Léa Pool, director & Ravida Din, producer. Ottawa, ON: National Film Board of Canada, 2011; Feature documentary, 97 min; Now in theatres across Canada & the US.

Reviewed by Brenda Sabo

Who isn’t familiar with one of the most successful awareness campaigns targeting cancer, specifically breast cancer? The pink ribbon campaign has extended its reach beyond North America to not only draw attention to women’s health, but also become one of the most successful global fundraisers for cancer research.

The campaign had its genesis in a small grassroots movement founded by 68-year-old activist Charlotte Haley in an effort to raise awareness about breast cancer and the need for funding to support prevention research. But, has the campaign met its objectives?

Enter filmmaker Léa Pool and her feature documentary from the National Film Board of Canada, Pink Ribbons, Inc. (2011). In the documentary, key researchers and authors encourage us to move beyond complacency and naive acceptance of a feel good initiative awash in soft feminine pink by exposing how social activism in the form of a successful awareness campaign can become a corporatized, political marketing machine.

Barbara Brenner of San Francisco, who for 15 years led the grassroots advocacy group Breast Cancer Action, known for its Think Before You Pink campaign, launched in 2002, suggests that “if people really knew what was happening they would be really pissed off.”

The landscape of philanthropy has shifted from government-driven policy and funding to corporatization, which set the stage for “cause-marketing.” The pink ribbon has become a unique phenomenon of capitalism in creating a viable link between business and breast cancer with the “bottom line” as the new objective.

With more than 80 per cent of purchasing decisions made by women, pink can now be seen in everything from toilet tissue to guns, Kentucky Fried Chicken (a rather short-lived association brought down by the “what the cluck” movement) to monument lighting such as Niagara Falls and parliament buildings. It is hard to fathom what guns, toilet tissue or lighting up Niagara Falls with rose spotlights has to do with breast cancer or even facilitating behavioural change.

Although the pink ribbon campaign may appear to be about connecting, communicating and conquering breast cancer, the actual message may be misleading. Is it about cure and survivorship or is it about how pink sells? Is it about large corporations such as cosmetic giants Estée Lauder, Avon and Revlon selling their products in a particular way so as not to alienate the consumer?

Pool challenges us to identify what, if any, change has occurred as a result of the pink campaign. Has research made a difference in identifying a cure; has behaviour changed; how much emphasis has gone into prevention strategies; are all groups of women and men reflected equally in the campaign? Where do women and men diagnosed with advanced and metastatic disease fit within a philosophy focused on survivorship and cure?

The status quo has remained relatively unchanged despite the multi-million dollars in research targeting a cure, with only 15 per cent of fundraising going to prevention, and just five per cent of that supporting research into possible environmental causes of the disease. Few dollars have explored what causes cancer to metastasize.

More important, according to researchers, more than 50 per cent of breast cancer patients do not have known risk factors. How could we have missed this? Does finding a cure sound nobler than prevention and risk identification?

Activists suggest the campaign has been successful in creating a culture wherein breast cancer appears to target ultra-feminine, middle-class women. Who else could be associated with soft pastel pink? The pink wash message appears comforting, non-threatening, everything breast cancer notably is not. It’s about quick fixes diverting us from what is currently outside our control — survivorship and cure.

America’s leading breast cancer charity, Susan G. Komen for the Cure, has been pivotal in generating momentum around survivorship and cure. By focusing on these two objectives, the foundation has effectively created a culture of breast cancer that has resulted in the isolation, alienation and stigmatization of women and men with advanced and metastatic disease. Where do women with advanced and/or metastatic breast cancer fit? They personify images of death.

The cultural norm within pink ribbon implies that if one complies with treatment, if one battles hard enough or if one is strong enough cancer can be beaten. In essence, the message emerging from the promotion fails to achieve a balance between hope, understanding and the reality of breast cancer — it kills up to 59,000 women in North America every year.

For women with advanced disease the message is about personal failure, of losing the battle. As one woman stated, “You can die in a perfectly healed state.” Survivorship is a label, an unintended put-down of women and men who don’t survive, who were unable to beat the disease.

In a misguided effort to encourage engagement, the pink ribbon campaign has relied heavily on the language of war: battles, warriors and the fight. Juxtaposed within a militaristic metaphor is the notion of remaining positive and upbeat. This would seem anathema if one considers the vicissitudes of war. How does placing a smile on your face 24/7 change the outcome for cancer beyond making society feel less uncomfortable when interacting with cancer patients?

Such an unrealistic expectation places undue pressure on breast cancer patients to conform to socially created norms which, in the end, only serve to alienate women with normal feelings of sadness, anger, etc. by delegitimizing their experience. This lack of conformity or “failure to fit” as some of my patients have commented about the campaign has led to what has been termed a “tyranny of cheerfulness.”

In the end, Pink Ribbons, Inc. challenges us to see the faces of breast cancer rather than the pink ribbons. It encourages us to think critically and call into question the meaning and purpose of the campaign. It is provocative, uncomfortable and non-complacent; a heady mix guaranteed to stimulate debate and encourage us to more closely examine social activism and how easily it can become corporatized under the umbrella of philanthropy.

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Brenda Sabo is a registered nurse and associate professor in the school of nursing at Dalhousie University in Halifax, Nova Scotia.