Pink power

Sunday Star Times

Each year we are deluged with products plugging breast cancer month, from pink biscuits to pink phones. But how did one disease come to monopolise the attention of the cancer charity market and where does all the money go?

There was nothing much you couldn't buy to support breast cancer awareness last month. There was bottled water with pink caps, pink hair-straightening irons, pink cordless phones, pink biscuits even pink tyre valve caps that resembled nipples.

Most of the products were advertised on the New Zealand Breast Cancer Foundation (NZBCF) website, but what was not always clear was exactly how much was going to the cause - and finding out is no easy task.

The companies all say they proudly support the cause and most say they donate to the foundation. But critics complain that not all companies backing breast cancer campaigns are so scrupulous.

The hijacking of the pink ribbon - the symbol for breast cancer fundraising - for marketing purposes has been dubbed "pink-washing". This ranges from the silly to the cynical. During breast cancer awareness month in the US, for example, cigarette-maker Philip Morris announced new "purse packs" of Virginia Slims - narrower sticks in a pink pack.

The critics attack what they term "the breast cancer industry" on at least three fronts: the lack of openness around the raising and spending of funds, that it focuses on awareness and a search for the cure rather than supporting women with breast cancer, and that commercial organisations trade on the powerful symbolism that, as NZ health researcher Sue Claridge says, "goes to the very heart of who you are physically as a woman".

Companies compete vigorously to be aligned with charities - known in the industry as cause marketing - and it is not difficult to see why: research has found 67% of people are more likely to buy a product from a company that supports a worthy cause.

Some companies on the NZBCF site said 100% of proceeds would go to the foundation, others talked of a "percentage" or a capped amount. Others simply noted they were "proudly supporting the foundation's ongoing commitment to research, education and raising awareness", which could potentially mean giving nothing at all.

"The lack of transparency is really problematic," says Samantha King, a Canadian women's health researcher, when discussing the general lack of information that might help consumers decide. Her book, Pink Ribbons Inc, Breast Cancer and the Politics of Philanthropy, examines the worldwide "corporatisation" of the search for a breast cancer cure.

"A consumer could potentially buy a product thinking that the money is going to cancer but if the maximum has already been reached, all that does is line the corporation's coffers more."

NEW ZEALAND breast cancer organisations raise millions of dollars each year and overseas figures suggest breast cancer does much better than prostate or lung cancer, for example.

But exactly how much is raised here remains secret - the NZBCF refused to show its annual accounts to the Sunday Star-Times. The other major recipient of corporate donations, the Breast Cancer Research Trust (BCRT), which focuses solely on finding a cure, does not publish its annual accounts either.

The foundation's executive director, Heather Shotter, formerly head of marketing at Sky City (the organisation is heavy with marketing skills, having a fulltime marketing manager, and executives for events, fundraising and direct marketing), says it will have to provide its accounts to the Charities Commission from next year in order to maintain its tax-free charitable status. In the meantime, she is staying mum.

She agrees the public has a right to know how much is raised and where it is spent, "but I just think it's inappropriate to release the figures through the media".

The only figure Shotter is willing to reveal is the amount raised during last year's pink ribbon street appeal - $765,000. She would not release this year's figure, claiming it is still being audited, even though a letter was recently sent to supporters saying $827,490 was raised.

Dalton Kelly, the chief executive of the Cancer Society, which represents all forms of cancer, says he doesn't know how much the NZBCF brings in overall each year, "but I think they are number two behind us, or maybe number three behind child cancer".

His organisation raises $29m a year, while the Child Cancer Foundation's publicly available annual financial statements show its income is about $10m, of which more than half goes on fundraising costs and administration.

Kelly says the various cancer groups "try to stay out of each other's way" to avoid "cancer clutter", whereas in Australia, for example, the various groups compete against each other.

But some groups which directly support women with breast cancer say it is hard to get a share of the charity dollar. The foundation has trademarked the pink ribbon in New Zealand - something no single breast cancer group in the US has been able to do - and aggressively protects its brand.

