The Wrong Kind of Awareness

In an ideal world, pinkwashing would be an amazing mechanism to bring about change. People can buy things they were already going to buy, but with the added bonus that a worthy cause will be getting a portion of the sales because the packaging is pink. Spoiler alert, it’s bad. The problem is two-fold: pinkwashing misleads the consumer in terms of how much money breast cancer charities are actually receiving, and the types of “awareness” these campaigns usually promote are not the most effective or necessary solutions.

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The second part of the problem is what kind of “awareness” pinkwashing fundraisers are often promoting. The nearly universal advice that’s given when it comes to “fighting” breast cancer is for women to get regular mammograms. A mammogram is an x-ray of the breast that is used to detect abnormalities in the breast tissue. Specifically, mammograms are use to detect tumors that are too small to be detected by touch or physical exams alone. The idea is that smaller tumors offer a better prognosis and are generally easier to treat, so tumors should be caught as early as possible. Women are generally encouraged to start having yearly mammograms once they turn 40, unless they are at a higher risk for breast cancer, in which case the recommendation is to start at age 30. Currently, over 37 million mammograms are preformed each year in the U.S.

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Recent studies, however, have found that regular mammograms have done nothing to lower the number of deaths from breast cancer. The largest American study regarding the effectiveness of breast cancer was published in 2014. It included over 40,00 participants and spanned 25 years. The women who participated in the study were randomly assigned to have either regular mammograms and breast exams, or just breast exams alone (a breast exam involves a doctor feeling the breast for tumors, without using imaging technology like mammograms). The results of the study showed that the breast cancer death rates between the two groups were the same, meaning there was no additional benefit for the women who had both mammograms and breast exams. A study done in Canada came to similar conclusions, saying that “annual mammography in women aged 40-59 does not reduce mortality from breast cancer beyond that of physical examination”.  While most researchers and medical experts are not yet ready to stop recommending mammograms altogether, the consensus is that the rational for such recommendations needs to be reexamined as the science is murky at beast.

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More so, these studies have found that early screening not only doesn’t lower the number of deaths from breast cancer, but it can actually cause more harm than good by leading to over diagnosis. Over diagnosis occurs when a tumor that will never grow or spread (and thus is not life-threatening) is found on a woman’s mammogram, but she receives cancer treatment for it anyways. The problem is that when a tumor shows up on a mammogram, there is no way for doctors to tell if that tumor will become life-threatening or not, so the woman receives cancer treatment regardless. While a “better safe than sorry” argument could be made here, women who are over diagnosed are put through months or even years of treatment, including chemotherapy, radiation, and surgeries that are useless and could be putting the woman’s health more at risk, not to mention the toll that takes on the woman’s mental health. The American study discussed above found that one in five cancers found on the mammograms ended up not being life threatening, but the women still received treatment.

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Equating breast cancer awareness with getting mammograms is also dangerous because it ignores systemic disparities in breast cancer treatment. Telling women to get mammograms is a great way of putting the responsibility on the individual person, even though different demographics of women are affected by breast cancer differently, regardless of how well they are able to take the situation into their own hands. According to the Breast Cancer Research Foundation, black women and white women are diagnosed with breast cancer at the same rates, but black women are more likely to die from the disease. More so, black women are more likely to be diagnosed with more aggressive forms of breast cancer, and to be diagnosed with cancer earlier in their lives than white women. The Centers for Disease Control and Prevention notes that breast cancer mortality among black women is a whopping 41% higher than that of white women.  According to Breast Cancer Action, Latina women are 20% more likely to die of breast cancer than white women. If breast cancer mortality and survival rates were at least comparable across races, advising women to get mammograms as a way to fight breast cancer could hold more water. But simply promoting mammograms as a way to combat breast cancer fails to address the systemic inequalities of breast cancer outcomes for women of color.

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Socioeconomic status is also at play here. Even if mammograms are as effective of a solution as pinkwashing campaigns make them out to be, mammograms, and all forms of healthcare, are significantly more accessible for some women than others. According to a 2015 study published by the National Institutes of Health, breast cancer mortality was significantly lower in women with a higher SES, as in women with more money were less likely to die of breast cancer as compared to poorer women. The NIH also found that women of higher SES are more likely to have access to mammography screening and other preventative healthcare measures, meaning their breast cancer was more likely to be found and detected. It’s not surprising that given how the U.S. handles healthcare, richer women have more access to healthcare resources than poorer women. But this further complicates the argument that mammograms are the best means by which to fight breast cancer. If that was really the case, then pinkwashing campaigns should be focusing their efforts on making sure all women have access to mammograms, not just simply telling women they should get them.  

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Ok, let’s take a step to summarize all of that. Mammograms, as a whole, are not the problem. Plenty of women, my own mother included, have their breast cancer detected through mammograms, get treatment because of it, and are able to go on and lead happy and healthy and lives. The problem is that mammograms are not nearly as perfect of a solution as pinkwashed breast cancer fundraisers make them out to be, and women who are over diagnosed suffer as a result. Promoting mammograms as the solution also makes it seem as though individual responsibility is enough to stay breast cancer free, ignoring how women’s race and SES greatly impact their experiences with breast cancer. But “remember to get a mammogram” is a lot easier to slap on a tube of pink lipstick than “mammograms might help but can also lead to years of mental and physical trauma and if you’re a minority or poor you’re still a lot more likely to die than white women regardless of if you are even able to get a mammogram at all”.