Breast cancer awareness

Breast cancer awareness is an effort to

Breast cancer advocacy and awareness efforts are a type of

Breast cancer awareness campaigns have been criticized for minimizing the risks of screening programs, conflicts of interest, and a narrow focus of research funding on screening and existing treatments at the expense of prevention and new treatments.

Marketing approaches

The goal of breast cancer

Generally speaking, breast cancer awareness campaigns have been highly effective in getting attention for the disease. Breast cancer receives significantly more media coverage than other prevalent cancers, such as prostate cancer.^[3]

Breast cancer as a brand

Breast cancer advocacy uses the

The establishment of the brand and the entrenchment of the breast cancer movement has been uniquely successful because no countermovement opposes the breast cancer movement or believes that breast cancer is desirable.^[6]

Pink ribbon

A pink ribbon is a

Each year, the month of October is recognized as

Various landmarks are illuminated in pink lights as a visible reminder of breast cancer, and public events, such as American football games, may use pink equipment or supplies.^[19][20][21] In 2010, all King Features Syndicate comic strips on one Sunday were printed in shades of red and pink, with a pink ribbon logo appearing prominently in one panel.^[22]

Private companies may arrange a "pink day", in which employees wear pink clothes in support of breast cancer patients, or pay for the privilege of a relaxed dress code, such as Lee National Denim Day.^[23] Some events are directed at people in specific communities, such as the Global Pink Hijab Day, which was started in America to encourage appropriate medical care and reduce the stigma of breast cancer among Muslim women, and Male Breast Cancer Awareness Week, which some organizations highlight during the third week of October. Most events are well-received, but some, like the unauthorized painting of the Pink Bridge in Huntington, West Virginia, are controversial.

Many cancer survivors find that BCAM is an emotionally difficult time, as it reminds them of a distressing time and because the cheerful marketing images do not match their experiences.^[24]

Companies and consumers

Thousands of breast cancer-themed products are developed and sold each year.

Business marketing campaigns, particularly sales promotions for products that increase pollution or have been linked to the development of breast cancer, such as alcohol, high-fat foods, some pesticides, or the

Some corporate sponsors are criticized for having a conflict of interest. For example, some of the prominent sponsors of these advertisements include businesses that sell the expensive equipment needed to perform screening mammography; an increase in the number of women seeking mammograms means an increase in their sales, which has led critics to say that their sponsorship is not a voluntary act of charity, but an effort to increase sales.^[44] The regulated drug and medical device industry uses the color pink, positive images, and other themes of the pink ribbon culture in direct-to-consumer advertising to associate their breast cancer products with the fear, hope, and wholesome goodness of the breast cancer movement. This is particularly evident in advertisements designed to sell screening mammograms.^[45]

Social role of the woman with breast cancer

The marketing of breast cancer awareness allows people to incorporate support for awareness into their

The term she-ro, derived from hero, is used in discussions of breast cancer to refer to women who have been diagnosed with breast cancer, and sometimes to those who have survived breast cancer. The term describes an "idealized" patient who combines assertiveness, optimism, femininity and sexuality, despite the effects of treatment, and as a "paragon [who] uses a diagnosis of breast cancer as a catalyst for a personal transformation".^[47]

Sociologist Gayle Sulik analyzed the she-ro's social role and ascribes it qualities that include being an educated medical consumer with a brave, pleasant and optimistic public appearance and demeanor, who aggressively fights breast cancer through compliance with screening guidelines and "disciplined practice of 'breast health'". In America the she-ro is diagnosed early due to adherence to early screening recommendations, and, by definition, she survives her diagnosis and treatment.^[48] The role emphasizes the femininity and female gender role of the she-ro, offsetting the masculine characteristics of assertiveness, selfishness and "fighting" cancer by cultivating a feminine appearance and concern for others.^[49] During and after treatment, the she-ro regains her femininity by using breast reconstruction, prosthetic devices, wigs, cosmetics, and clothing to present an aesthetically appealing, upper-class, heterosexual feminine appearance and by maintaining relationships in which she can nurture other people.^[50] Following the proper feeling rules of the breast cancer culture is encouraged, including remaining optimistic of a full cure, rationalizing the selfishness of treatment as a temporary measure, and feeling guilty that it forces her to put her needs momentarily above the needs of others or due to her perceived inadequacy in caring for her family or other women with cancer.^[51] Also included in the role is a form of the have-it-all superwoman, cultivating a normal appearance and activity level and minimizing the disruption that breast cancer causes to people around her.^[52]

