Sunday, December 23, 2012

Critique of the “Pinkificiation” of Breast Cancer – Justin Ragasa

1. Introduction
“Pinkification” of Breast Cancer
Overall cancer is the second leading cause of death in the United States with over 560 thousand deaths in 2009 (1). Of those cases, over 40 thousand were due to breast cancer (2). Because of this, breast cancer is one of the leading causes of cancer death. Breast cancer accounts for nearly 1 in 4 women that is diagnosed with cancer, making it the most common cancer in women. While women are more likely to develop breast cancer, men are also susceptible to this disease (2). Men are generally less likely to develop breast cancer, however it is estimated that 2150 men will be diagnosed and about 410 die from breast cancer every year (3).
Cancer is caused by a variety of factors. A large proportion of cancer deaths are attributed to lifestyle factors including tobacco and alcohol use, poor diet, and socioeconomic status (4). External factors including chemicals and radiation as well as internal factors such as hormones and genetics are other reasons for the cause of cancer. While most cancers affect adults and occur more frequently as people get older, anyone is at risk of getting cancer (5).
            In 1991, the Susan G. Komen Foundation started giving away Pink colored ribbons to symbolize breast cancer (6). The ribbon was given to survivors raise awareness of the existence of breast cancer. This allowed for a de-stigmatization of breast cancer and created an opportunity to open the lines of communication concerning the disease between everyone in society (7). For the foundation, the goal of the ribbon was to increase awareness and increase the funding given to breast cancer research (7).
            Because of this, the Pink ribbon soon became a symbol of breast cancer and breast cancer awareness. However, instead of symbolizing strength, survival, and courage, the ribbon represented support (7). The ribbon started to became a brand and companies started creating “pink” products with being part of the cure for breast cancer.
            This paper will look at how the “pinkification” of breast cancer makes society lose sight of the original cause, focuses on finding a cure instead of encouraging prevention, capitalizes on creating “pink” products that may cause breast cancer.
2. Critique of Intervention
2.1. Losing Site of Original Cause
Many women benefit from annual mammography screenings. The American Cancer Society and the National Cancer Institute recommend that women over the age of 40 go in for a mammogram yearly for early detection of breast cancer (8, 9). By getting a routine mammogram each year, doctors are able to detect if cancerous cells had developed. If identified early, the women would be able to take part in treatments or interventions to stop the spread of the disease to various parts of her body.
When the “Pink” movement started, women and activists had to fight to shed light on the problem of breast cancer (7). Women had struggled with simply getting the general public to acknowledge the existence of breast cancer.
            Soon breast cancer was becoming widely acknowledged by society and “Pink” was becoming more than just a symbol of breast cancer. The Susan G. Koman Breast Cancer Foundation was turning the prevalent disease into a brand. Instead of using older Public Health theories to increase the awareness of breast cancer, the foundation used advertising theory to spread the awareness. Even within its previous name, Susan G. Komen for the Cure, made it seem that the foundation was promising a cure. Though in the beginning of the movement, it may have started out that way.
            The reason “Pink” spread like wildfire is because the foundation carefully used advertising theory in promoting the brand. A company uses advertising theory by saying “our product will fulfill your deepest desires,” and this is exactly what the foundation did. The foundation tugged on the heartstrings of society showing that breast cancer can affect anyone. That the disease can affect not only you, but your mother, grandmother, cousins, and daughters as well. It allowed society to feel that the money you donate by purchasing a pink ribbon or wearing a pink shirt, will go directly to finding a cure for breast cancer.
However, because of this, many are losing sight to the dangers of breast cancer. The purchasing of “Pinkified” products does not directly encourage women to conduct a self-breast exam or to get a mammogram. Because of modern technology, women are able to get the results of a mammography more rapidly than before. However, since “Pinkified” products do not add additional information about mammography, woman may miss out on this information.
2.2 “For the Cure” instead of Prevention
The “Pinkificiation” of breast cancer by the Susan G. Komen Foundation and other organizations such as the Avon Foundation for Women have focused on finding a cure for the disease instead of trying to prevent the disease from happening. Countless studies have shown that prevention of a disease is more cost effective than trying to cure it. Despite the many findings, the focus of Pinkification is on breast cancer prevention compared to a cure.
By purchasing a product that is deemed “Pink” shows customers that they are contributing to a foundation to find a cure for cancer. Although previous studies have shown that a change small change in lifestyle can lower the risks of developing breast cancer, “Pink” foundations have not been advertising this.
