Hanging by a pink ribbon

I hate the mall. The only time I ever go is with my mom – and last week, since my mom was visiting from New Jersey, guess where we went? The mall. It occurs to me that you can take the girl outta Jersey, but you can’t take the Jersey outta the girl – especially when her mother’s in town.

So off to the mall we went. And when we got there, the first thing I noticed were all the pink ribbons. Pink ribbon signs, pink ribbon banners, even pink ribbon balloon sculptures. As it turns out, our local Race for the Cure was to be held that following Saturday, the day before Mother’s Day, and the Susan G. Komen Foundation was holding a race sign-up event and fundraising drive. Interestingly, there were quite a few stores that were holding Mother’s Day sales, several of which brandished the familiar pink ribbon logo on their Mother’s Day sale signs. It used to be that on Mother’s Day, you got carnations and breakfast in bed, I thought to myself as we walked through the mall. Now, you get a pink ribbon and a friendly reminder to get your mammogram.

And it isn’t just the mall. Many cities, including Philadelphia, Chicago, Minneapolis-St.Paul, and Pittsburgh, are holding Mother’s Day breast cancer walks and/or runs. The American Cancer Society is holding their “A Mammogram for Mother’s Day” campaign. And pink-stitched balls will be used at major league baseball fields throughout the country. Obviously, the link between Mother’s Day and breast cancer awareness has been firmly cemented – which, to me, seems a little odd.

Why? Because, compared to other groups, mothers aren’t the highest-risk group for breast cancer. Having a full-term pregnancy before age 30 significantly reduces cancer risk. Breastfeeding has also been shown to reduce breast cancer risk. If breast cancer awareness groups are looking to target women who are at a higher risk for breast cancer, they’re barking up the wrong tree by choosing Mother’s Day as their focus. Motherhood is actually a protective factor, not a risk factor.

So which groups are at higher risk?

Lesbian and bisexual women. According to a 2010 study published in the Journal of Women’s Health, lesbians are at higher risk for breast cancer, ovarian cancer, and endometrial cancer, compared to heterosexual women. Moreover, a 2012 study showed that women with same-sex partners have a greater risk of dying from breast cancer. Smoking and alcohol consumption, which some studies indicate are more common behaviors among lesbians, account for some of the heightened risk. According to some studies, lesbians tend, on the average, to weigh more than their heterosexual counterparts, and higher body weight is a risk factor for breast cancer. Women who are in relationships with women are less likely than married heterosexual women to have children, which also increases the risk. And numerous studies indicate that non-heterosexual women are less likely to seek health care due to a fear of a chilly health care climate – and studies show that, as a result,  a lower percentage of lesbians receive mammograms compared to other women.

Transgender men and women. To date, no prevalence studies have been conducted that assess the rates of breast cancer for transgender individuals. However, health care providers note that, for transgender women, being on long-term hormone therapy likely increases the risk of breast cancer, and for transgender men, the body converts excessive testosterone into estrogen, which elevates the risk of breast cancer. Moreover, transgender men are less likely to engage in breast self-examination, and they may not realize that top surgery does not remove all breast tissue.

African-American women. Although African-American women have lower rates of breast cancer compared to White women, their risk of dying from the disease is 38 percent higher, according to statistics from the National Cancer Institute. A 2010 study conducted by Cheryl Fields indicated that African-American lesbians and bisexual women may be at even heightened risk, given their multiple minority status and associated barriers to health care. Moreover, African-American women are at a higher risk for triple-negative breast cancer, in which the tumor is estrogen receptor-negative, progesterone receptor negative, and HER-2 (human epidermal growth factor 2) negative. Triple-negative breast cancer tends to be a very aggressive disease, with high mortality rates.

Latina women. Like African-American women, Latina women are at heightened risk for triple-negative breast cancer. In addition, although Latina women have a lower risk of breast cancer compared to White women, they tend to get diagnosed at the later stages of the disease.

Asian-American women. Oddly enough, for Asian American women, acculturation seems to be a risk factor: immigrants to the United States have a lower risk of breast cancer than Asian-American women who have lived in this country for many years. Women who are native Hawaiian and Samoan have even higher rates of breast cancer than White women.

Native American/Indigenous women. Compared to other ethnic groups, Native women have very low rates of breast cancer – but their mortality rates rank among the highest. Women who live in Alaska have the highest rates, whereas rates of breast cancer among Native women in the Southwest are much lower.