Consequences

The effort of maintaining the role of a she-ro can be stressful. The role encourages women with breast cancer to care for others rather than themselves. Some of them find this comforting, but it may lead to them feeling reluctant or unable to ask for the help they need or want, and this can lead to bitterness that their friends and family did not offer these services unbidden.^[53] The success of their efforts to look and act normally may paradoxically increase their dissatisfaction, as their apparent ability to handle it all discourages people from offering help.^[54]

The breast cancer culture celebrates women who display the attitude deemed correct, which implies that their continued survival is due to this positive attitude and fighting spirit. While cheerfulness, hope, and good social support can be advantageous to health outcomes, it cannot determine survival rates.^[55] Women who reject the she-ro model may find themselves socially isolated by the breast cancer support groups that are nominally supposed to help them. Support from "the sisterhood" favors the "passionately pink", and tends to overlook women whose response to being diagnosed with breast cancer is incompatible with the pink ribbon culture, because they feel angry, unhappy, or afraid.^[56]

The breast cancer culture is ill-equipped to deal with women who are dying or who have died,^[57] and their experiences may not be memorialized, validated or represented as part of the movement, instead being ignored or shunned as failures and as hope-destroying examples of reality. They may feel like treatment failure is a "dirty little secret" that others want to make invisible.^[58] Similarly, the culture is also ill-equipped to deal with the news that a previously hyped treatment or screening procedure has been determined to be ineffective, with women advocating for the acceptance and promotion of inexpedient activities and inefficient or even sometimes harmful drugs.^[59]

Breast cancer culture

Breast cancer culture, or pink ribbon culture, is the set of activities, attitudes, and values that surround and shape breast cancer in public. The dominant values are selflessness, cheerfulness, unity, and optimism. It is pro-doctor, pro-medicine, and pro-mammogram. Health care professionals are sources of information, but the rightness of their advice is not to be seriously questioned by women with breast cancer. Patients are not encouraged to ask where research money is going or if the research industry is making progress in finding the "cure".

Understood as a rite of passage, breast cancer resembles the initiation rites so exhaustively studied by Mircea Eliade: First there is the selection of the initiates—by age in the tribal situation, by mammogram or palpation here. Then come the requisite ordeals—scarification or circumcision within traditional cultures, surgery and chemotherapy for the cancer patient. Finally, the initiate emerges into a new and higher status—an adult and a warrior—or in the case of breast cancer, a "survivor".[65]

Mainstream pink ribbon culture has aspects that are trivializing, silencing, and

The breast cancer culture tells women with breast cancer that their participation in fundraising, social support of other women with breast cancer, and appearance at public events are critical activities that promote their own emotional recovery. Because of this message, some women begin to believe that refusing to raise money for breast cancer organizations or to become mentors for newly diagnosed women with breast cancer is an unhealthy response to breast cancer.[78]

Feminism and the breast cancer wars

The breast cancer wars were a series of conflicts between advocates and others about the causes, treatments, and societal responses to breast cancer.

