During National Breast Cancer Awareness Month (NBCAM), and throughout the year, pink ribbons and products abound in supermarkets, shopping malls, magazines, newspapers, television shows, billboards, and work places with inspirational stories from pink ribbon culture to accompany them. The media-friendly interplay of pink femininity and cancer culture provides a light, entertaining, and at times comical depiction of the cause of breast cancer that some, including myself, find disturbing.
Like most everyone else spreading the pink, NBCAM has its own store for pink products. These include the typical t-shirts, pins, and tote bags. But, I was especially concerned about a public service announcement video on the official website. It uses clay animation of a talking pink ribbon with large lips and eyelashes. The ribbon, with a child-like voice, flies from one office cubicle to the next, first to tell an African American woman, and then a white woman, that “early detection saves lives…get a mammogram every year…Tell your friends!”
Go to the NBCAM website to view the Dancing Ribbon.
The animated ribbon makes breast cancer palatable, even laughable, while enforcing the role of mammography screening in solving the breast cancer problem. Pink kitsch produces visibility for the cause and offsets the lingering fear about breast cancer while encouraging individuals to support the cause through consumption and social networking. It’s like a pink pyramid scheme only instead of the individual networker benefiting sometimes exponentially from the transaction, corporations and wealthy nonprofits do.
In addition to the trivial depiction of the cause, the dancing ribbon makes light of a mammography controversy that has been ongoing publicly for a decade and among scientists for longer than that. Despite continued recommendations from the American Cancer Society (co-sponsor of NBCAM along with pharmaceutical company AstraZeneca), clinical trials have not shown that population screening provides adequate benefit. In a 2006 review of 7 clinical trials involving over half a million women that compared the effects of population screening on mortality, Gøtzsche and Nielsen found:
“For every 2000 women invited for screening throughout 10 years, one will have her life prolonged and 10 healthy women, who would not have been diagnosed if there had not been screening, will be treated unnecessarily.”
They concluded that screening decreased the risk of death by about 15 percent for women ages 50 to 69, while increasing the risk of overdiagnosis and overtreatment by about 30 percent. A recent study in Norway of 40,000 women showed a reduction in mortality due to screening of only 10 percent.
The data reviewed suggest that widespread population screening causes more harm than good, and that the benefit of mortality reduction that results for a minority of women is actually relatively small. Yet the limitations of mammography are hard to discuss since there is so much investment in population screening.
Certainly, some groups of women are at a higher risk of breast cancer and for them screening might make sense. Strong family history of the disease may warrant screening. Similarly, it is important to think about group differences. White women develop breast cancer on average over the age of 55, so screening at 50 provides a five-year window for a baseline. Yet African American women under age 45 have a greater incidence of breast cancer than white women in this age range, suggesting that this group of women may benefit from earlier screening. At this juncture, clinical trials have not focused on specific groups of women based on race or ethnicity. For men, the breast cancer incidence rate increased 0.9% between 1975 and 2006, but it had nothing to do with mammography.
What is clear is that population mammography screening has many flaws including high rates of false positives and false negatives, overdiagnosis, and overtreatment. A one size fits all approach to screening is ineffective and harmful to many. Dr. H. Gilbert Welch suggests that there is a growing understanding among doctors that instead of more screening, there should be a dialing down. Unfortunately, the dancing pink ribbon of NBCAM prefers that women jump on the pink bandwagon without seriously considering the risks, benefits, and limitations of this technology.