October Awareness: Breast Cancer Is Neither Pink Nor Pretty

For as far back as I can remember, there has always been something about October "awareness" and the whole pink ribbon extravaganza that has made me feel slightly on edge and—ok, I admit it—a little bit pissed off. But beyond recognizing the emerging commercialization of breast cancer in the nineties, I could never really understand why this is so. Of course, now that I am in remission for breast cancer, I am royally pissed, and for other reasons that have become all too painfully clear. But first, let me begin at the beginning.

Many years ago, when I was a post-doc, there was an annoying 20-something tech in our lab—picture a former sorority girl type, high drama and professionally immature, always looking to cut corners so she could leave work early, and so calorie-obsessed that you wanted, for the love of God (and carbohydrates), to take the her to the cafeteria for a real lunch. Anyway, each fall this young woman became fixated on special pink ribbon embossed aluminum lids that, in support of breast cancer awareness, adorned a popular brand of yogurt. She was quite insistent that everyone on our floor who ate this yogurt should bring her the pink ribbon lids so she could mail them to the company, which would donate money to a nationally recognized non-profit in exchange for each lid received. And adamant she was: I remember one morning racing around the lab, simultaneously setting up three different experiments, spending approximately five leisurely minutes shoveling down breakfast (i.e. yogurt), and then tossing the empty container during my sprint back to the lab bench. Before I could even finish gloving up and arranging my microtubes in their rack, there was the tech, over in the corner, rummaging through the wastebasket to retrieve the pink ribbon lid. Until today, I have never admitted that I was the person who committed this atrocity.

At the time, I thought it all seemed pretty pointless. I mean, don't get me wrong, I am all for funding breast cancer awareness and research, but in the back of my mind I couldn't help wonder why this company just didn't donate the money outright? That is, why did consumers have to trouble themselves to carefully remove those damn lids, wash them, and then find a stamp and then an envelope and then mail them to the company in order that they would donate? Now, I don't think this tech ever read much of anything, much less the fine print, but had she ventured there she would have learned that there was a maximum amount that this company was willing to give, an amount that seemed quite paltry considering the profit they probably made off of this particular product alone. Back then (circa 1998-2000) we were talking about $500,000. Chump change. Since the world is full of many others like this well meaning tech, it was pretty clear that the company would be receiving an inordinate number of lids, far surpassing that "needed" for their donation (do you hear the cha-ching, cha-ching of the cash registers?). So, back then it was the commercialization of breast cancer--by food companies and a few others in the quest for the almighty dollar--that launched the vague pissy-ness I began to feel about October "awareness". But overall I tended not to dwell on stuff like this (other than to deliberately start purchasing another brand of yogurt--you know, one without any pink gimmicky crap), so my pissy-ness was pretty well contained while I spent my time on science and…well, more science (for the non-scientists, this is the typical post-doc lifestyle; that is, time spent on extracurricular activities such as sleep, or outside interests such as friends or family, is done at the peril of not being good enough to one day land a real job--or at least that's the bullshit message far too many young scientists assimilate).

And so for about a decade, I remained tethered to my lab bench and every October I thought the commercial aspect of the “awareness” was pretty much it, the impetus for my pink ribbon aversion.

That is, until the year I was diagnosed.

This time, when the pink ribbon extravaganza arrived (and it seems to be a bit like Christmas—just as the red and green holiday items that once were prominently displayed by Thanksgiving are starting to appear right after Halloween, the pink that was once reserved for October starts creeping in a little earlier each year), I already was undergoing chemotherapy, having reached level II toxicity as early as my second treatment cycle, which caused a mental fog so thick that on many days I couldn’t keep track of my medication schedule, sometimes taking double doses and other times forgetting altogether the oral chemotherapy drug that was intended to bolster the infusion drugs. On top of this were the debilitating physical effects, including hands that became too blistered to pick up a fork or spoon to feed myself (not that it mattered all that much—I was far too nauseous most of the time to even contemplate eating) and feet so raw that there were days that I literally couldn’t take a step without collapsing in pain. There wasn’t much coherent thinking then, but I am certain that this is when a deep visceral repulsion started to develop, one that eventually replaced the comparatively mild aversion I had had in years past over the pink ribbons. I didn’t yet understand it, but I loathed those damn ubiquitous pink ribbons.

Have you ever seen someone who is undergoing chemotherapy, or radiation therapy, or recovering from a mastectomy? Let me tell you, there is a tremendous disconnect between pink and breast cancer. I learned quite early in my girlhood—as myself and countless others were indoctrinated into the world of Barbie, where the seeds of body image and self esteem issues took root alongside desire to reside in the Dreamhouse, to marry Ken, and to drive the pink Corvette—that pink represented all the things that would ensure a life lived happily ever after. In short, pink became indelibly imprinted with beauty…happiness… success. But cancer? Oh, no. Cancer is the antithesis of pink; cancer is horrifically un-beautiful. From the steriod-induced puffiness, the unsightly bald head and missing lashes and brows and blackened fragments of nails--to the sickly, sallow pallor of post-chemotherapy nausea, the ravages of chemically-induced menopause, and the disfiguring scars where there once was a breast (or two)--breast cancer is downright ugly. With every passing treatment, as my body weathered each gruesome change, I hated, yes hated, those damn pink ribbons. Everywhere I went, everywhere I looked, there was a reminder of the disease I had, and of what I was losing to it. From yogurt to test-driving BMWs, and to toasters, blenders and other assorted kitchen gadgets that my undomestic self cannot name, much less operate, there was no escape. There was even a retro looking pink toilet tissue that paradoxically did give me a moment of much needed comic relief when I pictured thousands of well intentioned supporters wiping “for the cure”.

