Why other diseases deserve the breast cancer ‘pink ribbon’ treatment

It’s the end of October, which means that for the past month, pink ribbons have adorned store windows, we’ve been encouraged to “think pink,” and cutesy hashtags like #savethetatas and #pinktober popped up on Twitter and Insta like daisies. All are hallmarks of the annual event that is Breast Cancer Awareness Month.

The breast cancer awareness movement is probably one of the most successful marketing and awareness campaigns to exist. A 2019 study from Northwestern University found that relative to its “incidence and mortality rate,” breast cancer is the most well-funded cancer, with non-profits bringing in $460 million in fundraising in 2018. That’s absolutely a positive (and life-saving) thing—fundraising leads to new research, better technology, and better access to screening for underserved populations. But its success has also thrown into sharp relief the lack of attention and resources other diseases receive. How can we give those illnesses the breast cancer awareness “treatment,” so to speak?

To answer, it helps to look at a few specific factors unique to the breast cancer movement that have helped propel awareness—and fundraising—to stratospheric heights. One is that breast cancer is the second most common cancer in the U.S. for women, with one in eight women receiving a diagnosis in their lifetime. In 2017, the American Cancer Society (ACS) estimated that 252,000 women were diagnosed with invasive breast cancer and around 63,000 women were diagnosed with non-invasive (in situ) breast cancer. The second is that it has a high survival rate—per the ACS, 91 percent of women diagnosed with breast cancer will make it to the five-year mark; 86 percent, the 10-year mark. (It should be noted that those rates vary depending on an individual patient’s prognosis.)

That it’s so common, with such a large survivor pool, means that almost everyone knows someone who’s been impacted by breast cancer. Subsequently, “there’s a lot of awareness about breast cancer, there’s a tremendous amount of publicity every year in October, and there’s an emotional tinge to talking about breast cancer,” says J. Leonard Lichtenfeld, MD, the interim chief medical officer at the ACS. “Consequently, there’s a lot of fundraising that goes on surrounding that.”

It doesn’t hurt that breasts are ~*sexy*~. For better or for worse, they’re generally associated with femininity, and they’re everywhere—on billboards, TV, Twitter, in magazines, and blurred out on Instagram (#freethenipple). This might explain in part why people are generally much more comfortable talking about breast cancer than they are about, say, colon or anal cancer, says Kristine Blanche, MD, CEO of the Integrative Healing Center, and author of the forthcoming book The Prevention Plan: Protecting Yourself from the Perfect Storm in Your Health. “Breast cancer is easier to market,” she says. “No one wants to talk about the colon—it isn’t sexy.”

The breast cancer cause also has heavy hitters throwing their weight behind it, including the NFL, which until 2016 dedicated its “A Crucial Catch” initiative to going pink every October (in 2016, the organization announced that it would allow each team to choose its own cancers to support moving forward, Sports Illustrated reported). Numerous celebrities including Julia Louis-Dreyfus, Angelina Jolie, Christina Applegate, and Sheryl Crow have spoken about their experiences with the disease. At this point, breast cancer has a self-sustaining PR campaign.

But many others diseases don’t. Lung cancer is a perfect example, so let’s take a closer look as a case study. It’s less common than breast cancer—but it’s the number one cancer killer of men and women in the U.S., taking the lives of 20,000 more women per year than breast cancer. While overall lung cancer rates are dropping, a 2018 study found that rates are increasing in women under 35. So why doesn’t it get nearly the attention that breast cancer does?

For one, lung cancer is often thought of as something that only impacts smokers. That’s not true—an older study found that one out of every five women diagnosed with lung cancer has never smoked. (Pollution, second-hand smoke exposure, and exposure to asbestos may also contribute to lung cancer.) But stigmas linger, and a lot of people see lung cancer as something you bring on yourself, which impacts awareness efforts. Indeed, the Northwestern study mentioned earlier found that cancers “associated with stigmatized behaviors,” including lung cancer and liver cancer, are some of the least-funded. Lung cancer researcher and advocate Anne-Marie Baird told BBC Future in 2018 that she was once at a conference when someone asked her, “Why would you even bother researching that? They deserve it—and they’re all going to die anyway.” Can you imagine someone saying that about breast cancer research?