"That's bullshit; the pink ribbon belongs to all women," says Sue McLeod of Kerikeri, a breast cancer survivor and researcher who runs the website www.breast.co.nz. She is scathing of the way big business is riding the breast cancer bandwagon and says that of all the companies selling products for breast cancer, only Arnott's donates to an organisation directly supporting women suffering from the disease, through sales of pink Tim Tams.

"You've got to understand, it's become an absolute breast industry."

It's not surprising corporations have joined the cause, given how much money can be made out of how women feel about their bodies, says Claridge, a researcher with the Breast Cancer Network, a New Zealand-wide grassroots organisation for women with the disease.

In America, there are growing concerns that the pink ribbon campaign has become a corporate monster and that women are using it as a way of avoiding personal responsibility. Brenda Salgado, programme manager for Breast Cancer Action, a San Francisco-based watchdog group, says: "We're concerned that it's giving women a way of not doing something personally about breast cancer, but to feel that purchasing a product will take care of the problem."

CORPORATIONS HAWKING products to highlight breast cancer is one thing, but women's health advocates are most concerned about companies that promote the pink ribbon campaign but produce goods that allegedly contribute to the disease.

Says Canadian researcher King: "It's a huge irony that a disease that is shown in research to be linked to consumer lifestyles in industrial countries is being addressed by asking people to buy more stuff." She cites products such as cars and cosmetics containing questionable substances. Claridge adds: "A lot of cosmetics contain things like phthalate and parabens. These are estrogenic chemicals [that is, act like estrogen]. There's screeds of research that shows these chemicals have an effect on human beings from as early as in the womb."

The American Breast Cancer Action site, www.thinkbeforeyoupink.com, attempts to raise awareness around this type of pink-washing. For instance, it slates cosmetics company Estee Lauder, which is intrinsically linked with breast cancer fundraising in New Zealand, for "refusing to sign the Compact for Safe Cosmetics to ensure that its products do not contain chemicals that are known or strongly suspected of contributing to the disease".

Estee Lauder sent a statement to the Star-Times pointing out that all of its products are constantly reviewed and meet worldwide safety standards.

"The assertion that cosmetics are harmful to our health is a phantom risk. In essence, it is distracting women from the known, preventable causes of cancer and birth defects," the statement reads.

Shotter is confident that companies involved in the pink ribbon campaign stand behind the safety of their products. "We would not risk the credibility and ethics of our mission if we believed there were links between ingredients in pink products and breast cancer. I think these companies should be congratulated rather than criticised for their commitment to organisations like ours."

What is not widely known is that Estee Lauder is joined at the hip with the NZBCF. The foundation was formed in 1994 after Evelyn Lauder, Estee's daughter-in-law, launched the first pink ribbon awareness campaign in the US and asked branches of the company around the world to establish fundraising organisations. Today, Estee Lauder's general manager in New Zealand, Marie-Ann Billens, is also the foundation's vice-president.

Other cosmetics companies that support the foundation and the research trust include Revlon, Avon and the company that makes Dove products. Pharmaceutical companies have also been involved. The Anglo-Swedish firm AstraZeneca is a corporate sponsor of the BCRT, and Claridge is sceptical of its involvement.

"Ask yourself whether a pharmaceutical company really wants to find a cure for breast cancer. They make millions off women taking Tamoxifen, Herceptin and so on."

But Alison Taylor, chief executive of the BCRT, says all the trust's sponsors are committed to finding a cure, first and foremost.

"THERE'S NOTHING special about breast cancer," says Trevor Smith. The breast surgeon at Ascot Hospital in Auckland, who deals with breast cancer sufferers on a daily basis, says without hesitation that too much emphasis is put on the disease. "Bowel cancer kills just as many women, lung cancer kills as many women, but we don't have bowel and lung cancer awareness months."

