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WELCOME TO
CANCERLAND
A mammogram leads to a cult of pink kitsch
By Barbara Ehrenreich
Barbara Ehrenreich is a contributing editor to Harper's Magazine. Her last two essays for the magazine were the basis
for her best-selling book,Nickel and Dimed:On (Nor) Getting By in America,published by Henry Holt.
REPORT 43
case, with a yearning new to me and sharp as of me, has no further chance of normal repro-
lust, for a clean and honorable death by shark bite, duction in the postmenopausal body we share, so
lightning strike, sniper fire, car crash. Let me be why not just start multiplying like bunnies and
hacked to death by a madman, is my silent sup- hope for a chance to break out?
plication-anything but suffocation by the pink It has happened, after all; some genomes have
sticky sentiment embodied in that bear and ooz- achieved immortality through cancer. When I
ing from the walls of the changing room. was a graduate student, I once asked about the
My official induction into breast cancer comes strain of tissue-culture cells labeled "Hel.a" in the
about ten days later with the biopsy,which, for rea- heavy-doored room maintained at body temper-
sons 1cannot ferret out of the surgeon, has to be ature. "Hel,a," it turns out, refers to one Henrietta
a surgical one, performed on an outpatient basis Lacks,whose tumor was the progenitor of all HeLa
but under general anesthesia, from which I awake cells. She died; they live, and will go on living un-
to find him standing perpendicular to me, at the til someone gets tired of them or forgets to change
far end of the gurney, down near my feet, stating their tissue-culture medium and leaves them to
gravely, "Unfortunately, there is a cancer." It starve. Maybe this is what my rebel cells have in
takes me all the rest of that drug-addled day to de- mind, and I try beaming them a solemn warning:
cide that the most heinous thing about that sen- The chances of your surviving me in tissue culture
tence isnot the presence of cancer but the absence are nil. Keep up this selfish rampage and you go
of me-for I, Barbara, do not enter into it even as down, every last one of you, along with the entire
a location, a geographical reference point. Where Barbara enterprise. But what kind of a role mod-
I once was-not a commanding presence perhaps el am I, or are multicellular human organisms
but nonetheless a standard assemblage of flesh generally, for putting the common good above
and words and gesture-"there is a cancer." I have mad anarchistic individual ambition? There is a
been replaced by it, is the surgeon's implication. reason, it occurs to me, why cancer is our metaphor
This is what I am now, medically speaking. for so many runaway social processes, like cor-
ruption and "moral decay": we are no less out of
control ourselves.
LET ME DIE OF ANYTHING BUT After the visit to the pathologist, my biologi-
cal curiosity drops to a lifetime nadir. I know
SUFFOCATION BY THE PINK STICKY SENTIMENT women who followed up their diagnoses with
EMBODIED IN THAT TEDDY BEAR weeks or months of self-study, mastering their op-
tions, interviewing doctor after doctor, assessing
the damage to be expected from the available
In my last act of dignifiedself-assertion,I request treatments. But I can tell from a few hours of in-
to see the pathology slides myself.This is not dif- vestigation that the career of a breast-cancer pa-
ficult to arrange in our small-town hospital, where tient has been pretty well mapped out in advance
the pathologist turns out to be a friend of a friend, for me: You may get to negotiate the choice be-
and my rusty Ph.D. in cell biology (Rockefeller tween lumpectomy and mastectomy, but lumpec-
University, 1968) probably helps. He's a jolly fel- tomy is commonly followed by weeks of radia-
low, the pathologist, who calls me "hon" and sits tion, and in either case ifthe lymph nodes tum out,
me down at one end of the dual-head microscope upon dissection, to be invaded-or "involved," as
while he mans the other and moves a pointer it's less threateningly put-you're doomed to
through the field. These are the cancer cells, he chemotherapy, meaning baldness, nausea, mouth
says, showing up blue because of their overactive sores, immunosuppression, and possible anemia.
