Pink Ribbon Blues: How Breast Cancer Culture Undermines Women's Health

by Gayle A. Sulik

Pink ribbon paraphernalia saturate shopping malls, billboards, magazines, television, and other venues, all in the name of breast cancer awareness. In this compelling and provocative work, Gayle Sulik shows that though this "pink ribbon culture" has brought breast cancer advocacy much attention, it has not had the desired effect of improving women's health. It may, in fact, have done the opposite. Based on eight years of research, analysis of advertisements and breast cancer awareness campaigns, and hundreds of interviews with those affected by the disease, Pink Ribbon Blues highlights the hidden costs of the pink ribbon as an industry, one in which breast cancer has become merely a brand name with a pink logo. Indeed, while survivors and supporters walk, run, and purchase ribbons for a cure, cancer rates rise, the cancer industry thrives, corporations claim responsible citizenship while profiting from the disease, and breast cancer is stigmatized anew for those who reject the
pink ribbon model. But Sulik also outlines alternative organizations that make a real difference, highlights what they do differently, and presents a new agenda for the future.

Genres: Nonfiction, Health, Womens, Medicine, Academic, Feminism, Gender

402 pages, Hardcover

First published September 30, 2010

Reviews

[Sheryl · Rating 5 out of 5]

This book so embodies my feelings that it could be sub-titled "Why I Won't Play Nice". I appreciate that people want to help, but the pink ribbon "culture" spoken of by this author has become less about helping and more about being seen as supportive. In 2002, when I was diagnosed, I knew that October would be a hard month for me, but that it would only be one month. I began to steel myself for the onslaught of pink in September and avoided malls, etc. during October. Then, I could resume normal activity for the rest of the year. Now, I am constantly bombarded with pink reminders of what I cannot change. It is on the banners of my e-mail and in some of the e-mails themselves. Commercials on TV declare the support of major advertisers. Every corner I turn may crash me into someone's "show of support". Particularly offensive to me are campaigns like "Save the Tatas". When I see this slogan, I wonder if I should apologize. After all, the only thing we managed to save was my life. Along with the author of this book, I would like to request a return to sanity about this disease. I would greatly appreciate being able to go about my normal life without constantly being reminded of what happened. Please think, you are wearing our pain.

[Jodi · Rating 3 out of 5]

This book is fantastic and an essential read. We all need to think before we pink!

The easy breezy activism that asks so little of us and seems so simple and super-dooper-positive at all times can often not just be unhelpful but can often be actually making the fight for an issue WORSE. Taking it backwards and also taking all the oxygen from more worthwhile organisations. Faux activism and advocacy is everywhere, with so many diseases. It is a real problem. Following the money is always a good start at getting to the bottom of who to support and what makes sense to support.

People in an unhelpful charity may mean well but that alone isn't enough. Pink ribbons on chocolate biscuits and KFC and Pepsi and so many things associated with causing cancer just do not make sense.

If breast cancer groups are focused on early detection instead of actual prevention it should set your alarm bells ringing. The statistics in this book on how little impact early detection and all those stressful self breast exams and mammograms has had are just shocking. The number of false positives is also shocking. We need to stop supporting groups that are giving out such bad information, if nothing else. People deserve better. Women with breast cancer deserve a lot better.

Jodi Bassett, The Hummingbirds' Foundation for M.E. (HFME) and Health, Healing & Hummingbirds (HHH)

[Diana Eidson · Rating 5 out of 5]

This is a scholarly sociology book based on Sulik's extensive ethnographical research into what she calls "pink ribbon culture." The book is well-resaerched, accessible, and engaging. Sulik makes a compelling case for us to rethink our "conscientious consumerism," a do-gooder instinct that causes us to buy pink while ignoring the larger forces at play in the reality that breast cancer rates are steadily increasing despite all the dollars and hype. Focusing only on "awareness" and supporting the pink ribbon cause elides the impacts of environmental destruction, corporate collusion, and the high profitability of breast cancer detection and treatment. In short, Sulik skillfully and powerfully critiques pinkwashing, and her argument deserves our attention.

