The fallout over the decision by Susan G. Komen for the Cure to stop giving grants to Planned Parenthood affiliates reflects a growing anger across the country over the intrusion of political ideology in matters concerning women’s health.

It’s fair to say the well-funded foundation had not thought through, or vastly underestimated, the criticism it would receive for making a thinly veiled political decision to cut off funding for breast-screening exams for low-income women. And based on the level of disapproval it’s facing, it may be sometime before Komen can recover.

In the meantime, its decision may well be remembered for activating people who, up until now, may not have given much thought to the right-wing influence on women’s health care.

It’s surprisingly easy for people to separate politics from their own lives. While they might believe certain political decisions are not very smart, they are unlikely to speak up if it does not affect them. But the breast cancer community, comprised of women recently diagnosed, survivors, family members and advocates of more research funding, has long been portrayed as one big family — largely by Komen, which sponsors the very popular and very pink fundraising walks.

For Komen to cut out some of that family — because of pressure from anti-abortion activists who refuse to acknowledge Planned Parenthood’s delivery of vital health care services — simply strikes too close to home.

Deana Rohlinger, an associate professor at Florida State University who studies women’s groups, said on NPR’s “All Things Considered” this week, “It’s not a secret by any stretch of the imagination that Planned Parenthood does abortion. That’s not brand new information. But for some people, that Komen is getting politically involved is.”

The truth is that Komen has been politically involved for some time. OBOS Executive Director Judy Norsigian, in an interview on “Morning Edition,” noted that Komen’s founder and CEO Nancy Brinker has been a longtime Republican supporter and fundraiser, “and on many occasions has supported policies that most supporters of Komen probably wouldn’t approve of.” Some of those policies are outlined in this posting at Daily Kos.

But it took pulling money for breast cancer screening from one of the most popular organizations serving women of all backgrounds to blow open Komen’s politics.

According to news reports, Komen’s president, Elizabeth Thompson, told Cecile Richards, president of the Planned Parenthood Federation of America, in a phone call in December that it would not be renewing its grants. The funding totaled around $680,000 in 2011 and $580,000 in 2010 for breast-cancer screening and other breast-health services offered at 19 Planned Parenthood affiliates.

The reason given was that the charity had adopted new rules barring grants to organizations under investigation by local, state or federal authorities, and Planned Parenthood was under House investigation. It is, of course, very easy to open an investigation without merit. In this case, Republican Rep. Cliff Stearns of Florida launched an inquiry last fall to determine whether Planned Parenthood spent public money on abortions, which is prohibited by federal law. The inquiry was seen as a far-reaching political ploy to discredit the organization, after Republicans failed to cut off Planned Parenthood funding.

Reps. Henry Waxman and Diana DeGette, both Democrats, sent a letter to Stearns questioning the basis for the investigation, noting in part that federal audits “have not identified any pattern of misuse of federal funds, illegal activity, or other abuse that would justify a broad and invasive congressional investigation.”

It struck some as no coincidence that Komen had recently hired a new senior vice-president for public policy, Karen Handel. During her failed run for governor of Georgia in 2010, Handel described herself as “staunchly and unequivocally pro-life” and pledged to eliminate grant funding for breast and cervical cancer screening at Planned Parenthood.

The Atlantic’s Jeffrey Goldberg reports that the no-investigations rule was, according to “three sources with direct knowledge of the Komen decision-making process,” created specifically as an excuse to dump Planned Parenthood, and that decision was driven by Handel. A former employee talked on the record about the resignation of Mollie Williams, Komen’s top public health official, who left the organization in protest:

John Hammarley, who until recently served as Komen’s senior communications adviser and who was charged with managing the public relations aspects of Komen’s Planned Parenthood grant, said that Williams believed she could not honorably serve in her position once Komen had caved to pressure from the anti-abortion right. “Mollie is one of the most highly respected and ethical people inside the organization, and she felt she couldn’t continue under these conditions,” Hammarley said. “The Komen board of directors are very politically savvy folks, and I think over time they thought if they gave in to the very aggressive propaganda machine of the anti-abortion groups, that the issue would go away. It seemed very short-sighted to me.”

Lessons on Media Strategy

From a PR perspective, it’s been a disaster for Komen. Previously, the foundation has had to deal with a small number of anti-abortion activists who dismiss all of Planned Parenthood’s vital healthcare services (pdf) out of hand because a small percentage of its work is abortion-related (3 percent of services in 2010 — cancer screening and prevention accounted for 14.5 percent) and who don’t understand how grants work. Some of them erronesously believe abortion raises a woman’s risk of breast cancer, though numerous studies and the National Cancer Institute have affirmed it does not.

Now Komen must confront the wrath of its own supporters, many of whom have raised thousands of dollars for Komen over the years and won’t stand for political shenanigans. Based on interviews and comments left on Komen’s discussion forum and elsewhere online, many of those women who have developed strong ties with the breast cancer community are looking to send their money elsewhere.

Kivi Leroux Miller, a nonprofit communications strategist, told Politico that Komen “pretty much cut their fundraising support in half.”

“I don’t think they meant to make a huge political statement, but it was extremely naïve of them to think this wasn’t hyper-political,” Miller continued. “They have dove head first into the abortion debate — in fact, they fell into the pool — and whoever is doing their communications doesn’t know how to swim.”

Miller has more media analysis on her site in a post titled “The Accidental Rebranding of Komen for the Cure.” Social media consultant Beth Kanter has written a good summary of online responses, “Komen Kan Kiss My Mammagram, PinActivism, and Newsjacking for a Cause.” Kanter also set up a Pininterest board, “Komen Kan Kiss My Mammogram,” named after Allison Fine’s fundraising campaign for Planned Parenthood. Kanter invited other women to contribute, and the result is fabulous collage of pro-Planned Parenthood posters, videos and news.