DNA. Most of them are arranged in staid semi- These interventions do not constitute a "cure"
circular arrays, like suburban houses squeezed in- or anything close,which iswhy the death rate from
to a cul-de-sac, but I also see what I know enough breast cancer has changed very little since the
to know I do not want to see: the characteristic 1930s, when mastectomy was the only treatment
"Indian files" of cells on the march. The "ene- available. Chemotherapy, which became a routine
my," I am supposed to think-an image to save up part of breast-cancer treatment in the eighties,
for future exercises in "visualization" of their vi- does not confer anywhere near as decisive an ad-
olent deaths at the hands of the body's killer cells, vantage as patients are often led to believe, espe-
the lymphocytes and macrophages. But I am im- cially in postmenopausal women like myself-a
pressed, against all rational self-interest, by the en- two or three percentage point difference in ten-
ergy of these cellular conga lines, their determi- year survival rates.' according to America's best-
nation to move on out from the backwater of the
1 In the United States, one in eight women wiUbe diagnosed
breast to colonize lymph nodes, bone marrow,
with breast cancer at some point. The chances of her sur-
lungs, and brain. These are, after all, the fanatics viving for five years are 86.8 percent. For a black woman
of Barbaraness, the rebel cells that have realized thisfaUs to 72 percent; and for a woman of any race whose
that the genome they carry, the genetic essence cancer has spread to the lymph nodes, to 77.7 percent.
REPORT 47
ity with the medical profession, been largely ruled Mamm, for example-but more commonly grate-
out. Hence suspicion should focus on environ- ful; the overall tone, almost universally upbeat.
mental carcinogens, the feminists argue, such as The Breast Friends website, for example, features
plastics, pesticides (DDT and PCBs, for example, a series of inspirational quotes: "Don't Cry Over
though banned in this country, are still used in Anything that Can't Cry Over You," "I Can't
many Third World sources of the produce we Stop the Birds of Sorrow from Circling my Head,
eat), and the industrial runoff in our ground wa- But I Can Stop Them from Building a Nest in My
ter. No carcinogen has been linked definitely to Hair," "When Life Hands Out Lemons, Squeeze
human breast cancer yet, but many have been Out a Smile," "Don't wait for your ship to come
found to cause the disease in mice, and the inex- in ... Swim out to meet it," and much more of that
orable increase of the disease in industrialized na- ilk. Even in the relatively sophisticated Mamm, a
tions-about one percent a year between the columnist bemoans not cancer or chemotherapy
1950s and the 1990s-further hints at environ- but tfie enaof chemotherapy, and humorously
mental factors, as does the fact that women mi- proposes to deal with her separation anxiety by
grants to industrialized countries quickly develop pitching a tent outside her oncologist's office. So
the same breast-cancer rates as those who are na- pervasive is the perkiness of the breast-cancer
tive born. Their emphasis on possible ecological world that unhappiness requires a kind of apolo-
factors, which is not shared by groups such as gy, as when "Lucy," whose "long term prognosis
Komen and the American Cancer Society, puts is not good," starts her personal narrative on
the feminist breast-cancer activists in league with breastcancertalk.org by telling us that her story "is
not the usual one, full of sweetness and hope, but
true nevertheless."
BREAST CANCER WOULD HARDLY BE THE There is, 1discover, no single noun to describe
a woman with breast cancer. As in the AIDS
DARLING OF CORPORATE AMERICA IF ITS movement, upon which breast-cancer activism is
COMPLEXION CHANGED FROM PINK TO GREEN partly modeled, the words "patient" and "vic-
tim," with their aura of self-pity and passivity,
have been ruled un-P'C, Instead, we get verbs:
other, frequently rambunctious, social move- Those who are in the midst of their treatments are
ments--environmental and anticorporate. described as "battling" or "fighting," sometimes in-
But today theirs are discordant voices in a tensified with "bravely" or "fiercely"-language
general chorus of sentimentality and good suggestive of Katharine Hepburn with her face to
cheer; after all, breast cancer would hardly be the wind. Once the treatments are over, one
the darling of corporate America if its complex- achieves the status of "survivor," which is how the
ion changed from pink to green. It is the very women in my local support group identify them-
blandness of breast cancer, at least in main- selves, A.A.-style, as we convene to share war sto-
stream perceptions, that makes it an attractive ries and rejoice in our "survivorhood": "Hi, I'm
object of corporate charity and a way for com- Kathy and I'm a three-year survivor." For those
panies to brand themselves friends of the mid- who cease to be survivors and join the more than
dle-aged female market. With breast cancer, 40,000 American women who succumb to breast
"there was no concern that you might actually cancer each year--:again, no noun applies. They
turn off your audience because of the life style are said to have "lost their battle" and may be
or sexual connotations that AIDS has," Amy memorialized by photographs carried at races for
Langer, director of the National Alliance of the cure--our lost, brave sisters,our fallen soldiers.