[Christal · Rating 4 out of 5]

This is an excellent read that informs of current statistics and research about issues with the Breast Cancer movement. It truly makes you think about the way Breast cancer and women or men with the disease are portrayed. Great if you appreciate sociological theory and its application especially social control...lol. Must read especially for women since we undergo mammography and specific treatments.

[Lesley]

"I empathize when the first thing I see upon entering a grocery store is a cascade of pink ribbon balloons hanging from the ceiling, pink shopping bags, and a table full of sugary baked goods slathered in hot pink frosting. Is breast cancer really so festive?"

[Katherine · Rating 1 out of 5]

This could have been a very good book. There are many things about our pink ribbon culture that are ripe for critique: the lack of access many women have to diagnostic and treatment services, the use of breast cancer as a marketing tool, the overselling of early diagnosis and the inexcusable tendency to ignore patients with metastatic cancer or even worse, blame them for the state of their disease. Instead, it descends into chemophobia, and when she discusses changes in disease mortality or incidence rates, she often cites conspiracy-mongering books written by non-scientists, because why cite the CDC, when you could just as easily cite a guy with a PhD in classics who once worked as a writer at a major cancer center? Perhaps the social sciences have vastly different standards, but citing books that peddle disproven conspiracy theories is generally frowned upon in the sciences.
The chemophobia leads her to exhort activists to condemn synthetic chemicals manufactured by corporations as possible causes of the rise in breast cancer and she repeatedly implies that this is one of the major drivers of recent rises in breast cancer rates. She points the reader to activist groups that are either uninterested in or silent on the strong links between alcohol and tobacco and breast cancer, but are very focused on chemicals that have caused tumors in animals at high doses or have shown to be endocrine disrupters in non-mammal systems.
Over and over, she implies that medical treatment of breast cancer is compromised because someone is making money and, well, capitalism. In science, we ask ourselves whether there is evidence to support a hypothesis. In this book, qui bono? appears to be the most important question. She repeatedly talks about conflicts of interest. On page 19, she sniffs out a conflict of interest when noting that AstraZeneca sponsored a mammography-promotion effort while also making chemicals. Later on she discusses “the pharmecutical industry’s fraudulent practices in pursuit of profits” pointing to Wyeth’s promotion of HRT. In her view, promoting it for prevention of heart disease while downplaying the breast cancer view amounts to fraud. I was a teenager in the 90’s when HRT really took off and even I knew that it raised your risk of breast cancer; the question was whether the purported cardiovascular benefits were worth it. It didn’t lower heart disease risk, but early studies came to that conclusion because the study designs were weak. Wyeth’s promotion of HRT’s cardiovascular benefits (they hired ghostwriters to create articles touting cardiovascular benefits) was clearly unethical, but unless medical sociology has an alternate definition of fraud (perhaps “stuff corporations do that I personally disagree with”), this doesn’t come close to fraud.
In general, the incidence of breast cancer has risen, while the mortality rate has dropped and the five year survival rate has risen. Some of this is likely due to overdiagnosis—the diagnosis of cancers that would have regressed or never caused symptoms. However, there have also been significant improvements in treatment – thanks to Herceptin and other drugs ER+ cancer’s prognosis has improved substantially as evidence, the age-adjusted death rate has dropped by about a third since 1975, while life expectancies for women have risen and the biggest cause of death, cardiovascular disease, has dropped. Sulik frequently insists that little progress has been made in the fight against breast cancer and flings out random and not particularly relevant statistics citing books by cranks. There are also insinuations that we’d have fewer cancers and better treatments if only some malevolent cancer industry – there isn’t any acknowledgement of just how complex cancers are and how difficult it is to find drugs that only or mostly kill the your mutated cells. One gets the impression that she’s decided to take the cancer people down and is just flinging everything she’s got at them in the hope that something will stick.
Occasionally, she trots out the point that women of color are less likely to get breast cancer, but far more likely to die of the disease. She doesn't really explore the reasons for this inexcusable situation: less access to diagnostic testing and empirically-validated treatment.
The best part of the book is a section of the book where she recounts interviews with breast cancer patients. It’s interesting to read what people with the disease think of it, but it’s bogged down by Sulik’s constant stressing of how women struggle because of the societal pressures to be carers or selfless or optimistic. This is an important problem, but she almost completely ignores the possibility that being diagnosed with a potentially deadly disease may play a role in their accounts. In the end, the book comes off as a very poorly argued polemic.

