— Even as the economy implodes and the nation prepares for a historic election, America is flooded with the pink ribbons of Breast Cancer Awareness Month. During October, the ribbons are on yogurt containers, race cars, video game machines, foot callous scrapers, teddy bears, jewelry, cruise ships, cosmetics, department store gift cards — every conceivable product.
But behind the pink there is politics.
Some advocates for research into other diseases, and some scientists, worry the breast cancer movement is hogging the spotlight — and the money — at the expense of other worthy causes. Some within the breast cancer movement itself accuse advocacy organizations and corporate donors of “pink washing,” using a veneer of altruism to cover up practices these critics find objectionable.
In the world of cancer charities and government funding, breast cancer is queen. The top four breast cancer charities take in a combined annual revenue of roughly $256 million according to their tax returns. The largest breast cancer charity, Susan G. Komen for the Cure, had a total revenue of
$161,974,711 for the year ending March 31, 2007 according to its tax return.
The National Cancer Institute (NCI) devoted $572.4 million researching breast cancer in 2007. Other National Institutes of Health (NIH) funding for breast cancer boosted the total spent on the disease to $705 million. Plus, the Department of Defense operates its own breast cancer research outfit at a cost of another $138 million in fiscal 2008.
By way of comparison, in 2007 the NCI spent $226.9 million studying lung cancer, the leading cancer killer in the U.S., and $73.3 million studying pancreatic cancer, which kills nearly as many patients as breast cancer, usually within a year of diagnosis. Cardiovascular disease, the biggest killer of both men and women, received $381 million.
Downside to generous funding
Breast cancer is so generously funded partly because advocacy groups have powerful lobbying arms. Last year, Komen spent $724,073 lobbying legislators, almost double the amount from 2004, its tax returns show, while the National Breast Cancer Coalition (NBCC) spent $432,680 during 2006.
“Disease advocacy has become a well-recognized component of the funding landscape,” explains University of Pennsylvania bioethicist and msnbc.com contributor Art Caplan, “and breast cancer is the modern marvel everyone wants to emulate.”
As NCI lung cancer researcher Phillip A. Dennis pointed out in the journal Science in 2004, breast cancer received nine times the funding per death as lung cancer. “Important health issues such as diarrhea, influenza, and lung cancer may not be sexy, but they deserve the public’s attention and commitment from policymakers and the scientific community,” he wrote.
The downside is some diseases don't lend themselves to generous fundraising. "I don’t think you will see much in the way of a 10K run for urinary incontinence," says Caplan.
Breast cancer organizations have another advantage: many breast cancer patients live to become an army of walking, letter-writing, TV-appearing advocates. Nearly 90 percent of women with breast cancer survive the disease at least five years.
On the other hand, “pancreatic cancer patients are dead,” points out Barron Lerner, professor of medicine and public health at Columbia University, author of a book called "The Breast Cancer Wars."
Which helps explain the full-page ad in the Oct. 1 edition of the New York Times, the day Breast Cancer Awareness Month kicked off:
“odds of surviving airline crash: 25%
“odds of surviving pancreatic cancer: 4%”
The Lustgarten Foundation, the pancreatic cancer group that sponsored the ad, claims the timing was coincidence. But Lerner is skeptical. “It is a jab at breast cancer,” he says. “They are saying ‘Come on, guys. We want a seat at the table, too.’”
Unfair playing field
In the zero-sum game that is medical research funding, money given to one disease program is money that does not go to another.
“I have had people say to me ‘the playing field is just not fair,’” Caplan reports. “‘Breast cancer did so well, got there first, nailed down corporate support, got the tops of buildings turning pink, the walks, the runs, there is nothing left for us. We are envious.’”
The saturation of breast cancer awareness has left even some survivors dismayed. Writer, social critic, and former breast cancer patient Barbara Ehrenreich has called the movement “an outbreak of mass delusion,” and “a cult.”
“The products — teddy bears, pink-ribbon brooches, and so forth — serve as amulets and talismans, comforting the sufferer and providing visible evidence of faith,” she has written.
Such faith is not the best way to allot research dollars, argues Dr. Ann Flood, director of health policy studies at Dartmouth University. “It is certainly not rational by any means,” Flood, herself a breast cancer survivor, says. She believes breast cancer is worthy of generous funding, but “I do not think we should be doing it in this micromanaged way, which diseases we should study.”
Funding that is driven by public demand comes with risks. Just because a campaign is successful “does not mean science is at the point where it can do anything with the money that could fruitfully go someplace else,” says Caplan.
Caroline Wall, manager for marketing operations at Komen, dismisses such arguments. No amount of funding, she says, will “be enough until we find a cure for the disease.”
Not all breast cancer organizations agree. “I argue we do not need more money for breast cancer research,” says Barbara Brenner, a breast cancer survivor and the executive director of Breast Cancer Action (BCA), a San Francisco-based activist organization which has launched a Web site called thinkbeforeyoupink.org. Brenner argues that nobody knows just what all the money has purchased.
Making a correlation between the amount of money spent and medical advances made is virtually impossible, especially for cancer, experts say. The rate of breast cancer incidence has been rising over the decades, probably due to better detection, and the rate of breast cancer death has been slowly dropping. There is often great dispute about why, but most scientists agree it is likely a combination of new drugs, especially estrogen blockers like tamoxifen, and early detection. Since breast cancer, like many cancers, is really a constellation of different processes, there is not likely to be any such thing as “a cure.”
With no cure in sight despite billions spent on research, many activists like Brenner want more attention paid to breast cancer prevention — especially possible environmental factors — and closing the gap in treatment between social and racial groups. They also advocate more rigorous science backing up the supposed benefits of mammograms and new drugs under consideration for approval.
Komen makes no apologies for seeking corporate money. “It is a group effort to try and get the message out about breast health and breast cancer and there is no way we could do that without the support of corporate sponsors,” says Wall, noting that Komen distributes millions of dollars in research grants every year. It's that money that has helped turned breast cancer into a national cause and the envy of other disease fundraisers nationwide.