Breast Cancer Organizations, told the New York But in the overwhelmingly Darwinian culture
Times in 1996. "That gives corporations a cer- that has grown up around breast cancer, martyrs
tain freedom and a certain relief in supporting . count for little; it is the "survivors"who merit con-
the cause." Or as Cindy Pearson, director of the stant honor and acclaim. They, after all, offer
National Women's Health Network, the orga- living proof that expensive and painful treat-
nizational progeny of the Women's Health ments may in some cases actually work.
Movement, puts it more caustically: "Breast Scared and medically weakened women can
cancer provides a way of doing something for hardly be expected to transform their support
women, without being feminist." groups into bands of activists and rush out into the
.1
In the mainstream of breast-cancer culture, streets, but the equanimity of breast-cancer cul-
one finds very little anger, no mention of possible ture goes beyond mere absence of anger to what'
environmental causes, few complaints about the looks, all too often, like a positive embrace of
fact that, in all but the more advanced, metasta- the disease. As "Mary" reports, on the Bosom
sized cases, it is the "treatments," not the disease, Buds message board:
that cause illness and pain. The stance toward I really believe I am a much more sensitive and
existing treatments is occasionally critical-in thoughtful person now. It might sound funny but I
REPORT 49
medicine. There is plenty of evidence that de- receive a few words of encouragement in my fight
pressed and socially isolated people are more with the insurance company, which has taken
prone to succumb to diseases, cancer included, the position that my biopsy was a kind of op-
and a diagnosis of cancer is probably capable of tional indulgence, but mostly a chorus of rebukes.
precipitating serious depression all by itself. To be "Suzy" writes to say, "1 really dislike saying you
told by authoritative figuresthat you have a dead- have a bad attitude towards all of this, but you do,
ly disease, for which no real cure exists, is to en- and it's not going to help you in the least." "Mary"
ter a liminal state fraught with perils that go well is a bit more tolerant, writing, "Barb, at this time
beyond the disease itself. Consider the phenom- in your life, it's so important to put all your en-
enon of "voodoo death"-described by ethnog- ergies toward a peaceful, if not happy, existence.
raphers among, for example, Australian aborig- Cancer is a rotten thing to have happen and
ines-in which a person who has been there are no answers for any of us as to why. But
condemned by a suitably potent curse obliging- to live your life, whether you have one more year
ly shuts down and dies within a day or two. Can- or 51, in anger and bitterness is such a waste ...
1hope you can find some peace. You deserve it.
We all do. God bless you and keep you in His lov-
IN THE BREAST-CANCER CULTURE, ing care. Your sister, Mary."
"Kitty," however, thinks I've gone around the
CHEERFULNESS IS MORE OR LESS MANDATORY, bend: "You need to run, not walk, to some coun-
DISSENT A KIND OF TREASON seling.... Please, get yourself some help and 1
ask everyone on this site to pray for you so you can
enjoy life to the fullest."
cer diagnoses could, and in some cases probably I do get some reinforcement from "Gerri," who
do, have the same kind of fatally dispiriting effect. has been through all the treatments and now
So, it could be argued, the collectively pumped- finds herself in terminal condition: "I am also
up optimism of breast-cancer culture may be just angry. All the money that is raised, all the smil-
what the doctor ordered. Shop for the Cure, dress ing faces of survivors who make it sound like it is
in pink-ribbon regalia, organize a run or hike- o.k. to have breast cancer. IT IS NOT O.K.!"
whatever ,gets you through the night. But Gerri's message, like the others on the mes-
But in the seamless world of breast-cancer sage board, is posted under the mocking heading
culture, where one website links to another-
from personal narratives and grassroots endeav-
ors to the glitzy level of corporate sponsors and
"C "What does it mean to be a breast-
cancer survivor?"