There are many factors that contribute to the development of breast cancer. Fortunately, by making small some decisions in lifestyle, women can lower the risk of developing the disease. Physical activity and food intake, for example, are some things that many women can increase that is link with a lower risk of developing breast cancer (6). Thirty-three percent of adults do not participate in physical activity during their leisure time, despite recent study findings showing that physical activity is a protective factor for cancer (6). Additional studies have shown that obesity and lack of physical activity may lead to about 25-30% of major cancers including breast cancer (10). The “Pink” movement does not address this issue. The movement seems to be primarily concerned with just finding a cure for breast cancer instead of encouraging people to practice cancer prevention activities such as increasing physical activity or making small modifications in their diet.
            In addition to physical activity and food intake, participating in routine cancer screenings is another lifestyle modification that women can participate in to prevent breast cancer that the “Pink” movement fails to encourage. Mammography has played a very important role in the decrease in deaths due to breast cancer (11). While the number of women receiving mammograms has increased, what seems to have leveled off is the fact that women do not return for subsequent mammograms.  In addition, the number of women who report having had a mammogram in the past two years has remained the same since 2000 (11). Similar to physical activity and food intake, the “Pink” movement does not seem to address the importance of annual mammography screening that the American Cancer Society and National Cancer Institute recommend (8, 9).
With such a large amount of people supporting the “Pink” movement, it is unfortunate that the focus has been on solely finding a cure. If the movement were to incorporate the importance of prevention into its focus, it would not only lessen the amount of deaths due to breast cancer but also give many women a peace of mind.
2.3. What to Make Pink?
The “Pink” movement has become such a large and marketable brand, that many companies have started to create products in hopes of generating funds for breast cancer research. While companies had very good intentions when “pinkifying” certain products, some products that became pink were actually linked to the disease itself. Certain companies are even linked to terrible records on environmental pollution or other activities that are related to high cancer rates (12).
In 2010 the Susan G. Komen Breast Cancer Foundation partnered with the fast food chain Kentucky Fried Chicken Company (KFC) to create a “pink” bucket of chicken that would donate a portion of sales to finding a cure for breast cancer (13). The locations of the fast food chain are disproportionally located in communities with lower-socioeconomic status. These are neighborhoods and communities that also have a shortage of stores and restaurants with other healthy food options, such as grocery stores. With previous studies showing the an association between obesity and breast cancer, it is a shame that the Susan G. Komen Foundation partner up with KFC.
Moreover, having a pink product in in a fast food chain places the responsibility of making a health decision on the consumer. A customer will then have to decide whether she wants to donate money to this foundation to help find a cure all the while she puts herself at risk of developing breast cancer by eating fried chicken. With the PhIP, a carcinogenic, levels in KFC chicken being high it is absurd to have customers donating money to find a cure while consuming this product (13).
Recently, 5-Hour Energy introduced a new flavor Pink Lemonade. The company joined the “Pink” movement to raise funds for the Avon Foundation for Women Breast Cancer Crusade (14). As with the partnership with KFC, the company is marketing a product that studies have shown to increase the chance of developing breast cancer (15, 16).
The studies show that women who consume a large amount of caffeine increase the chance of developing large tumors (15, 16). By promoting the energy drink to women, is similar to telling women to purchase the product to support your own disease.
In addition to the KFC buckets and 5-Hour Energy drinks, Yoplait joined the Pink movement by selling cups of yogurt with Pink lids. As with all the Pinkified products, a portion of the proceeds collected by the Yoplait went to raise money for breast cancer research. What was found in the pink-lidded yogurt was dairy stimulated with the rBGH hormone. Recombinant Bovine Growth Hormone (rBGH) is a hormone that is injected to cows to increase milk production (17). Studies have shown that the consumption of dairy with rBGH is associated with increased risk of breast cancer (18).
3. Intervention
Now that awareness of breast cancer is widespread since the movement began, it is crucial to encourage women (and men) to take a step forward and lessen the burden of dying from the disease. The Pinkification of breast cancer has already paved a road to reaching the population that is needed to make sure a new public health campaign on breast cancer will succeed. We need to open up lines of communication between women (and men) with their health care providers so that women can feel comfortable speaking with their doctors about health issues.
A new campaign will be created to increase not only the awareness of the existence of breast cancer, but also to promote and encourage breast cancer prevention. The new campaign will learn from the above critiques to have a more successful movement. First, it is important to remind society of the disease. It will steer away from the glitz and glamour of over the top pink products, and instead focus on what really matters, breast cancer prevention. Building on that, the campaign will not only focus on raising funds to find a cure for breast cancer, but it will encourage women to participate in annual mammography screenings. Finally, the campaign will encourage and empower women and men to become more aware of the products that they will be supporting for the cause.