[Amanda · Rating 4 out of 5]

I read the first edition of this book, as part of my academic work (dissertation) and my own emotional work (working through the "narrative wreckage" my breast cancer diagnosis left behind).

Although the scientific citations in the book are a bit dated (I read the 2011 edition, which was certainly published before Oncotype DX testing existed, for example), the social/cultural stuff is REALLY good.

The section on war metaphors and the masculine/feminine binary and how breast cancer patients/survivors are expected to be brave, fearless, fighters who are also lighthearted, rational, and humorous about it all (rather than emotional with fear, anger, etc), absolutely rang true to me, even in 2022. It helped me make sense of why I hated being told I was brave by friends (which happened all the damn time), and it helped me add more nuance to Arthur Frank's illness narratives idea. I was able to see how I was telling stories that didn't fit into the cultural narratives my friends wanted to hear, and I was able to see how they were unable to listen to what I wanted to say. Very helpful.

Do feel like Sulik was trying to cram EVERYTHING in one book. Think it might have been richer if the case studies has been spun off into a second book. Also, while Sulik make a brief, brief mention of race and racial inequities in breast cancer diagnosis and survival rates, she doesn't explicitly discuss how the breast cancer "she-ro" also arises out of Whiteness. (She does mention class and how it comes from upper-class views of womanhood.)

Can see how people who buy into the she-ro model of survivorship might not like this one. For me, it helped me pinpoint some of the things that I really hated about the she-ro model. Helpful.

Would not have been great to read in the middle of treatment, though.

[Leslie · Rating 3 out of 5]

I purchased this book because I greatly believe in the premise; the fight against breast cancer, as exemplified by pink ribbon culture, is misguided and isn't really helping more women to be diagnosed, successfully treated or live longer, better lives after they have been diagnosed. As a woman, I am of course at risk for breast cancer. Even though I an black and have dense breast tissue, Imy lifelong risk has been judged to be relatively low, so I don't walk around every day thinking I will get this disease, but with the ubiquitousness of breast cancer awareness and pink ribbons, it woudl be nice if I could trust that if I were to be diagnosed, the disease would be caught early (I get my annual mammogram and do self exams, after all) and I would stand a great chance of surviving. The way the "cancer industry" works though, this isn't necessarily the case. If so much time, money and energy weren't being spent, the status quo would be much easier to accept, but with the billions being spent and no appreciable differences in outcomes, that is hard to do. This book captures all of that very well, although I do not agree with the strong feminist nature of some of the argument...too much focus on the patriarchy and how infantilized women are by pink ribbon culture. Pulling in the Powerpuff Girls to sell that point of view didn't help. Overall though, I think this book does a good job in pointing out the weaknesses of the culture in the way breast cancer is handled in the media and medically treated, as well as how diagnosed women are "expected" to behave. No ill person, regardless of their disease, should be made to feel as if they aren't handling their disease process appropriately. However they have to handle it in order to survive and get through it is the right way.

[Janet · Rating 5 out of 5]

At times I felt like I was reading someone's thesis for a Ph.D. is sociology, but I nevertheless really enjoyed reading this book. It changed the way I think about "battling" breast cancer, and raised some really important questions. Is mass screening really the appropriate focus for all the money collected? Or has it resulted in overdiagnosis and overtreatment, which benefits Susan G. Komen's corporate sponsors while hurting the women who may be having unnecessary treatment? Is the focus on a positive attitude harming the women who have treatable but incurable metastatic breast cancer? Is all that pink merchandise enforcing heteronormative and consumerist behavior patterns and doing more harm than good? I'm glad I read this book, and I'm sharing it with some of my coworkers who, like me, frequently speak to women with breast cancer.

