Marketing Breast Cancer in America: What Role Should Corporate Sponsorship Play in Health Activism?

What would happen if corporate America no longer invested in breast cancer? The role of corporate marketing support for breast cancer activism has been criticized ever since corporate sponsorship began to visibly increase in the 1980s. Corporations that support breast cancer interest groups believe that the purpose of a cause-related marketing relationship is to associate their brand with funding for breast cancer research, education, screening, and treatment. But who determines whether a corporation involved in such an enterprise is beneficent, corrupt, or simply medically ineffective, intertwining useless marketing gimmicks with effective information about breast cancer treatment? Governmental oversight must play an important role as a guardian of public safety by evaluating the information underwritten by corporate sponsors for false claims. Failing stricter governmental regulation, the cause-related marketing relationships that developed in the breast cancer movement may begin to mirror the free-for-all market in other sectors of the medical economy, such as erectile dysfunction drugs, where the pharmaceutical companies provide most of the treatment information to the public.

The emotional significance of breast cancer as a women’s health issue has established a competitive market with large economic stakes for research, treatment, and screening equipment. Breast cancer affects 1 in 11 women, affects women in all demographic groups, and currently has a variable response to medical treatment. It kills 40,000 women a year in the United States and is the leading cause of death for women between the ages of 40 and 59.[1] This may explain that although the current leading cause of death in U.S. women is heart disease, more money is raised per year for breast cancer research because breast cancer activists are able to tap into this strong emotional issue for women.[2] Because breast cancer is so pervasive among women, the symbol of support for breast cancer awareness, the pink ribbon, has become ubiquitous in the United States. This visibility attracted the attention of medical corporations, such as DuPont and AstraZeneca Pharmaceuticals, who considered this a co-marketing opportunity, simultaneously marketing their brand to the public and their products to the medical profession. Breast cancer activists have worked together with corporations in the 1990s and 2000s to influence medical research, particularly emphasizing earlier cancer detection and less toxic therapies. Other non-medical corporations, such as Yoplait, have shown that co-marketing with the pink ribbon can be a successful strategy to improve their corporate image and visibility while increasing funding for breast cancer research.

Before breast cancer became one of the dominant medical issues of the late Twentieth Century, developing a diversity of medical treatments for this disease, earlier treatment options were very limited and not very successful. Breast cancer was not treated at all until the development of anesthetics, such as ether. Soon after the popularization of anesthetics an American physician, William Stewart Halsted, performed the first radical mastectomy in 1892. While this procedure had a relatively low cure rate and high mortality it remained the dominant treatment for breast cancer well into the 1960s and 1970s. It was only then that studies demonstrated simple mastectomy with radiation could increase post-surgical survival rates.[3]

Corporate involvement in the breast cancer movement began in the 1980s once breast cancer activists successfully developed an acceptable social foundation for public debate in the media. As women of the Baby Boomer generation, those born between 1946 and 1964, began to reach middle age they were diagnosed with breast cancer in increasing numbers. The social norm at this time was for women who were diagnosed with breast cancer to suffer alone and in silence. The diagnosis was a death sentence and public reference to women’s breasts was taboo in U.S. society. But by the 1980s, breast cancer activism was successfully able to begin the dissociation of the sexual connotations of breasts with breast cancer. Furthermore, many more Baby Boomer women with breast cancer were college educated, and were more politically active than women of those generations before them. As a result, activists were more successful in encouraging women to discuss breast cancer in public forums as a way to promote awareness of the disease. This process also gained momentum from the success of the women’s health movement in general, which was also developing visibility at this time. This collective openness about women’s issues was reinforced by networking among women, especially those who were suffering from the stress of aggressive breast cancer treatment. In summary, during this period in the United States, changes in social norms, partly as a result of women’s health activism, made breast cancer a topic for public discussion.