3.1. Remind people about original cause
            In part to the Pinkification, or branding, of breast cancer, awareness about the disease has improved. Because of breast cancer has become its own brand we could use advertising theory to promote an increase in communication between a woman and her health care provider.
            The new intervention would use advertising theory to remind society of the original cause, to spread the awareness of breast cancer. Many studies have examined the risk factors associated with breast cancer. The findings from those studies can be used to increase the awareness and knowledge of the population on the disease. By incorporating advertising theory into the new intervention, a new promise will be created. The promise will no longer be “By purchasing our Pinkified product, your desires of having a cure for breast cancer will be fulfilled.” Instead, the promise will include “By purchasing our Pinkified product, there will be an increase in awareness and knowledge as well as a portion of the purchase will go towards finding a cure for breast cancer.
            Television advertisements would be used to re-promote the Pink brand. Instead of capturing the population with facts and statistics, videos of real breast cancer survivors, family members, and supporters would be used to share the importance of breast cancer awareness. The advertisements would be used to captivate the population to want to get out to their health care provider to receive their annual mammogram or to encourage the important women in their lives to receive their breast cancer screening.
3.2. Reframing to Prevention
            Because there is already a market for pink products, we could re-brand the Pink movement to not only finding a cure for breast cancer, but for also encouraging the practice of annual mammography. Previous social theories have shown that the general population does not want to hear about health statistics and probabilities, which is where many public health interventions have failed.
            What really tugs at the heartstrings are experiences and stories from people that are familiar to them. In order to make a public health message effective at getting society to make a change in their lifestyle by getting a mammogram or increasing physical activity is by having someone share their experiences. We could put the many faces of breast cancer on the pinkified packaging of the products to show that breast cancer can affect anyone, transcending gender, race, income, social status. It can show that breast cancer does not skip out on certain people.
            In addition to having the faces of breast cancer, a series of quotes could be attached to the different products to encourage women to receive their annual mammograms or complete a self-breast examination. These quotes could come from many different women who has had her life affected by breast cancer. For example, attached to a picture of a mother could read a quote “I am getting a mammogram to make sure I am able to watch my children grow up.” Another example could be of a daughter with a quote saying “A mammogram early enough could have saved my mother’s life.”
            In addition to having pictures of breast cancer and quotes for encourage women to receive an annual mammography screening, this new intervention would address the issue of obesity’s link to breast cancer. Specifically on pink products that are related to food, the new intervention would have encouraging words towards exercise. By having the encouraging words, the amount of physical activity will increase and lower the risk of developing breast cancer.
3.3. Safe products
            Breast Cancer Action, an education and advocacy group, has been tracking the Pinkification of breast cancer. The organization has been striving to create a change in the social context of breast cancer. In 2002 Breast Cancer Action launched a project called Think Before You Pink to address the pinkification in the consumer market (6). Breast Cancer Action was responsible for starting the conversation about the controversy of the KFC pink buckets as well as the Yoplait pink-lidded yogurt.
            Having an intervention similar to the Think Before You Pink, or even in partnering with Breast Cancer Action, a new intervention could be used to encourage and empower women (and men) to stand up and take action of the products that are going though the pinkification process. This will give women a sense of control of the products that are going to be used in the movement. Women will be able to choose which, and what types of products will be used to promote the foundation.
            This will raise the awareness not only for products and activities that are related to breast cancer, but it will also raise the awareness and give them the same power to control which products will be promoted for general health. The Breast Cancer Awareness campaign really empowered women to take action and write letters and sign an online petition to Yoplait to not have yogurt that contained dairy from cows that had the rGBH hormone (13).
4. Conclusion
            In conclusion, many public health campaigns and interventions have not been as successful because of the following of traditional public health models. While these models have been successful in early public health interventions such as making a decision to become vaccinated, their applications to many of the current public health issues does not seem to work.
            In order for this proposed public health intervention and campaign to work, other models and theories need to be used. Future public health campaigns such as the one proposed here should focus on the use of advertising theory to pull at the heartstrings of the community instead of bombarding them with statistics and facts. There are many breast cancer survivors and warriors that have stories of survivorship and the battle that they had to go though. Going back to framing the issue as not one of finding a cure, but rather to encourage prevention though annual mammograms. Finally, it is important to encourage the community to take a stand and be conscious of the products that some of their favorite companies produce. By creating public health campaigns that use theories and models developed by the social sciences, we can encourage change the landscape of breast cancer.

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