Advocates for women's issues have said that breast cancer is special because of its status as a largely female disease, society's response to it is an ongoing indication of the status of women and the existence of sexism.^[81] Breast cancer activist Virginia Soffa wrote that "[a]s long as it is not a national priority, the breast cancer epidemic will remain a metaphor for how society treats women".^[82] Barbara Ehrenreich writes that, before the feminist movement "medicine was a solid patriarchy", and women with breast cancer were often treated as passive, dependent objects, incapable of making appropriate choices, whose role was to accept whatever treatment was decreed by the physicians and surgeons, who held all of the power.^[83] Because of sexism in education, female surgeons were far outnumbered by their male counterparts, and until the 1990s, when Susan Love of the University of California, Los Angeles Breast Center published Dr. Susan Love's Breast Book, the physicians who provided breast cancer treatments were generally men. Love said that some male physicians tended to impose their own values on women, such as recommending mastectomy to older women because, being past the age of child bearing and breastfeeding, they no longer "needed" their breasts.^[84] The women's health movement promoted mutual aid, self-help, networking, and an active, informed role in the patient's health care.^[85] Since the end of the breast cancer wars, feminists have again objected to the breast cancer culture's treatment of women with breast cancer as little girls who need to be obedient to authority figures, cooperative, pleasant and pretty.^[86]

Achievements of the breast cancer movement

Social progress

Breast cancer has been known to educated women and caregivers throughout history, but modesty and horror at the consequences of a largely untreatable disease made it a

The breast cancer movement has resulted in widespread acceptance of

Halsted radical mastectomy in favor of simple mastectomies and lumpectomies.^[94]

The breast cancer movement has supported practical, educational, emotional, and financial care for women with breast cancer. Support groups, individual counseling opportunities, and other resources are made available to patients.

Educational interventions using written material and brief one-to-one interaction about breast checking behaviour, breast cancer symptoms and age-related risk have the potential to increase breast cancer awareness in older women, over a sustained period of time.[95]

Increased resources for treatment and research

Supporting breast cancer detection and treatment was seen as a distinctively pro-woman stance popular among public official. This has resulted in better access to care. For example, in much of the United States, low-income women with breast cancer may qualify for taxpayer-funded health care benefits, such as screening mammography, biopsies, or treatment, while women with the same income, but another form of cancer or a medical condition other than cancer, do not.^[i]

Breast cancer advocates have successfully increased the amount of public money being spent on cancer research and shifted the research focus away from other diseases and towards breast cancer.^[96] Breast cancer advocates also raise millions of dollars for research into cures each year, although most of the funds they raise is spent on screening programs, education and treatment.^[97] Most breast cancer research is funded by government agencies.^[98]

The high level of awareness and organized political lobbying has resulted in a disproportionate level of funding and resources given to breast cancer research and care. Favoring breast cancer with disproportionate research may have the

unintended consequence of costing lives elsewhere.^[99] In 2001 UK MP Ian Gibson said, "The treatment has been skewed by the lobbying, there is no doubt about that. Breast cancer sufferers get better treatment in terms of bed spaces, facilities and doctors and nurses".^[100]

Risks of over-awareness

Causes of death among women: Breast cancer is the cause of death of 2% of women.
Source: WHO (2004)[ii]

  Deaths from

heart disease or stroke (32%)

  Deaths from other cancers

(10%)

  Other (56%)

Awareness has also led to increased anxiety for women. Early detection efforts result in overdiagnosis of precancerous and cancerous tumors that would never risk the woman's life (about one-third of breast cancers diagnosed through screening programs), and result in her being subjected to invasive and sometimes dangerous radiological and surgical procedures.[101]

In recent years, the definition of breast cancer has expanded to include non-invasive, non-cancerous conditions like

market size for breast cancer organizations, medical establishments, pharmaceutical manufacturers, and the makers of mammography equipment.^[103]

Women fear dying from breast cancer more than dying from

heart disease, even though, as of 2006, eleven times as many women died from heart disease and stroke as from breast cancer.^[104] According to cardiologist Lisa Rosenbaum, this may be because women "view heart disease as the consequence of having done something bad, whereas to get breast cancer is to have something bad happen to you".^[105]

An emphasis on educating women about lifestyle changes that may have a small impact on preventing breast cancer often makes women feel guilty if they do develop breast cancer. Some women decide that their own cancer resulted from poor diet, lack of exercise, or other modifiable lifestyle factor, even though most cases of breast cancer are due to non-controllable factors, like genetics or naturally occurring background radiation. Adopting such a belief may increase their sense of being

relationship with the patient.^[107]

Similarly, the emphasis on early detection results in many women wrongly blaming themselves if their cancer is not detected at an early stage.

The promotion of research to make screening programs find ever more cancers is also criticized. One-third of diagnosed breast cancers might recede on their own.[108] In addition to efficiently finding most deadly cancers, screening programs also find most non-life-threatening, asymptomatic breast cancers and pre-cancers, and miss some fast growing, aggressive, dangerous cancers. According to H. Gilbert Welch of the Dartmouth Institute for Health Policy and Clinical Practice, "I'm certainly not asking anyone to stop getting mammograms. I am asking my profession to tell women the truth about overdiagnosis".^[109] Welch said that research on screening mammography has taken the "brain-dead approach that says the best test is the one that finds the most cancers" rather than the one that finds dangerous cancers.^[110]

Clinicians have responded that they are unwilling to consider the possibility of leaving potential deadly cancers alone because it is "far-riskier" than the alternative. Eric Winer, director of the breast cancer program at Dana-Farber Cancer Institute in Boston, says, "I don't know anyone who offers women the option of doing nothing".^[111] Further complicating the issue of early diagnosis is the fact that it is currently impossible to distinguish malicious cancers from benign ones. Otis Brawley, a top official for the American Cancer Society, says that "even if we overdiagnose 1 in 5, we have numerous studies showing that by treating all these women, we save a bunch of lives". For instance, a 2011 Cochrane review showed a sample of mammogram screening programs resulted in a 15% reduction in mortality rate despite over-diagnosis, indicating that mammography programs save lives regardless of over-diagnosis.^[112]

Conflicts of interest in organizations

Some critics say that breast cancer awareness has transformed the disease into a market-driven industry of survivorship and corporate sales pitches.

captive companies that support and provide social capital to the breast cancer industry, including pharmaceutical companies, mammography equipment manufacturers, and pollution-causing industries, as well as large corporations, creating or exacerbating other problems.^[114]

For example,

automotive industry crisis of 2008–2010 because "It's part of our DNA now." Ford believes that the recipient of the funds, Susan G. Komen for the Cure, benefited because Ford helped it reach "people who might not have thought of this organization before or may be supporting other organizations".^[116]

However, the primary sponsors are part of the breast cancer industry, particularly cancer drug makers like AstraZeneca, Bristol-Myers Squibb, and Novartis. Because the national breast cancer organizations are dependent on

corporate sponsorships for survival, this situation may represent a conflict of interest that prevents these organizations from representing the needs of current and future people with breast cancer when those needs conflict with the profit-making motives of the corporate sponsors.^[117]

The structure of the breast cancer movement may allow large organizations to claim to be the voice of women with breast cancer, while simultaneously ignoring their desires.[118]

Some breast cancer organizations, such as Breast Cancer Action, refuse to accept funds from medical or other companies they disapprove of.^[119]

Environmental breast cancer movement

Most of the money raised by advocates is spent on increasing awareness, cancer screening, and existing treatments.^[120] Only a small fraction of the funds is spent on research, and less than 7% of the total research funding provided by breast cancer organizations goes to prevention.^[121] Instead, most of the charities fund research into detection and treatment.^[122] Advocates like Breast Cancer Action and women's health issues scholar Samantha King, whose book inspired the 2011 documentary Pink Ribbons, Inc., are unhappy that relatively little money or attention is devoted to identifying the non-genetic causes of breast cancer or to preventing breast cancer from occurring.^[123] The mainstream breast cancer culture has been criticized for focusing on detecting and curing existing breast cancer cases, rather than on preventing future cases.^[124]

As a result, screening mammography is promoted by the breast cancer culture as the sole possible approach to public health for breast cancer.^[125] Alternatives, such as pollution prevention, are largely ignored.^[126]

As the majority of women with breast cancer have no risk factors other than sex and age, the environmental breast cancer movement suspects pollution as a significant cause, possibly from pesticides, plastics, and industrial runoff in ground water.^[127] Large organizations, such as Susan G. Komen for the Cure and the American Cancer Society, are not part of the environmental breast cancer movement.^[128] These large organizations benefit the most from corporate sponsorships that critics deride as pinkwashing, e.g., polluting industries trying to buy public goodwill by publishing advertisements emblazoned with pink ribbons, rather than stopping their pollution under the precautionary principle.^[129]