The Susan G. Komen Foundation was established in 1982 to raise money and awareness for breast cancer. Komen is the world’s largest organization of breast cancer survivors and activists, with a company mission to work together to save lives, empower people, ensure quality care for all, and energize science to find the cure for breast cancer.[4] The organization was founded by Nancy Brinker to commemorate her sister, Suzy, who died from breast cancer in 1980. Two years later, her cause became more personal when she herself was diagnosed with breast cancer. Initially using the economic and political capital from her restaurateur husband, she set out with the belief that all breast cancer cures are done one woman at a time. As a result of the Komen Foundation to promote breast cancer as a public health issue, they successfully encouraged millions of women to get regular mammographic screenings. Brinker also used her social position to develop high-profile sponsored public events, such as a series of 5 kilometer running events called Race for the Cure, designed to fundraise and educate women about breast cancer.

In terms of their ability to attract corporate partners and sponsors to invest in breast cancer, the Komen Foundation has been a huge success. From 1982 to 2004 the Komen Foundation raised more than $180 million for research alone, with three-quarters of the money coming from more than one hundred Race for the Cure events and corporate marketing relationships.[5] The Komen Foundation was one of the first breast cancer organizations to raise funds for breast cancer research, instead of cancer research in general. Other breast cancer activists in the early 1980s were less successful because they participated in the debate of controversial feminist political topics that aimed to accommodate medically marginalized women. That Komen avoided these political debates is one reason why corporations and women from a variety of social and economic backgrounds have come together to fundraise and participate in Race for the Cure events. Also, the Komen Foundation probably receives more private philanthropy because of political neutrality. For example, Tipper Gore and Marilyn Quayle, both former vice-presidential ladies, have served as honorary chairs of the Komen Foundation’s Race for the Cure.

The Komen Foundation relies heavily on corporate relationships for financial support. Corporations also benefit from their sponsorship of Komen since they co-market their brand with a popular cause. In fact, national surveys indicate that consumers are more likely to buy a product if the brand supports a cause.[6] The business community currently supports Komen in three ways: corporate foundations, sponsorships, and cause-related marketing relationships. Corporate foundations are tax-exempt organizations that operate with a percentage of corporate profits and outsides donations. This differs from sponsorships, which align business marketing with a social issue. Lastly, cause-related marketing relationships contribute a percentage or predetermined amount of corporate profits to a social cause, which serves to link a product with that cause.

In the future, companies are likely to continue marketing for the Komen Foundation because a major target consumer for corporate America is affluent women, many of whom have breast cancer or know others who do. Another reason that corporations will probably continue their relationship with the Komen Foundation is that, according to the American author Barbara Ehrenreich, “breast cancer [activism] provides a way of doing something for women without being feminist.”[7]

Once corporate marketing became established as a supporter of breast cancer activism, it also adopted the pink ribbon as a co-marketing branding tool. In recent years the pink ribbon “brand” has expanded to pink consumer products, even such items as garbage cans, which indicate to the buyer that the producer of the product donates a portion of its proceeds to breast cancer organizations. Other pink ribbon products, such as teddy bears, have been designed as a way to comfort patients during their diagnosis and treatment of breast cancer.

The media has questioned whether it is helpful for women to get medical information about breast cancer from cause-related marketing. Breast Cancer Action (BCA), a support group that advocates for policy change, has especially focused on Yoplait’s support of the Komen Foundation. They have asserted that Yoplait had more advertising gain than their comparatively small contribution to Komen, since only 10 cents for every yogurt label was donated. Rob Wilson, an organizer of charitable races for corporate clients, said “it would be much easier and more productive if people . . . would write out a check to the charity.”[8] In response to BCA, the Komen Foundation countered that what mattered was “the fact that millions of people can come together to raise money by doing activities they do every day.”[9] Komen’s argument is that advertisement campaigns support networking among breast cancer survivors, and this increases awareness of routine breast screening, early detection, and successful treatment.

To combat criticism that the pink ribbon brand is a passive approach to fundraising for breast cancer research, the National Breast Cancer Coalition (NBCC) and Breast Cancer Action (BCA) began to circulate images of empowered women in mass media communications. In comparison to Komen, which avoids controversial politics, both the NBCC and BCA have been strong advocates for public policy changes that increase breast cancer research since they were founded in the 1990s. According to a poll conducted by the National Breast Cancer Coalition (NBCC) in October 2002, “50 percent of the population believes that wearing a pink ribbon is a somewhat effective tool to fight breast cancer and 32 percent have worn a ribbon as a symbol of support, [but] only six percent has contacted an elected official to push for Congressional action.”[10] The NBCC attempted to address this issue in their 2003 publicity campaign, “Not Just Ribbons,” using a pink tool belt, hard hat, and bulldozer to symbolize that hard work is required in breast cancer activism.

