October, as everyone knows, is National Breast Cancer Awareness Month, which is to say that it is the month that every retailer and manufacturer and sports franchise imaginable will put forth a pink version of themselves that is designed to sell things by making everyone more “aware” of breast cancer. And, as everyone who has paid the slightest attention to the messaging of pink Octobers past knows, awareness leads to early detection which leads to cure. Right?
Not exactly. Not always.
Some breast cancers, even if they are discovered early, will become metastatic and spread to other areas of the body, a Stage IV form of the disease that has a five-year survival rate of just 22 percent. The exact process that causes some cancers to metastasize, while others do not, is not entirely clear. But it is a reality that is often misunderstood, or just left out, of all we've been made so pinkfully "aware."
It is true that mammography screening remains the very best tool for early detection and that, generally speaking, breast cancers detected at earlier stages are more likely to be cured. This I know first-hand, having learned it at my first mammogram, when I was living with four small children I knew about and a hidden, aggressive cancer in my breast that I did not. My tumor was not the "good kind,” but it was small and contained enough to provide me with decent odds, survival percentages that would not earn me an A in school, but maybe a B, provided I completed a year of treatment that included surgeries, chemotherapy and targeted therapy. Even then, there were no guarantees. Still, if I hadn’t followed doctor’s orders to get that first recommended mammogram at 40, things surely would have gone differently, and it is safe to say that early detection saved my life.
But, as any survivor will tell you, early detection and pink ribbons do not tell the whole story of breast cancer survivorship; it is more complicated than the pink part of the story. As a nation, we are more aware now, to be sure; the Octobers of years past have, in large part, been a success — they have done their job.
There is still work to be done to eliminate the myths that still exist, however: the outdated belief that the surgeon “getting it all” is curative and the more recent notion that being positive is essential — the idea that breast cancer survivors somehow enjoy, rather than endure, the 31-day blitz of treatments; the constant reminders of their struggle; the assumption that if you are alive, and especially if you still have your hair, you must surely have “beaten it.”
The truth is that few of us who have walked this road — our hearts broken and our ears rung by the first c-word, which was “cancer” — ever got to hear the c-word we longed for: “Cured.” Some of us, by the luck of the draw, got to hear some d-words, like “done” with treatment, and maybe even “discharged” from our oncologist’s care; and when this happens, it fits the narrative of National Breast Cancer Awareness Month: Everyone feels good.
Even then, in the best-case scenario, there is no representation, on pink stand-mixer displays and on pink-ballooned car lots, for the losses and fears we live with forever, the intense, post-traumatic uncertainty, the tentative, frightened gratitude of "wait and see."
And what of our Stage IV sisters who, having also done everything right, having gotten the mammogram, and followed doctor's orders, and hoped in and believed in a cure, now do their level best to live as fully as they possibly can, despite breast cancer that has spread in their bodies — despite the fact that there will be no cure? Where are they represented in the pink merchandise, in the cure- based messaging?
It’s time to include everyone, to enter a new stage in breast cancer awareness. The CDC estimates that there are more than 150,000 women living with metastatic breast cancer (MBC), or Stage IV breast cancer, in the U.S. today. Three out of four women living with MBC were initially diagnosed with an earlier stage of breast cancer.
It's time to make National Breast Cancer Awareness Month a time for real talk about metastatic breast cancer, increasing awareness of this stage, what it is, how and why it happens. It’s time to talk about how we can better support all breast cancer survivors, in a full color spectrum that goes beyond the pink.
Beth Thompson is a registered nurse; her email is firstname.lastname@example.org.