Then there’s the fact that the five-year survival rate for lung cancer is low, hovering around 18 percent, according to the American Lung Association. Treatments do improve every day, but because lung cancer is so hard to catch early (often, it’s asymptomatic; by the time you do experience symptoms, that likely means the cancer has spread to other organs and is almost impossible to treat, the American Lung Association reports), there’s been a feeling that until recently, “we couldn’t do anything about it anyway,” Dr. Lichtenfeld says. As a result, he says that even in the medical community there is a strong belief that not much progress has been made to fight the disease. “Unfortunately, there’s not a large natural constituency of people who are focused on lung cancer,” he adds.

Ovarian cancer suffers from some of the same problems: Known as the “silent” killer, the aggressive cancer is much less common than breast cancer, but it’s often not diagnosed until it’s spread to other organs. When caught early (before the cancer has spread beyond the ovaries), the five-year relative survival rate for ovarian cancer is 94 percent, but only about 20 percent of cases are discovered early. Once the cancer metastasizes, the five-year relative survival rate drops dramatically depending what form of ovarian cancer it is and how far it has spread to—as low as 30 percent, the American Cancer Society reports. As with lung cancer, there aren’t as many ovarian cancer survivors as there are breast cancer survivors to speak out about their experiences.

Fewer people sharing their experiences means fewer people raising awareness and connecting with the public—and public support plays a large role in how much money private charities and nonprofits bring in. “We [the American Cancer Society] fund a lot—we’re the largest nonprofit funder of cancer research in the country…but the amount of money we apply toward research is still very little compared to what the National Cancer Institute (NCI) and what the Department of Defense (DOD) supply toward cancer research,” says Dr. Lichtenfeld. Like many other organizations, those last two heavily favor breast cancer when it comes to funding—to the tune of $545 million (NCI) and $120 million (DOD) in 2017. Comparatively, the NCI put $320 million toward lung cancer research and $109 million toward ovarian cancer that same year.

Again, none of this is to say that we should stop funding breast cancer research. It’s a devastating disease that touches hundreds of thousands of people yearly. But so do other cancers—which is why they, too, deserve awareness and funding.

One way to help: Talk about them. In fact, Dr. Lichtenfeld says this is something that’s actually helped raise breast cancer’s profile. Nowadays, there’s not much of a taboo about sharing your breast cancer story, but that wasn’t the case back in the ’70s and ’80s. “Not so long ago, breast cancer was something that nobody talked about,” he says. “There was an element of—I hate to say ‘shame’ because that’s not the word—but maybe personal concern where if a woman had breast cancer, she didn’t want to publicize it. People really didn’t talk about it.”

Doctors didn’t really talk about it with their patients either, he says. Even as the research got better and the treatment options improved, it took a lot of effort to get doctors to move away from traditional procedures such as modified radical mastectomies (where your entire breast, nipple, and areola are removed), meaning women were having their breasts removed when they didn’t necessarily have to. Ultimately, there ended up being a push from organizations and researchers for doctors to talk more openly with their patients, and once that happened, more funding, research, and publicity followed.

Plus, Dr. Lichtenfeld says that as we learn more about how cancer develops from a “molecular genetic standpoint”—basically, how cancer operates at a cellular level—there may be less of a need to focus on certain cancers over others. Recent research has shown that while some characteristics of cancer are unique to certain organs, “more and more they’re going to become diseases where similar problems occur no matter where the cancer starts,” he adds. Not all the findings can currently be applied to every single cancer across the board, but it’s possible that in the future this knowledge can be used as a blueprint to better treat multiple kinds cancer simultaneously. Hopefully one day advocates, researchers, and doctors will no longer have to “compete” with one another for attention, time, and money—and simply focus on making people better.

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