I first saw the article Thursday night on Facebook, then stayed up until midnight reading it. In a helluva story, Peggy Orenstein addresses The Feel-Good War on Breast Cancer in this Sunday's New York Times Magazine.
Orenstein is uniquely situated to write an article she hopes will "help change the national conversation." She's been treated for breast cancer twice in the last 15 years, including a mastectomy last fall, and the Times Magazine -- for which she writes regularly -- is one of the most powerful publications in the world.
Orenstein was first diagnosed with breast cancer in 1997 after her doctor sent her for a screening mammography. "I used to believe a mammogram saved my life," she writes as the opening line of her piece. Today, she's not so sure.
As she writes in the Times:
Sixteen years later, my thinking has changed. As study after study revealed the limits of screening — and the dangers of overtreatment — a thought niggled at my consciousness. How much had my mammogram really mattered? Would the outcome have been the same had I bumped into the cancer on my own years later? It’s hard to argue with a good result. After all, I am alive and grateful to be here. But I’ve watched friends whose breast cancers were detected “early” die anyway. I’ve sweated out what blessedly turned out to be false alarms with many others.
She goes on to clearly and comprehensively detail the benefits and the harms of mammography, that breast cancer is not one disease, but many.
After she's thoroughly explained the state of breast cancer screening and treatment, Orenstein travels to Dallas to talk to the Susan G. Komen Foundation about what she calls "pink ribbon culture." She pulls no punches:
The ribbon has come to symbolize both fear of the disease and the hope it can be defeated. It’s a badge of courage for the afflicted, an expression of solidarity by the concerned. It promises continual progress toward a cure through donations, races, volunteerism. It indicates community. And it offers corporations a seemingly fail-safe way to signal good will toward women, even if, in a practice critics call “pinkwashing,” the products they produce are linked to the disease or other threats to public health. Having football teams don rose-colored cleats, for instance, can counteract bad press over how the N.F.L. handles accusations against players of rape or domestic violence. Chevron’s donations to California Komen affiliates may help deflect what Cal OSHA called its “willful violations” of safety that led to a huge refinery fire last year in a Bay Area neighborhood.
More than anything else, though, the ribbon reminds women that every single one of us is vulnerable to breast cancer, and our best protection is annual screening. Despite the fact that Komen trademarked the phrase “for the cure,” only 16 percent of the $472 million raised in 2011, the most recent year for which financial reports are available, went toward research. At $75 million, that’s still enough to give credence to the claim that Komen has been involved in every major breast-cancer breakthrough for the past 29 years. Still, the sum is dwarfed by the $231 million the foundation spent on education and screening.
In what's sure to be a long media blitz, Orenstein was a guest on KQED's Forum Friday morning.
"Pink ribbon in general has been specifically promoting awareness, and that generally means mammography," Orenstein said. She argued powerfully in her article that death rates for metastatic breast cancer have barely budged. Mammography isn't going to do much for you if you have metastatic breast cancer, she told the Forum audience.
I caught up with Orenstein after Forum wrapped up. She talked about a survey from BreastCancer.org of 2,500 girls 8-18. Nearly 30 percent of those surveyed believe they might have breast cancer right now, despite the fact that breast cancer in girls is exceedingly rare.
BreastCancer.org argues we need to "replace fear with facts." Orenstein's article takes us a huge step forward. She told me it was the hardest article she's written in her career, but it could end up being the most important.
Listen to Orenstein on Forum: