Going beyond the pink ribbon

The October onslaught of pink is upon us. The color, and its meaning, have become almost as ubiquitous as pumpkin spice lattes and the impending debate about how early is too early for Christmas music. From the pink cleats and gloves adorning NFL players to the pink ribbons slapped onto any product that will allow it, we have become desensitized to the pink ribbon, once a symbol of hope, now easily dismissed. October is breast cancer awareness month. This push for awareness started in the 1990s as a way to bring breast cancer into the public eye. Often accompanied by campaigns around prevention and early detection, including mammograms and self-exams, these ribbons provided a beacon for those whose lives had been impacted or cut short by breast cancer.

I remember this indoctrination well. As an adolescent, not knowing many women with breast cancer, I found the concept frightening and foreign. I knew so little about this disease, but knew enough to fear it. As I grew older, concerns about this abstract illness escaped my mind; I had become an attorney for the aging and people living with disabilities, and was singularly focused on the pressing issues faced by my clients. I was placated by the omnipresent pinkitude of breast cancer. “Women with breast cancer are warriors!” shouted the pharmaceutical commercials and bumper stickers, and this message was even touted on bags of bird seed I occasionally purchased. This message conjured the image of a lone heroine, her cloak a swath of pink, victorious. These women are survivors; they have battled the beast and won.

It was not until I was diagnosed with breast cancer myself, in November 2017 at the ripe old age of 32, that I began to recognize the shortcomings of these awareness campaigns. What benefits were derived from a pink ribbon on a bag of bird seed? I grew sensitive to the language surrounding my breast cancer diagnosis. Suddenly, I heard myself described a warrior and I bristled. I was not a survivor. I was surviving, yes, for now, but my breast cancer had already metastasized, making it stage IV, terminal, incurable. I would never ride up on my gallant horse, throw back my cape, and, with the hoisting of my sword, declare my disease defeated. I had been conscripted to fight a battle I had never agreed to fight.

In conversation with many friends and family members, they often act as if I have lost my battle long before any white flags are raised. When we talk, the spread of my cancer is veiled in euphemism, referred to only as my “situation.” Others choose not to acknowledge it at all, the specter of death accompanying me far too uncomfortable to allow its presence be made known. But yet, the minute they see a pink ribbon, that lovely, feminine symbol of awareness and survival, the conversation softens. There is familiar ground in this representation of awareness, even if the awareness it provides is superficial. The pervasive nature of the pink ribbon serves as a euphemism in its own right, allowing the bearer to recognize this disease without pressing further into the nuances of the life following a breast cancer diagnosis, or the inequities in research funding and treatment — ironically, two issues in tremendous need of advocacy. I admit that I was guilty of this too: Prior to learning that I had breast cancer, I bore the pink ribbon as a talisman, believing it was sufficient not only to ward off cancer from my own body, but to serve as a lodestar, a blush-colored beacon signaling to others of my awareness.

Now, as I come to terms with my diagnosis, I recognize the intention, the limitations, and the opportunities conveyed in the pink ribbon. This archetype acts as a gathering point, a communal symbol of acknowledgment of the insidiousness of breast cancer. But rather than a landing point, the pink ribbon should further serve as a facilitator for both action and real understanding. The presentation of the pink ribbon has the opportunity to invite conversation about, for example, the lack of funding made available for metastatic disease, still one of the leading causes of death for women, as well as significant discrepancies for treatment options along the lines of race and economic status. According to METAvivor, an organization dedicated to funding metastatic breast cancer research, an estimated 2 to 5 percent of funding for breast cancer research is spent on metastatic breast cancer, despite the fact that 6 to 10 percent of breast cancer diagnoses are, like mine, metastatic at the time of diagnosis, and an additional approximately 30 percent of early-stage breast cancer diagnoses develop into metastatic disease. Further, the American Cancer Society reports that non-Hispanic black women are more likely to die of breast cancer at every age, and in 2015, breast cancer death rates were 39 percent higher in black women than in white women.

The symbol of the pink ribbon cannot stand alone to appropriately convey many of these issues. Some efforts have been made to raise awareness with, for example, a metastatic ribbon and a male breast cancer ribbon, but these efforts lack the influence and ubiquity of the pink ribbon. The diminished impact of the use of “awareness” ribbons in general has led to the creation of a movement within the breast cancer community calling for “research, not ribbons.” This movement calls for the departure from the ribbon in its entirety, proclaiming that, as a banner for true breast cancer awareness, the pink ribbon has failed. This movement seeks the eradication of the pink ribbon as a symbol of breast cancer, because the pink ribbon glosses over so many of the research and treatment inequities, as well as the still-staggering death rates from metastatic breast cancer.

In this light, the symbol of the pink ribbon has become meaningless. It no longer captures public attention in the intended manner, and it serves as punctuation, instead of the intended facilitation for deeper understanding, education, and community. Standing alone, the pink ribbon fails to recognize these issues, allowing the more frightening aspects of life with cancer to be swept aside. This does not have to be so; the pink ribbon is not static, and there is no reason that it cannot be reclaimed and repurposed to encompass a holistic presentation of the breast cancer experience as well as to further more equitable research and treatment agendas. We do not live in a post-cancer society, and therefore, we cannot avoid the presence of the pink ribbon. However, its continued existence allows us to encourage a broader and more nuanced understanding of breast cancer itself. If we are to continue to utilize this symbol, we cannot be satisfied with its provision of “awareness” as projected in most campaigns. We must push for breast cancer campaigns that create greater understanding of the experience of life with breast cancer, and work to eliminate the realities of inequities across both socio-economic classes and diagnostic stages.