But back on point, one of the hardest hitting reminders was that one of those losses was my femininity, a loss that was particularly difficult to process while surrounded by young women wearing tee-shirts reading "save the ta-tas" or ads for local bars announcing wet tee-shirt contests with proceeds earmarked for breast cancer "awareness". Even women (and to some extent men, too) wearing the simple unadorned pink ribbon or the occasional pink tie or scarf were hard to face; these people were healthy (or at least appeared so--I realize that some of them may have been cancer survivors), they had hair and they had unbutchered bodies (well, ok, maybe some of them had great plastic surgeons). But my point is that at the time, it still was another reminder of what I was and what I wasn't. And let's face it, I don't think there are many women who could get through breast cancer in our culture without taking a hit in the body image department. On top of the cancer, I had recently left a long term marriage, one in which for years I had believed myself to be unattractive and undesirable (philandering, sociopathic, porn-addicted husbands excel in shredding self-esteem in their wives), and with this as my starting point at diagnosis, there were many, just far too many days when my hatred turned inward, when I despised myself even more than the pink ribbons or the beautiful people wearing them.

Of course I did make it through chemotherapy and “Pinktober” as it is aptly called by those in the trenches, but there were rounds two (surgery), three (radiation) and four (more chemo) looming in the not so distant future. Because my tumors were so large, I underwent chemotherapy in hope of reducing their size, which in turn would decrease risk of potential damage to surrounding tissues (such as nerves) during the bilateral mastectomy. With each successive pre-surgical chemotherapy cycle (there were 8 total, spread out over the course of about six months), the tumors in my breast and lymph nodes became barely palpable, a result that gave my medical team and myself considerable optimism. The day after my surgery, which I had scheduled on December 30 (thinking that spending New Years eve bald, sick and alone would be depressing, so why not add a little surgical pain and some more body image crisis to the mix?), my surgeon visited my room with a glowing smile and told me that my response to chemotherapy was tremendous, with only a very small residual mass visible where there had once been a 5 centimeter+ tumor. And with much to celebrate, I tried my best to get the nurses on my floor to share the champagne that I was certain they had stashed somewhere out of view (I ended up settling for a vanilla ice cream and a narcotic induced bliss that carried me into one of the most restful sleeps I had had in very nearly a year).

But then came the post-surgical pathology report. Despite an absence of overtly visible cancer in my lymph nodes, all but two were found still to harbor “viable tumor” when they were examined microscopically. My optimism and celebration plummeted instantaneously and all I could think about, besides my two young children, was the mass email I had sent just days before, announcing the wondrous success of my treatments. I cried, not uncontrollably like I had during one of my chemo cycles, but rather with the quiet distress of a veteran, one who had studied the cancer literature so well that I should have been awarded an honorary doctorate to keep my real one company. And in this distressed state of mind, I went back home—alone—and crawled into the corner of the sofa, huddled beneath the soft blanket that a friend had lovingly given to me as part of a treatment survival kit. In attempt to ward off the inevitable depression and to let my shock dissipate (running was not an option so soon post-surgery), I logged on to Facebook, intending to distract myself by spending a couple of mindless hours perusing the holiday antics of my friends and racking up some points on Sorority Life (one of many popular Facebook-sponsored online games).

I still remember the riveting sickness in my gut when I opened the many messages in my inbox. The first one went like this:

"We are playing a game for Breast Cancer Awareness ...... write the color of your bra as your status, just the color, nothing else!! Copy this and pass it on to all girls ...... NO MEN!! This will be fun to see how it spreads, and we are leaving the men wondering why all females just have a color as their status!! Let's have fun!

There were at least five different versions of this message in my box, a “game” that had gone so viral that the mainstream media even picked up on it by the end of the week. As I sat there, with two raw slashes on my chest and three surgical drains hanging out of my body, filled with blood tinged fluid that seemed never to stop flowing, I felt a nausea like no other, one that surpassed anything I had felt during the not so distant days of chemotherapy. Finally, it was all starting to make some sense—the images of beautiful young women wearing pink, the “save the ta tas” merchandise and bumper stickers on cars and pick-up trucks (many driven by men), the wet tee-shirt contests, and the girlish giggling and titillation over public disclosure of one’s bra color—at the root of all this was the sexualization of breast cancer.

I don’t quite know when the pink campaign became co-opted in such a sexist fashion, but putting the pieces together unleashed a hurt in me that had me so revved up that I could not clearly articulate it when I tried to talk to two of my close friends later that evening. The many thoughts and emotions stemming from this were compounded by the fear and disappointment that I felt over the post-surgical path report. Save the ta-tas they say? How about saving some fucking lives? is what I wanted to scream. The more academic side of me also was busy deconstructing the viral Facebook “game” trying to comprehend why women were willingly participating in such a sexist activity and why no one but me seemed to object to being called “girls” who were going to leave the “men” wondering. And as for “awareness”, I’m pretty sure that there are very few women, at least in developed countries with access to healthcare, who don’t already know about the importance of breast self-exams or mammography. And for this theoretical minority of those who don’t know about routine screening, I just couldn’t figure out how peeking down one’s shirt to look at bra color would convey useful information.