Smith believes the foundation's focus on awareness and detection, and use of younger women such as Lucy Lawless to front campaigns, is frightening young women who are less at risk of contracting the disease.

"Women come in; they're only 20 or 25, with hormonal breast pain, but they've read so much about breast cancer they are convinced they must have it and need mammograms. I personally can't see that the solution for breast cancer is going to be to systemically irradiate the entire female population indefinitely, which is what mammographic screening is."

He says the UK-based World Cancer Research Fund last year released a report, which went largely unnoticed, concluding that there were strong links between environmental and lifestyle factors and incidences of breast cancer.

It recommended 10 simple steps, such as exercising more, reducing smoking and alcohol, eating well, having babies earlier and breastfeeding longer, which could reduce the risk of breast cancer by up to 40% (see sidebar, right).

Whether it's because women are heeding such health warnings, or screening and education campaigns are paying off, Ministry of Health statistics suggest that in the past decade there has been a 28% drop in the breast cancer mortality rate. John Childs, the national clinical director of the Ministry of Health's cancer programme, confirms that the risk of dying from breast cancer is falling, "but of course the total number of deaths isn't because the at-risk population has been increasing. That's because of the ageing population".

Shotter puts the lower mortality rate down to to the foundation's awareness campaigns.

"The fact is, we don't know what causes breast cancer. What we do know is how to treat it, and how to detect it, and these are the areas the foundation focuses on. I'm sure the women and their families who have had breast cancer would not say that education and awareness campaigns were a waste of time."

Kerikeri's McLeod agrees it is time the focus moved on from awareness campaigns and the search for a cure.

"They're focusing on `early detection is your best protection'. There's no need for the foundation to be doing that advertising any more, they should be switching to something else."

Says Claridge: "I'm not saying we shouldn't aim to cure breast cancer, but a lot of us feel we need to be starting at the other end as well, we need to be talking about prevention. A cure is great, but not getting it is better."

Lowering your risk
Perhaps a third of cancers could be prevented by more attention to diet, exercise and weight, say experts. Here are 10 ways to lower your risk.
1 Be as lean as possible without becoming underweight, through a balanced diet and regular physical activity.
2 Be physically active for at least 30 minutes every day which helps with maintaining a healthy weight.
3 Avoid sugary drinks and energy-dense processed foods high in added sugar, low in fibre, or high in fat. These foods, eaten frequently, promote weight gain and increase your cancer risk.
4 Eat five a day of a variety of vegetables, fruits (rather than juice), whole grains (eg, brown rice, wholemeal bread and pasta) and pulses such as beans. Their dietary fibre will limit weight gain and may protect against a range of cancers.
5 Limit consumption of red meats (such as beef, pork and lamb) to less than 500g cooked weight and avoid processed meats such as bacon, ham, salami, corned beef and some sausages, as there is strong evidence they increase cancer risk.
6. If consumed at all, limit alcoholic drinks to two for men and one for women a day. The evidence that alcoholic drinks can increase the risk of a number of cancers, including breast and colon cancer, is strong.
7 Limit consumption of salty foods and food processed with salt, as evidence suggests salt and salt-preserved foods probably cause stomach cancer. Try to use herbs and spices instead and remember that processed foods, including bread and breakfast cereals, can contain large amounts of salt.
8 Don't use supplements to protect against cancer. Research shows that high-dose nutrient supplements can affect our risk of cancer, so it's best to opt for a balanced diet without supplements (unless illness or dietary limitations demand it).
9 It's best for mothers to breastfeed exclusively for up to six months and then add other liquids and foods. Strong evidence shows that breastfeeding protects mothers against breast cancer and babies from excess weight gain.
10 After treatment, cancer survivors should follow the recommendations for cancer prevention. Maintaining a healthy weight through diet and physical activity may help to reduce the risk of cancer recurrence. And do not smoke or chew tobacco. Smoking or using tobacco in any form increases the risk of cancer and other serious diseases.

Source: World Cancer Research Fund