My Breast Cancer Story Part 12: Cancer Controversies - Battle Terminology, Pinkwashing & Benefits of Screening

Since being diagnosed with breast cancer in November 2020, I’ve don a ton of reading and come across some interesting cancer controversies that I didn’t know much about before: battle terminology, pinkwashing and whether or not early detection saves lives. Since I’m no expert I’ll just share the broad strokes of each, along with my take, and links to further reading if you want to learn more.

1. “Battle” terminology

“She’s battling cancer.”

“He lost his fight with the disease.”

We often hear (and use) this sort of war terminology when talking about people going through cancer, and I’ve learned that some take issue with it as it implies that patients have control of this disease, and if only they would stay strong and fight harder they could “win”. This is, of course, inaccurate because no matter what we do, science has shown a randomness when it comes to cancer which is out of anyone’s control. (“Living with cancer” is suggested as a preferable alternative.)

The battle terminology can actually be harmful. A study was conducted that showed “military metaphors resulted in healthy individuals rating cancer treatment as more challenging than when these treatments were described with journey metaphors, or no metaphors. These battle metaphors also resulted in people being more fatalistic.”

That said, some patients really identify with and take comfort in thinking of themselves as warriors, and it helps motivate them when they visualize winning their “battle” – which is certainly their prerogative.

My thoughts: From day one when I started sharing my experiences, I made a conscious decision to call it “My Breast Cancer Story“. I had already heard some of the criticism of the term “battle” and I thought “journey” sounded a bit cheesy (for me, not judging anyone else) but as a content creator I feel like I’ve always shared stories, so that word just seemed to encompass what I wanted to convey. I’m not at all bothered or offended if anyone uses that terminology with me, (many have said “You can beat this!”, etc.) however I also have an extremely hopeful prognosis. When speaking of others currently going through treatments I often say “patients” and I’ve used the term “survivor” before which I hear is also controversial because we never really know that we’ve survived cancer. As long as I’m alive, I think I’ll consider myself a survivor!

For more reading on this topic:

Words Matter: Why Cancer Isn’t a Game of Winners and Losers

Let’s Stop Talking About “Battling Cancer”

Battling, brave or victim: why the language of cancer matters

‘War on cancer’ metaphors may do harm, research shows

2. Pinkwashing

There are two parts to the pinkwashing (or pinkification) issue. One is (in a nutshell) that many companies go pink in October (Breast Cancer Awareness Month) with products and packaging (sometimes items that really aren’t all that cancer-friendly, like fried chicken) and often we have no idea what portion of the proceeds is going to support a cancer charity, or what charity is being supported. As well, many groups are calling for a move towards action (with funds being directed towards research and treatment) and away from “awareness”.

As the author states in the Why I Hate Pink October piece: “As far as I know, there might be a dozen adults in the US who still need to be made aware of breast cancer. Those limited numbers don’t seem to have stopped all the commercialization of the color and the disease. How is anyone helped by pink potato chips or pink toilet paper? In what way are we helped by NFL players sporting pink shoes? And, if you read the small print on the packages, maybe some money is being donated to a breast cancer research fund or charity. Or maybe not. And, if so, maybe it is a good organization. Or maybe not.”

A second angle to the pink controversy is that the colour itself is not seen as inclusive to all who may be faced with breast cancer. The author of What Breast Cancer Awareness Month & The Pink Ribbon Get Wrong says, “…the whole thing makes me grimace because it’s supposed to represent me, support me. And it doesn’t. It feels straight. And white. And feminine. All things I’m not.” While the symbol itself may alienate some, many people living with breast cancer also do not see themselves reflected in breast cancer-related media and advertising.

My thoughts: Certainly any company profiting from the pink needs to be completely transparent about how much money is going towards helping the cause, and what specific charities or organizations are benefiting from the funds. As a white, straight, cisgender woman who actually has quite a fondness for the colour pink, it’s easy for me to say the traditional ribbon doesn’t bother me, but I can absolutely acknowledge that there are inequities in the breast cancer world (as everywhere else) that need to be addressed, for example Black women having a lower incidence rate but higher mortality rate than white women. I also believe that many organizations have made a conscious shift to be more diverse in the past year, and this needs to be evident in materials for cancer patients like support guides, fundraising brochures and drug advertising. We need to see people with different skin colours, sizes, ages, abilities, hairstyles and headwear living with breast cancer, remembering of course that men can get it too.

For more reading on this topic:

Pinkification: How Breast Cancer Awareness Got Commodified For Profit

A Growing Disenchantment with October ‘Pinkification’

Why I Hate Pink October

What Breast Cancer Awareness Month & The Pink Ribbon Get Wrong

3. Does early screening really save lives?

My cancer was found because I did a self-exam…indirectly. I found a lump, but the mammogram and ultrasound I was sent for determined that it was benign. However, the same ultrasound showed a different spot, which turned out to be a 1.1 cm cancerous tumour. Was my life actually saved by finding it early? What if I had waited until the recommended mammogram at ago 50 (seven years later) – would it have grown or spread? Would I have felt it by myself by then? Would my treatment and prognosis have actually been any different? Who knows?

As I shared in an earlier post, current Canadian guidelines recommend that women younger than 50 who aren’t high risk for breast cancer do not need to do breast self-exams, have breast exams at their regular physical appointments, or begin mammogram screening (issues include false positives, over-diagnosis and over-treatment). Some studies suggest that older women who aren’t at risk shouldn’t even be screened regularly. Note that the controversy is around screening, which is different from mammograms being used when a lump has already been detected, and the studies and arguments typically refer to women who don’t have an elevated risk of the disease.

The community of women with metastatic breast cancer (their cancer has spread to the lungs, liver, brain or bones, sometimes years after the primary cancer was removed) understandably would like to see more education and funding go towards curing the later-stage disease as opposed to “awareness” (see section above) or getting women in for early screening which they feel may not actually impact the outcomes, especially when early stage breast cancer typically has a very positive prognosis.

For the purposes of this post I kept digging, and found varying medical viewpoints:

Early Detection Does Not Save Lives (cites 2014 study)

Mammography Screening is Harmful and Should Be Abandoned (2015)

Evidence Confirming Improved Survival With Screening Mammography (2020)

Routine Mammograms Do Save Lives: U of T Expert (2017)

I really like this one (very thorough and convincing), though admittedly there may be some confirmation bias at play for me, as my unexpert feeling is that regular mammograms are still a good idea:

Correcting a decade of negative news about mammography (2019)

My thoughts: I have no medical background to add anything of real value to this discussion. I will say that it makes me nervous to think my tumour could have been there seven more years (or longer) before my first routine mammogram, but as I mentioned earlier, maybe that wouldn’t have changed the size, treatment or outcome. And I certainly can’t argue with the women whose cancer has become incurable wanting to see more efforts to eradicate the disease in later stages, but it shouldn’t (in an ideal world) have to be an either/or situation.

If you made it to the end of this post – good for you! I know most people prefer reading about my personal story, but I also feel called to educate…so I hope you learned something, and I would love to hear what you think about any of these three issues!

I will end on a personal note though with this little Instagram post that you may have missed: