Abstract
Women's health and breast cancer are intricately connected as breast cancer has become the most common women's cancer and the most common cause of cancer death in women both in the United States and globally. Accordingly, awareness and education of the significance of self-breast care, early prevention, timely detection of suspect breast abnormalities, and advancing research for superior screening and treatment strategies are essential for overcoming this significant threat to women's health. Reversing growing incidents of breast cancer starts with the timely detection of suspect breast abnormalities and, in turn, from focusing on breast cancer awareness and educating young women about the significance of self-breast care and preventive measures in saving lives. These issues directly feed into the topic of this commentary—Breast Cancer Transcending October.
Over the past few decades, Breast Cancer Awareness Month, 1 –3 popularly known as Pink October, has served as a vital platform for raising awareness about issues germane to breast cancer, increasing research funding, and exhibiting solidarity with breast cancer patients, survivors, and researchers. In the United States and internationally, we have come a long way from when breast cancer diagnosis was synonymous with an end of life for many patients (while still the end of life for countless women). Yet, Pink October has faced substantial criticism for various reasons, including the campaign's infusion with commercial and corporate influence, and the October campaign might be somewhat drifting from the original purpose of raising awareness, championing increased research funding, and patient advocacy. 4,5
Many of us consider every day of the year an opportunity for breast cancer awareness. Sustaining a high awareness year-round is critical to reducing the mortality rate. Here, we will explore breast cancer awareness beyond the designated month of October, take a fresh perspective, and delve deeper into this continuously evolving topic while introducing issues faced by younger women with breast cancer and the Pink–Purple Ribbon.
Reflections on the History of Pink October and the Pink Ribbon
The origin of National Breast Cancer Awareness Month (NBCAM) in the United States, which is now globally recognized as Breast Cancer Awareness Month, could be traced back to a week-long event in October 1985—inaugurated by the First Lady, Betty Ford, a breast cancer survivor herself—when the American Cancer Society and Imperial Chemical Industries (now a unit of AstraZeneca) started a public campaign to bring attention to breast cancer and promote mammography for early detection. 6 –10 Tightly linked to NBCAM is the genesis of the pink ribbon. The tradition of using ribbons as symbols to raise awareness and support breast cancer patients and survivors goes back to 1991 when Charlotte Haley, a breast cancer survivor, used her favorite peach color to create peach ribbons to raise awareness and advocate for increased research funding for breast cancer both at the local grassroots and government levels. 7
Also, in year 1991, the Susan G. Komen Breast Cancer Foundation (now Susan G. Komen for the Cure) distributed the pink ribbon to those participating in the New York City Race for the Cure. 1 –3,6 –10 Soon after, in 1992, Evelyn Lauder, also a breast cancer survivor and Founder of the Estée Lauder Cosmetic Companies, created the iconic pink ribbon, along with Alexandra Penny of SELF magazine, and, in October 1992, launched the first nationwide breast cancer awareness campaign. 1 –3,6 –10 However, her advocacy for better breast cancer care goes back to 1989 when she supported a structured breast and diagnostic center at Memorial Sloan Kettering Cancer Center, the current Evelyn H. Lauder Breast Center. To further strengthen the momentum and recognize the growing national campaign against breast cancer, U.S. President George Bush proclaimed October as National Breast Cancer Awareness Month in 1990. 11
Continuing Quantum Leap of Awareness: October Campaign
Looking at the cumulative positive effects of Pink October since 1985, the campaign achieved several of its original goals and undoubtedly played an instrumental role in de-stigmatizing the disease, promoting breast cancer awareness, and early detection. 12 –15 In addition, the campaign empowered and supported patients and survivors, infused hope in newly diagnosed patients, raised funds for research, involved communities, and served as a prototypic awareness movement for other cancer types to follow in the United States and globally.
One of the coauthors reminisces about all the progress made from the time when a breast cancer diagnosis was a taboo subject and considered by the public to be a probable death sentence in most if not all, cases. Today, about 80% of patients will be cancer-free, and a growing number of those with metastatic disease will have indefinite disease control; most breast cancers can be treated with cosmetically excellent breast conservation, and if mastectomy is necessary, there are several remarkably effective reconstruction options. Over the decades, progress in breast cancer outcomes is paralleled by its near-complete de-stigmatization. Most women feel comfortable discussing breast cancer risk and treatment with their health care providers, families, friends, and other affected women informally or in a formal support group.