The non-genetic factors with consistent evidence increasing breast cancer risk include "

estrogen–progestin hormone therapy, and greater postmenopausal weight. ... for many other factors, the evidence from human studies is more limited, contradictory, or absent" and called for additional research.^[130] Conducting research into whether a chemical causes cancer is difficult, because "suspect chemicals cannot ethically be given to people to see if they cause cancer. People exposed in the past can be studied, but information about the dose and timing may be sketchy. Animal studies can provide useful information, but do not always apply to humans. And people are often exposed to mixtures of chemicals that may interact in complex ways, with effects that may also vary depending on an individual's genetic makeup".^[131]

Samantha King says that prevention research is minimized by the breast cancer industry because there is no way to make money off of cases of breast cancer that do not happen, whereas a mammography imaging system that finds more possible cancers, or a "magic bullet" that kills confirmed cancers, would be highly profitable.[132]

Breast Cancer Action

Main article: Breast Cancer Action

Breast Cancer Action is an American grassroots education and advocacy organization that promotes breast cancer awareness and public health issues relating to breast cancer, and advocates for system-wide change based on prevention. Breast Cancer Action is also known for its Think Before You Pink campaign, launched in 2002, which encourages consumers to ask critical questions before buying pink ribbon products.^[133]

Dissent through art

While the pink ribbon culture is dominant, there are alternatives. The environmental breast cancer movement is one type of dissent. Another is the rejection of compliant optimism, aesthetic normalization, and social pleasingness that the pink ribbon culture promotes.^[134]

In 1998, the Art.Rage.Us art collective published a book that collected some of the art work from their traveling collection. This included art that was shocking, painful and realistic rather than beautiful, such as several self-portraits that showed mastectomy scars.^[135]

Another art form has a wider range: the

chaos narrative (the situation inexorably goes from bad to worse). The cure and quest narratives fit neatly with the breast cancer culture. Chaos narratives, which are rarer in stories about breast cancer, oppose it.^[136]

History

Breast cancer has been known since ancient times. With no reliable treatments, and with surgical outcomes often fatal, women tended to conceal the possibility of breast cancer as long as possible. With the dramatic improvement in survival rates at the end of the 19th century—the radical mastectomy promoted by William Stewart Halsted raised long-term survival rates from 10% to 50%—efforts to educate women about the importance of early detection and prompt action were begun.^[137]

Early campaigns included the "Women's Field Army", run by the American Society for the Control of Cancer (the forerunner of the American Cancer Society) during the 1930s and 1940s. Explicitly using a military metaphor, they promoted early detection and prompt medical intervention as every woman's duty in the war on cancer. In 1952, the first peer-to-peer support group, called Reach to Recovery, was formed. Later taken over by the American Cancer Society, it provided post-mastectomy, in-hospital visits from women who had survived breast cancer, who shared their own experiences, practical advice, and emotional support, but never medical information. This was the first program designed to promote restoration of a feminine appearance, e.g., through providing breast prostheses, as a goal.^[138]

Organizations

A wide variety of charitable organizations are involved in breast cancer awareness and support. These organizations do everything from providing practical support, to educating the public, to dispensing millions of dollars for research and treatment. Thousands of small breast cancer organizations exist. The largest and most prominent are:

• Susan G. Komen for the Cure: Komen is the largest and best funded organization, with highly visible fundraisers.
• National Breast Cancer Coalition: This large umbrella organization played key roles in several prominent pieces of American legislation, such as the creation of the United States Department of Defense's Breast Cancer Research Program, genetic non-discrimination laws, and the patients' bill of rights. They are committed to evidence-based medicine.
• Breast Cancer Action: Famous for its "Think Before You Pink" campaign against pinkwashing, BCA emphasizes the need for research into pollution as a cause of breast cancer.^[139] Like the National Women's Health Network, they refuse funding from any group that may have a conflict of interest, such as pharmaceutical companies, medical imaging companies, or pollution-causing industries.
• National Breast Cancer Organization: Closed in 2004. A dissenter to the notion of mandatory public unity, it provided
  case management
  and other services.