REPORT 51
100 percent accurate, the admirable goal of "ear- ty to a combination of surgery, chemotherapy, ra-
ly" detection is more elusive than the current diation, and/or anti-estrogen drugs such as ta-
breast-cancer dogma admits. A small tumor, de- moxiten. Others, though, would have lived un-
tectable only by mammogram, is not necessarily treated or with surgical excision alone, either
young and innocuous; if it has not spread to the because their cancers were slow-growing or be-
lymph nodes, which is the only form of spreading cause their bodies' own defenses were successful.
detected in the common surgical procedure of Still others will die of the disease no matter what
lymph-node dissection, it may have already moved heroic, cell-destroying therapies are applied. The
on to colonize other organs via the bloodstream. trouble is,we do not have the means to distinguish
David Plotkin, director of the Memorial Cancer between these three groups. So for many of the
Research Foundation of Southern California, con- thousands of women who are diagnosed each
cludes that the benefits of routine mammogra- year, Plotkin notes, "the sale effect of early de-
phy "are not well established; if they do exist, tection has been to stretch out the time in which
they are not as great as many women hope." Alan the woman bears the knowledge of her condi-
Spievack, a surgeon recently retired from the Har- tion." These women do not live longer than they
vard Medical School, goes further, concluding might have without any medical intervention, but
from his analysis of dozens of studies that routine more of the time they do live is overshadowed
screening mammography is, in the wordsof famous with the threat of death and wasted in debilitat-
ing treatments.
To the extent that current methods of detec-
tion and treatment fail or fall short, America's
breast-cancer cult can be judged as an outbreak of
mass delusion, celebrating survivorhood by down-
playing mortality and promoting obedience to
medical protocols known to have limited effica-
cy. And although we may imagine ourselves to be
well past the era of patriarchal medicine, obedi-
ence is the messagebehind the infantilizing theme
in breast-cancer culture, as represented by the
teddy bears, the crayons, and the prevailing pink-
ness. You are encouraged to regress to a little-girl
state, to suspend critical judgment, and to accept
whatever measures the doctors, as parent surro-
gates, choose to impose.
Worse, by ignoring or underemphasizing the
vexing issue of environmental causes, the breast-
cancer cult turns women into dupes of what could
be called the Cancer Industrial Complex: the
multinational corporate enterprise that with the
one hand doles out carcinogens and disease and,
with the other, offersexpensive, semi-toxic phar-
maceutical treatments. Breast Cancer Awareness
Month, for example, is sponsored by AstraZeneca
(the manufacturer of tamoxifen), which, until a
corporate reorganization in 2000, was a leading
producer of pesticides, including acetochlor, clas-
British surgeon Dr. Michael Baum, "one of the sified by the EPA as a "probable human carcino-
greatest deceptions perpetrated on the women of gen." This particularly nasty conjuncture of in-
the Western world." terests led the environmentally oriented Cancer
Even if foolproof methods for early detection Prevention Coalition (CPC) to condemn Breast
existed.' they would, at the present time, serve on- Cancer Awareness Month as "a public relations
ly as portals to treatments offering dubious pro- invention by a major polluter which puts women
tection and considerable collateral damage. Some in the position of being unwitting allies of the
women diagnosed with breast cancer will live very people who make them sick." Although As-
long enough to die of something else, and some traZeneca no longer manufactures pesticides, CPC
of these lucky ones will indeed owe their longevi- has continued to criticize the breast-cancer cru-
sade-and the American Cancer Society-for its
2 Some improved prognostic tools, involving measuring a tu-
unquestioning faith in screening mammograms
mor's growth rate and the extent to which it is supplied with and careful avoidance of environmental issues.
blood vessels, are being developed but are not yet in use. In a June 12, 2001, press release, CPC chairman
REPORT 53