[Christy · Rating 2 out of 5]

This book could have been great, but so much of it was bogged down by tedious academic ramblings that added nothing to the author's thesis (was it necessary to bring the Power Puff Girls into a book on breast cancer)? I would really have appreciated more case histories (the second half of the book is built around them) and a discussion of the probable environmental causes of the diseases. Also, the book ends abruptly, and the author did not propose any concrete alternatives to the pink ribbon culture she dislikes so much. I agree with her that "Komen culture" oversimplifies and stereotypes the experience of living with cancer in many ways, but I wanted solutions, not more ranting. I did learn a lot about the shortcomings of mammography, which is invaluable knowledge. But this book is likely useful only for sociologists and other academics.

[Karen · Rating 2 out of 5]

Probably more like 2.5. The book was published in 2010, ten years ago, so we can't expect it to match the rapidly changing culture since then. The author does certainly explore the negative aspects of the "rah rah" hooray for breast cancer culture embodied in the pink ribbon and its supporters, and the not necessarily needed mammograms, but she could have done more than reporting. She could have explored alternative treatments that are squelched by the pink ribbon medical and corporate environment, and alternatives or other tools to detect breast cancer in other less invasive ways, such as thermography and sonography. The history of the development of the Komen culture is not so pleasant either, and that was left out. All in all, it was worthwhile for what it did provide.

[Jessica Silk · Rating 3 out of 5]

I'm saying "I liked it" even though I really thought it was "OK" because that is probably more fair. The book is well-researched and it's a great project, but I think I was looking for something else. The book is organized into different chapters that oftentimes feel disconnected--more like a collection of papers on a larger topic. Sulik's research is great--incorporating multiple methods--but her writing here lacks personality. I wish there was more of a voice to pull the pieces together.

[Philski · Rating 1 out of 5]

Some decent points about how the culture and symbolism of pink detracts from activism and progress, instead encouraging consumerism and complacency... but man the feminist screed is strong with this one.

(I only looked at it briefly after the fact, but Pink Ribbons, Inc looks like it might be a better read on the subject. I just feel compelled to finish books I start reading.)

[Michelle · Rating 4 out of 5]

If you or anyone you know has had breast cancer, you need to read this book. Sulik does an incredible dive on the social construction of breast cancer culture, the commodification of breast cancer, and how the Komen Foundation has turned it into a business that ultimately harms women. I had stopped supporting Komen years ago, but this book reinforces that decision.

[Deborah · Rating 4 out of 5]

The writing is a little dry, but it's worth it for the information and details, lots to think about.
There is a lot of information in this book, but it's not as long as it appears because there are several pages of notes between chapters and an index.

[Terrie · Rating 4 out of 5]

This reads too much like a thesis, which is unfortunate because the content is fabulous, and I wish it would be more accessible to the general public. A must-read for all women and anyone who thinks buying 'pink' is really helping matters.

[Katherine]

I've read Pink Ribbons, Inc. (from a few years ago); another take on this subject should be interesting...

[Betty · Rating 4 out of 5]

Excellent book on the greed of corporate America and the whole "pinking" process.

[Ellison · Rating 4 out of 5]

this examines the culture of the ribbon. originally created to bring 'awareness' this examines weather or not awareness is also associated with reduction in the ailment or merely a fundrai$ing activity? shares numbers and questions weather testing actually exposes patients to unneeded threat, as well as false positives?

reviewer's note: i have a pink ribbon debit card thought might help the cause, now i am not so sure?

