're tangible; their tremendous sex appeal practically lets them sell themselves. Online fundraisers like the Boobie-thon testify to the movement's charm and marketability.

The PR machine behind breast cancer awareness has a good playbook, but it has an even better client. What the fuck is a prostate anyway? It isn't sexy, that's for sure. And lungs? Lung cancer bears the stigma of smoking, meaning many people will never accept lung cancer as a disease that we should all rally against because, quietly, some are convinced that those who got it probably deserved it. This is a shameful attitude, but people are people.

Plus, let's be honest, even if it means being slightly sexist: to their endless credit, women are more vocal about their health and their health problems than men are. More power to 'em.

So is it all working?

If we learned anything from Nixon's war on cancer, it's that money can't buy a cure. Neither can awareness, especially if it's misguided or ill-informed, as in the case of say mammogram parties. The mammogram's ability to detect indolent or benign tumors that deserve no attention is on par with the mixed success of the PSA test in prostate cancer.

National Breast Cancer Awareness Month is over 25 years old. Is it responsible for the progress against breast cancer over the last 20 years? I think it can rightfully claim a fraction of the credit, but that doesn’t amount to much:

In 1991, 117 American women died of breast cancer each day.
In 2010, 110 die each day.

No one would dispute that saving the lives of 7 women every day is wonderful. It's just not what anyone can call progress, comparatively speaking. At that rate (and I realize this calculation is rather absurd) breast cancer will be wiped out in about three hundred years.

In sum, it is possible that National Breast Cancer Awareness Month—in its current form of pink fundraising frenzy, and under the primary sponsorship of a pharmaceutical company (AstraZeneca) that makes four drug therapies against breast cancer (anastrozole, fulvestrant, tamoxifen, and goserelin) and therefore entertains a mammoth conflict of interest—needs an overhaul.

Here it is, presented by the National Breast Cancer Coalition as part of their 2020 deadline to end breast cancer:

Sources

SEER (Surveillance Epidemiology and End Results) statistics
Think Before You Pink
The Boobie-thon
2010 National Health Observances, National Health Information Center, Office of Disease Prevention and Health Promotion, US Department of Health and Human Services, Washington DC.