First Posted at Common Sense Family Doctor on 4/25/2013
“I used to believe that a mammogram saved my life,” begins breast cancer survivor Peggy Orenstein in a revelatory New York Times Magazine story that every woman (and man) should read before making personal decisions about screening for cancer. Although the ubiquitous spectacle of pink ribbons for “cancer awareness” has certainly raised breast cancer’s profile as disease, Orenstein raises serious concerns about whether these campaigns have been good for patients:
Before the pink ribbon, awareness as an end in itself was not the default goal for health-related causes. Now you’d be hard-pressed to find a major illness without a logo, a wearable ornament and a roster of consumer-product tie-ins. Heart disease has its red dress, testicular cancer its yellow bracelet. During “Movember” — a portmanteau of “mustache” and “November” — men are urged to grow their facial hair to “spark conversation and raise awareness” of prostate cancer (another illness for which early detection has led to large-scale overtreatment) and testicular cancer.
As I’ve blogged before, there are no easy victories in cancer screening and prevention. Physicians, researchers, politicians, and health advocates who exaggerate the benefits and minimize the harms of early detection of cancer with mammograms and other tests ultimately do patients a disservice. Orenstein makes this case on the personal and public health levels:
The idea that there could be one solution to breast cancer — screening, early detection, some universal cure — is certainly appealing. All of us — those who fear the disease, those who live with it, our friends and families, the corporations who swathe themselves in pink — wish it were true. Wearing a bracelet, sporting a ribbon, running a race or buying a pink blender expresses our hopes, and that feels good, even virtuous. But making a difference is more complicated than that.
It has been four decades since the former first lady Betty Ford went public with her breast-cancer diagnosis, shattering the stigma of the disease. It has been three decades since the founding of Komen. Two decades since the introduction of the pink ribbon. Yet all that well-meaning awareness has ultimately made women less conscious of the facts: obscuring the limits of screening, conflating risk with disease, compromising our decisions about health care, celebrating “cancer survivors” who may have never required treating. And ultimately, it has come at the expense of those whose lives are most at risk.