[Terri · Rating 3 out of 5]

This book was a very hard read. It read like a PHD thesis. Actually, I think it was this author's PHD thesis. She made some very good points in the book, but I think she could have presented the same information in about 50% less words. It was very wordy and used the same phrases over and over: "pink ribbon culture," "illness narrative," "survivorship." Her voice comes across as sounding rather feminist and very angry over what she calls "pink ribbon culture." I agree with her on a lot of the points about this pink culture; I guess I'm just not quite as angry. I realize there are well-meaning people that are part of that culture, and I want to give them the benefit of the doubt to an extent. She makes some good points about how pink ribbon culture expects survivors to act a certain way, and when we don't we are marginalized. I think this is true. She does a good job of detailing how the push for mammography is driving the pink propaganda machine and in describing "pinkwashing." Probably the best takeaway I have from this book was some references to other reading I would like to do, specifically writings by other women with breast cancer such as Audre Lord and Christina Middlebrook. I look forward to reading some more work by others on these subjects. Like I said, this was a tough read, and I didn't really learn anything that I didn't already know from reading other works, most of which were written in a way that is more readable.
ADDENDUM: I wanted to amend this review to say that she does not really sound "angry" in that she is very objective in her language. Like I said, it reads like a PHD thesis. I guess the reason I used "angry" as a description is that she is pretty much 100% negative against the "pink ribbon culture." I agree about the negative side of it, but I also concede that there are well-meaning people on that side of the culture who really do want to contribute something to the cause of breast cancer, and they do feel like they are supporting women with the disease. Some women do feel supported by such activities; some don't. Also, some of the money raised by these pink activities is going to good causes; some is not. So while I don't feel like I fit into "pink culture," I am willing to concede that it's not all bad.

[Joe · Rating 3 out of 5]

At its core, this book has a message that needs to be heard: people are different, and the dominant breast cancer culture and message is not appropriate for everyone. An approach that may be perfectly helpful for one person may not resonate with someone else -- and if that person can't find a message that works for them, they may feel alienated and alone, and end up being hurt. Additionally, while breast cancer culture may be largely composed of people that have only the best intentions, some people, organizations, and companies involved in breast cancer culture may be driven by their own interests.

Unfortunately, the message in this book is largely buried by irrelevant and distracting terminology and stories. As an example, the author often uses the term "she-ro" -- a shorthand for an idealized model of near-superhuman breast cancer fighters that have an endless source of optimism and courage. It seems to me that Sulik ends up using the term to quickly dismiss a number of messages that don't really fit the harmful model she presents. Yes, some books and groups encourage people to embrace optimism wholeheartedly, and while that is not the right approach for everyone, it may end up being perfect for others.

Ultimately, this book would have been much stronger if the author had been able to remove the extraneous parts, and focus her message more tightly.

[Mariana M. · Rating 2 out of 5]

I had to do a book report and presentation about this book. I did very well on it and learned so much about pink ribbon culture. I want to know more to begin with because of two people im close to had breast cancer and they thankfully recovered after the battle. I had admire them so much and that's the reason i decide to choose this book out the list my sociology professor gave me. I did learned so many things i had no clue about.

[Kim · Rating 1 out of 5]

I have to qualify this by saying that someone with an academic or social scientist interest would probably get a lot more out of it. I'm not a regular nonficton reader. I made it about half way - too dr and redundant. Style is like a text book with footnotes rather than a narrative. I read an article in Slate summarizing the book, I should have stopped there.

[Kara · Rating 1 out of 5]

This was to disjointed and read too much like a college paper. Never really engaged me. I'm sure there are some great ideas in it, but I put it down after the second chapter, and never picked it up again. (My mind has been made up about SGK well before I took this out of the library, so maybe the value was lost before I ever opened the cover!)

[Leah · Rating 1 out of 5]

I didn't finish this book because I wasn't particularly enjoying it. I just couldn't connect with the writing or content and found myself getting frustrated by wasting my time on something I didn't find engaging.

[Jenny · Rating 2 out of 5]

I'm not sure how I feel about this book. It seemed quite repetitive and sometimes seemed to ramble...but there might have been something good underneath it all.

[Juliana Philippa]

http://www.npr.org/2011/10/16/1414021...

[Scorchy Barrington · Rating 2 out of 5]

Poorly edited. Poorly written.

[Kate · Rating 3 out of 5]

A bit too much of a dissertation, but depressing nonetheless