The pink ribbon symbol was first tarnished by a corporate association after mammography screenings were reevaluated by the National Cancer Institute (NCI) in 1993[11] and recently this practice was again criticized by an independent panel of experts appointed by the U.S. Department of Health and Human Services in 2009. [12] In 1993 the ACS issued a press release against the NCI review, stating that the scientists had not done enough research to support this announcement, a statement considered to be a suspicious reflex dismissal on the part of the ACS. In 2009 the ACS repeated their rejection of the update on mammographic screenings, supporting their statement with the argument that, “When recommendations are based on judgments about the balance of risks and benefits, reasonable experts can look at the same data and reach different conclusions.”[13] What the public needs to know about this debate is the coincidence that the ACS is arguing for increased mammographic screening and DuPont, a corporation that manufactures mammographic film, funds the ACS.[14] Clearly, such conflicts of interest may have far reaching effects for the public.

Even National Breast Cancer Awareness Month (NBCAM), a month long event in October that encourages screening through public service announcements, pamphlets, and public events, is funded by a health corporation. In October 1985 Imperial Chemical Industries (ICI) founded NBCAM and today its subsidiary, AstraZeneca Pharmaceuticals, has taken over these events. AstraZeneca Pharmaceuticals works with other sponsors, such as the ACS, the National Cancer Institute, and the American College of Radiology. The ACS has especially been criticized for their co-sponsorship with AstraZeneca Pharmaceuticals, since the company manufactures tamoxifen, a synthetic hormone used in the treatment of breast cancer. According to Jeanne Marshall of Cambridge’s Women’s Community Cancer Project (WCCP), NBCAM should actually stand for National Cancer Industry Awareness Month to emphasize “the true motive behind National Breast Cancer Awareness Month: corporate greed.”[15] An especially important protest took place in October 1995, when demonstrators held candle light vigils outside their local ACS chapter to highlight the economic stakes held by the ACS in co-marketing tamoxifen.

Whatever the motivations of health corporations, cause-related marketing has “profoundly changed the public’s awareness of the disease and significantly increased the budget of many breast cancer organizations, thereby increasing the impact of their work.”[16] A total of 184 corporations[17] helped Komen invest $55 million in 2008 alone in the fight against breast cancer.[18] A problem with this vast sponsorship is that by itself, Komen is unable to review the motivations of every corporate sponsor.

Legislation implementing health reform would allow the millions of women who have no health insurance to have access to a range of resources and services to educate them on the risks and benefits of different breast cancer treatments. With the guidance of a physician, paid for by universal health care, all women could make informed decisions about treatment options. Corporate-sponsored information could be helpful if determined by the government to have an unbiased presentation. Truth in medical advertising should be an important goal for improving the health of U.S. society. Pharmaceutical companies now are able to promote inaccurate expectations of women about the fight against breast cancer. One such advertisement reads, “If you care about breast cancer, care more about being a 1.7 than a 36B. Know your breast cancer risk assessment number. Know that NOLVADEX© (tamoxifen citrate) could reduce your chances of getting breast cancer if you are at high risk.”[19] Women must receive a balanced presentation of the risks and benefits for their treatment options. Although the FDA approved it for the prevention of breast cancer, what is not mentioned in these advertisements is that tamoxifen makes women twice as likely to develop endometrial cancer, three times as likely to develop pulmonary embolism, and 50 percent more likely to suffer a stroke.[20] Only the government has the scope and ability to shape the content of medical advertising in the United States. It might be argued that the public lacks the sophistication to understand a comprehensive discussion of the risks and benefits of a pharmaceutical treatment. This actually argues against advertising that only presents positive attributes.  

The relationship of corporate America with breast cancer awareness promotion has become more complex since the pure activism of the 1980s. Such engagement of corporations in medical affairs has led to significant increases in awareness, research funding, and treatment options for women with breast cancer. However, the large financial gains of these arrangements, including those related to medical marketing makes it essential that these relationships are scrutinized for corporate bias and accuracy by the federal government.

 

 

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