Transcending October: Consider Above and Beyond
While Breast Cancer Awareness Month is a powerful platform for raising awareness about breast cancer, substantial concerns and criticisms about the October campaign have been raised. “Pink-washing” is a term used to describe the exploitation of the recognizable pink ribbon by companies to market a product or service without meaningfully supporting breast cancer research or awareness. 4,5,12 –15 Other criticisms include inadequate lobbying for insurance companies to cover all available screening methods and the lack of emphasis on risk factors and preventive measures. 16 –21 Pink October and Pink Diplomacy also bring mixed emotions, sometimes referred to as “Pink Ribbon Fatigue,” 4,6,12 –21 to those recently diagnosed or still fighting the disease and those diagnosed with cancer in October. Lifestyle modifications and chemoprevention for higher-risk women can significantly reduce the incidence of breast cancer. 22
There are also concerns relevant to younger women. For example, the emphasis during Breast Cancer Awareness Month on early detection with screening mammograms may suggest to health care providers and the general public that younger women are not at significant risk for developing breast cancer, resulting in delayed diagnosis and poorer outcomes. Not only are women as young as those in their late teens at risk for breast cancer, with risk increasing exponentially with age, but breast cancer incidence has been rising in young women for reasons that are not entirely clear. 23,24
Young women (and their health care providers) must be taught about breast cancer signs and symptoms, genetic and nongenetic risk factors, and must be “breast aware” of their bodies. Risk reduction and, when that is not successful, early detection (and, consequently, timely treatment) is crucial to reduce the burden of breast cancer among young women. This is necessary to improve cure rates and reduce short- and long-term morbidity. Chronic treatment side effects (brain fog, peripheral neuropathy, cardiotoxicity, metabolic syndrome, premature menopause, and others) are particularly troublesome to younger women due to their healthier peers and longer life expectancy. Breast Cancer Awareness Month is an opportunity to increase knowledge and help inform young women, but sadly this demographic is not often the target of the October campaign. Incidentally, Susan G. Komen (of Susan G. Komen For the Cure) died at age 36 in 1980.
Likewise, breast cancer research often prioritizes postmenopausal women due to their higher incidence rates. Breast cancer in young women tends to be biologically more aggressive and is usually diagnosed later due to faster tumor growth and the lack of routine screening. Compared to their older counterparts, young women face unique challenges, such as fertility preservation, family planning, premature menopause, and pregnancy-associated breast cancer. The October Campaign may not always highlight the need for specific research targeting women under age 40, and this disparity must be addressed.
The Pink–Purple Ribbon
The pink ribbon is a recognized global symbol of breast cancer awareness and represents the lives touched by breast cancer. As mentioned, younger women with breast cancer experience additional, unique challenges associated with their age. Though an overall poor prognosis and special clinical and biological features of breast cancer in young women have been known for some time, we at the Breast Cancer in Young Women Foundation 25,26 now introduce a Pink–Purple ribbon Logo to explicitly raise awareness about the increasing incidence of breast cancer in young women and the unique challenges this demographic faces (Fig. 1). The Pink-Purple ribbon is a tribute to the resilience of young women battling breast cancer. It aims to empower them with the knowledge to detect the disease early when the chances of successful treatment are the highest.
The Pink–Purple Ribbon Logo: A vibrant Pink–Purple ribbon adorns a young woman, serving as a powerful symbol to unequivocally heighten awareness regarding the rising incidences of breast cancer among young women and shed light on the distinctive challenges faced by this demographic in the battle against breast cancer.
To completely capture the experiences and determination of these younger women to beat breast cancer, the silhouette of a woman gracefully flying represents her journey to regain her health and well-being. The purple color carries profound meaning, symbolizing dignity, equality, and justice, making it a fitting representation of the struggles young women worldwide face against this common scourge. The white waves in line with the body represent a young woman's power, boldness, courage, and resilience to conquer any challenge that comes her way. The silhouette's soaring position embodies her positive attitude and unwavering spirit to defeat breast cancer. The stars in the logo signify badges of hope, illuminating the path toward a brighter future and highlighting the importance of a collective effort to combat breast cancer among young women. Because of the unique challenges of young women with breast cancer (and the risk faced by all young women), we encourage cancer communities to embrace the use of the “Pink–Purple Ribbon” along with the historical “Pink Ribbon.”
Moving Forward Through Reflections
By acknowledging these unique challenges, there is room for Breast Cancer Awareness Month to become more inclusive and carry the momentum throughout the year; therefore, more effective in increasing awareness of breast cancer risk and the importance of early detection by supporting all individuals affected by breast cancer, regardless of age or circumstances. Providing information, resources, and support tailored to young women will help improve outcomes and the overall well-being of this population while building awareness from the youngest age that they will carry throughout their lives. Taking a comprehensive and informed approach to breast cancer awareness and promoting both Pink and Pink–Purple Ribbons using traditional and innovative routes throughout the year is crucial. This involves promoting evidence-based information, supporting organizations prioritizing research, patient support, and prevention, and engaging in discussions highlighting breast cancer's challenges and complexities beyond October and Pink and all year-round while incorporating breast cancer awareness and self-breast health as an integral part of our New Year's resolutions.
Acknowledgment
Due to the paucity of space, the authors apologize for not citing additional references. The Pink–Purple Ribbon logo of the Breast Cancer in Young Women Foundation is used to promote young women's breast cancer awareness in various forums.
Author's Contributions
R.K.: Conceptualization, integrating parts, draft writing, reviewing, and editing. M.M., L.C., S.S., C.V.-G., B.A.M.-C., G.M., S.S., Z.H., A.M.F., S.H., T.C., H.B., G.A., C.S., V.Z., M.T., A.L., and M.M.: Partial draft writing and reviewing. A.A. and L.L.: Partial writing for the draft and reviewing. P.B.F. and R.C.: Reviewing and editing. E.W.: Partial draft writing, reviewing, and editing.
Footnotes
Author Disclosure Statement
No competing financial interests exist.
Funding Information
No funding was received for this article.