See also

• List of awareness ribbons
• List of health-related charity fundraisers
• Male breast cancer
• The Scar Project

Footnotes

1. diabetes mellitus, or lung cancer, the income limit is 185% of FPIG Archived 1 February 2011 at the Wayback Machine
2. ^ Grouped by cause World Health Organization 2004, p. 120

References

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2. ^ ^{a b} Sulik 2010, pp. 157–210
3. ^ Arnst 2007
4. ^ Sulik 2010, p. 22; King 2006, p. 38
5. ^ Sulik 2010, pp. 133–146
6. ^ King 2006, p. 111
7. ^ Moore 2008, p. 43, 65
8. ^ Sulik 2010, pp. 359–361
9. ^ Landman 2008
10. ^ Borrelli 2010
11. ^ Sulik 2010, pp. 365–366
12. ^ Sulik 2010, pp. 372–374
13. ^ Sulik 2010, pp. 48, 370
14. ^ King 2006, p. xxi
15. ^ Ehrenreich 2001
16. ^ Sulik 2010, p. 56
17. ^ King 2006, pp. 46–49
18. ^ Ehrenreich 2001
19. ^ Elliott 2009
20. ^ King 2006, p. xx
21. ^ King 2006, p. 15–18
22. ^ Gustines 2010
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41. ^ Sulik 2010, pp. 369–372
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43. ^ King 2006, pp. 110–111
44. ^ King 2006, p. 37
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46. ^ Sulik 2010, p. 125–145
47. ^ Zuger 2010
48. ^ Sulik 2010, pp. 158, 243
49. ^ Sulik 2010, pp. 78–89
50. ^ Sulik 2010, pp. 42, 101–105, 374
51. ^ Sulik 2010, pp. 225–272, 277
52. ^ Sulik 2010, pp. 279–301
53. ^ Sulik 2010, pp. 279–301
54. ^ Sulik 2010, pp. 283, 286
55. ^ Sulik 2010, pp. 243–244
56. ^ Sulik 2010, pp. 274–277
57. ^ Sulik 2010, p. 4
58. ^ Burns 2021
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60. ^ Sulik 2010, pp. 365–366
61. ^ Olson 2002, pp. 460–469; Sulik 2010, p. 342
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65. ^ Ehrenreich 2001
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68. ^ Ehrenreich 2001; Sulik 2010, pp. 240–242
69. ^ Sulik 2010, pp. 35–45, 262
70. ^ Olson 2002, p. 120; Sulik 2010, pp. 37–38, 42, 101–105, 374
71. ^ Ehrenreich 2001
72. ^ Ehrenreich 2001
73. ^ Kingston 2010
74. ^ Sulik 2010, pp. 372–374
75. ^ Kingston 2010
76. ^ Sulik 2010, pp. 308–309
77. ^ Sulik 2010, p. 57
78. ^ Sulik 2010, pp. 305–311
79. ^ Olson 2002, pp. 192–220
80. ^ Olson 2002, pp. 192–220
81. ^ Olson 2002, pp. 195–202
82. ^ Soffa 1994, p. 208
83. ^ Ehrenreich 2001
84. ^ Olson 2002, p. 198
85. ^ Ehrenreich 2001
86. ^ Ehrenreich 2001
87. ^ Sulik 2010, p. 4
88. ^ Mukherjee 2010, pp. 26–27
89. ^ Olson 2002, pp. 124–144
90. ^ Lebo et al. 2015
91. ^ Olson 2002, pp. 124–144
92. ^ Olson 2002, pp. 121, 171–220
93. ^ Ehrenreich 2001; Olson 2002, pp. 168–191
94. ^ Olson 2002, pp. 176, 185–186, 250
95. ^ O'Mahony et al. 2017
96. ^ Mulholland 2010
97. ^ Ave 2006; Forman, Gould & Rizzo 2013, pp. 7–12
98. ^ Forman, Gould & Rizzo 2013, pp. 7–12
99. ^ Browne 2001
100. ^ Browne 2001
101. ^ Aschwanden 2009
102. ^ Sulik 2010, pp. 165–171
103. ^ Sulik 2010, pp. 170–171
104. ^ Ave 2006
105. ^ Rosenbaum 2014
106. ^ Olson 2002, pp. 240–242; Sulik 2010, pp. 74, 263
107. ^ Welch 2010
108. ^ Aschwanden 2009
109. ^ Beck 2012
110. ^ Aschwanden 2009
111. ^ Beck 2012
112. ^ Beck 2012
113. ^ Ave 2006; King 2006
114. ^ Sulik 2010, pp. 160–210
115. ^ Sulik 2010, pp. 130–135
116. ^ Elliott 2009
117. ^ Sulik 2010, pp. 209–210
118. ^ Sulik 2010, p. 376
119. ^ Sargeant 2014, pp. 271–213
120. ^ Ave 2006
121. ^ Forman, Gould & Rizzo 2013, pp. 7–12
122. ^ Forman, Gould & Rizzo 2013, pp. 7–12
123. ^ Ave 2006
124. ^ Ave 2006; King 2006, p. 38
125. ^ Sulik 2010, p. 204
126. ^ King 2006, p. 38
127. ^ Ehrenreich 2001
128. ^ Ehrenreich 2001
129. ^ King 2006, pp. vii–xxv, 1–28; Sulik 2010, pp. 55–56, 188–189
130. ^ Institute of Medicine 2012
131. ^ Grady 2011
132. ^ King 2006, p. 38
133. ^ Levine 2005
134. ^ Sulik 2010, pp. 229–377
135. ^ Sulik 2010, pp. 326–332
136. ^ Sulik 2010, pp. 321–326
137. ^ Olson 2002, p. 1; King 2006, p. xix
138. ^ Sulik 2010, pp. 37–38
139. ^ Levine 2005