Ashkenazi Jewish women. Women of Ashkenazi Jewish descent seem to be at a higher risk for breast cancers that result from BRCA gene mutations. Genetic testing can determine whether a woman has a mutated form of the BRCA1 or BRCA2 gene.

Poor women. This almost goes without saying – obviously, if a woman lacks health insurance, doesn’t have access to preventative care, or faces other socioeconomic barriers, she will be at a higher risk for a range of illnesses and diseases, including but not limited to breast cancer. However, the Susan G. Komen Foundation and other cancer awareness groups don’t typically isolate this group as being high-risk – so I thought I would.

If you scan the list, I think it’s fair to say that being a member of a historically marginalized group is a significant risk factor. Note that many of these groups are not necessarily at a high risk for a breast cancer diagnosis – but they are at a high risk for breast cancer mortality. And note, too, that women in most of these groups, due their marginalized (or multiply marginalized) status, are more likely to be economically disadvantaged, which increases the breast cancer mortality risk dramatically. Given those realities, is a Mother’s Day breast cancer awareness event the most effective intervention?

I think not.

Instead, the Susan G. Komen Foundation ought to head over to LGBT Pride events and community centers, to transgender-specific events, to ethnic and cultural celebrations, to religious and spiritual centers, to food banks, to WIC offices, to community health centers that serve ethnically-specific populations. And merely spreading awareness isn’t enough – we need to address the numerous barriers to health care that these historically marginalized groups experience. Instead of pinkwashing our malls, streets, and ballfields with the familiar ribbon logo, let’s refocus our efforts and think about how we can truly reach all women.




Filed under health, intersectionality, psychological research, Uncategorized

5 responses to “Hanging by a pink ribbon

  1. I certainly don’t want to minimize the seriousness of cancer, but I think stores tend to use breast cancer awareness as more of a marketing ploy than anything else. I’m also skeptical about groups like Susan G Coleman because I hear quite a bit about them holding fundraisers and almost nothing about providing treatment or preventive services.

    • I agree with you. Peggy Orenstein wrote a great piece for the New York Times Magazine a couple of weeks ago called “Our Feel-Good War on Breast Cancer.” Her subtitle is: “Has raising awareness become more important than saving lives?” It’s an excellent article, and raises a lot of questions about the overall effectiveness of the “pink-ribbon” campaign.

  2. Gary Hollander

    I concur with the great data reporting you provide, Gayle. As a guy who follows all things health disparities, I am impressed by the breadth and depth of your list. As always, you do not disappoint. And eawachs skepticism about Komen’s vagueness about what they fund with the money they raise is understandable. The devil is in the detail.

    But what I want to offer as a white flag on behalf of Komen and other organizers of programs like this one is the sliver of the transtheoretical model or stages of change theory. In it, we learn that at any point in time we are not yet thinking of change, thinking of change, preparing to change, changing, maintaining, or lapsing into old behaviors. My thought about Mother’s Day as a focal point for breast cancern awareness is not that mothers per se are at greater risk, but that it is an easy day to remember and associate with some sort of maintained action. Can it be this is just a device to remember mammograms like daylight savings time is associated with changing smoke alarm batteries (at least it should be)?

    Mothers Day may not be the optimal day to select for this structure device to jog our memories, but as choices go it isn’t half bad. The vast majority of us have had mothers. The vast majority of them had breasts. As a public health device the day could work. But your points, all of them, are well taken.

    • Thanks, Gary, for your response. I have a couple of issues regarding the choice of Mother’s Day. First, as I mentioned in my blog, motherhood actually appears to be a protective factor (of course, some mothers do get breast cancer, but statistically speaking, having children and breastfeeding lowers the risk). While Mother’s Day targets a lot of women, there are many women who are not mothers – and they end up not getting targeted.

      My second issue comes from a feminist standpoint. I read an article yesterday (and I can’t for the life of me remember where it was) in which the author talked about how, even on Mother’s Day, women still have to be “motherly” and responsible. The meta-message that comes from the pink ribbon/Mother’s Day link is “be responsible and get a mammogram, so you’ll be around for your children.” If only Mother’s Day could be a day where women get to be REALLY selfish, and not worry about doing the responsible thing, or worry about taking care of others.

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