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  ISBN 978-1-134-61992-4
  .
• Singer, Natasha (16 October 2011). "Welcome, Fans, to the Pinking of America". The New York Times. p. BU1.
• Soffa, Virginia M. (1994). The Journey Beyond Breast Cancer: From the Personal to the Political. Rochester, VT:
  OCLC 26217697
  .
• Stukin, Stacie (8 October 2006). "Pink Ribbon Promises".
  ISSN 0040-781X. Archived
  from the original on 30 September 2007.
• Sulik, Gayle (2010). Pink Ribbon Blues: How Breast Cancer Culture Undermines Women's Health. New York:
  OCLC 535493589
  .
• Welch, H. Gilbert (20 October 2010). "The Risk of Being Too Aware".
  ISSN 0458-3035
  .
• World Health Organization (2004). "Annex Table 2: Deaths by cause, sex and mortality stratum in WHO regions, estimates for 2002" (PDF). The world health report 2004 -changing history. Retrieved 1 November 2008.
• Zuger, Abigail (25 October 2010). "Breast Cancer Tales: The Inspirational vs. the Actual". The New York Times.

Further reading

Wikimedia Commons has media related to Breast cancer awareness.

• Aronowitz, Robert A. (2007). Unnatural history: breast cancer and American society. Cambridge, UK:
  ISBN 978-0-521-82249-7
  .
• Kasper, Anne S.;
  ISBN 978-0-312-29451-9
  .
• Klawiter, Maren (2008). The biopolitics of breast cancer: changing cultures of disease and activism. Minneapolis:
  ISBN 978-0-8166-5108-5
  .
• Leopold, Ellen (2000). A Darker Ribbon: A Twentieth-Century Story of Breast Cancer, Women, and Their Doctors.
  ISBN 978-0-8070-6513-6
  .
• Lerner, Barron H. (2001). The breast cancer wars: hope, fear, and the pursuit of a cure in twentieth-century America. Oxford [Oxfordshire]:
  ISBN 978-0-19-516106-9
  .
• Mackenzie, Carpenter (1 October 2006). "Just about everything turns pink for cancer in October". Pittsburgh Post-Gazette.