In another brilliant stroke of online activism, media technologist Deanna Zandt yesterday launched a Tumblr site for people to submit stories about how Planned Parenthood literally saved or changed their lives by providing birth control and affordable preventive health care. Here’s one of the many stories you’ll see:

I had gone back to school in my late 20s and was temporarily uninsured. I went to Planned Parenthood in Manhattan for my yearly checkup and contraceptives. They detected abnormal cervical cells that were precancerous, and soon afterward they performed cryosurgery to remove the cells. The fee was something this temporarily poor college student could afford. I remained loyal to PP for my annual checkup. Several years later, they found a breast lump and guided me to further screening (by then, I was insured again). I was fortunate that it turned out to be nothing, but my knowledge that PP would be there for me no matter what put my mind at ease during that week between tests.

Planned Parenthood has benefited greatly, in funding as well as good will. It received nearly $400,000 in donations in the first 24 hours after the Komen news broke. New York City Mayor Michael Bloomberg announced Thursday he would personally give Planned Parenthood a $250,000 matching gift, donating $1 for ever new dollar Planned Parenthood raises up to $250,000. For more donation and activism opportunities, Katha Pollitt has a nice round-up at the end of her wonderfully titled column, “The Komen Foundation Pinkwashes Anti-choicers, Punks Planned Parenthood.”

Critiques Against Komen Go Beyond Political Bias

Komen seemed to completely misjudge the extent of the fallout, refusing to make spokespeople available Tuesday and failing to respond quickly on Facebook or Twitter. Brinker, Komen’s founder, finally appeared in a video posted to YouTube late Wednesday, terming the criticisms a “dangerous distraction.” She said the decision resulted from a review of grants and standards and pledged that the changes in grantmaking would enable Komen to ultimately help more women. Brinker also said Komen would “never turn our backs on women who need us the most.”

That remains debatable. While the public outcry stems from learning that Komen currently is not acting in the best interest of women’s health, its critics have long questioned whether the enormous amount of money Komen raises is put to good use. For instance, Komen only recently decided to start looking at the environmental causes of breast cancer — something groups like Breast Cancer Action and Silent Spring Institute have long advocated for.

In recent years, there’s been growing criticism of Komen’s ties to companies that don pink ribbons each year while developing products that contain carcinogens and increase cancer risks. (Remember the mocked “Buckets for the Cure” hookup with Kentucky Fried Chicken?) This practice, known as pinkwashing, sparked BCA’s Think Before Your Pink campaign. As Barbara Brenner, former BCA director, told NPR in 2010: “If shopping could cure breast cancer, it would be cured by now.”

In addition, Komen’s screening guidelines are at odds with recommendations put forth in 2009 by the U.S. Preventive Services Taskforce — guidelines that OBOS explained in detail back then and fully supports. Komen’s promotion of certain drugs used to treat breast cancer has also come under scrutiny.

“In the past, they’ve let women down by insisting that the FDA should continue to approve Avastin as an effective treatment for breast cancer when new evidence sadly showed, that it’s not,” Cindy Pearson, executive director of the National Women’s Health Network, said on NPR’s “Morning Edition.” “They’ve also insisted that screening for breast cancer start at a young age and be very frequent when evidence shows it’s not that much of a slam dunk anymore.”

Writing in The Atlantic, Linda Hirshman raises another question:

In a ghastly coincidence, the same day Komen pulled the money from Planned Parenthood because Stearns thought they were spending federal funds on abortions, the Journal of the America Medical Association published a damning study that almost half of women receiving second surgeries after lumpectomies didn’t need the procedure. Painful, disfiguring, unnecessary surgery. At least three of the four sites studied in the JAMA report — the University of Vermont, Kaiser Permanente Colorado, and the Marshfield Clinic — has a relationship with the Komen Foundation. Kaiser Permanente is a “corporate campaign partner,” the University of Vermont received a research grant, the Central Wisconsin Komen affiliate sponsors programs at the Marshfield Clinic. Maybe Komen should concentrate their granting criteria on whether the recipients are actually helping cancer patients.

But for now, the spotlight is on Komen’s politics.

The AP’s David Crary spoke with Patrick Hurd, CEO of Planned Parenthood of Southeastern Virginia, a recipient of a 2010 grant from Komen. His wife, Betsi, has participated in several Komen for the Cure fundraising races and is currently battling breast cancer.

“We’re kind of reeling,” Hurd said. “It sounds almost trite, going through this with Betsi, but cancer doesn’t care if you’re pro-choice, anti-choice, progressive, conservative,” Hurd said. “Victims of cancer could care less about people’s politics.”

Unless those holding the purse strings play politics with cancer.

Via Susan Love’s Army of Women project, we learned about a breast cancer research study headed by Boston University researchers that is currently recruiting lesbian and bisexual women. The goal of the study is to learn more about quality of life and well-being issues for lesbian and bisexual women who have been diagnosed with breast cancer, and to use that information to inform services and reduce health disparities.

From the email announcement:

It is widely known that a breast cancer diagnosis can have far reaching effects both socially and emotionally. Less well understood are the ways in which a breast cancer diagnosis impacts the well-being and quality of life of women who have historically been underserved by the medical community. Lesbian and bisexual women are one of these underserved populations, and little research has been done to assess their health and well-being as women with breast cancer. Identifying their unique needs by asking some questions in a survey will help researchers to develop culturally appropriate programs for these women.

The researchers are interested in hearing from all lesbian and bisexual women who have had a breast cancer diagnosis. They have a particular interest in women who have metastatic disease, recurrent disease, or an additional invasive cancer diagnosis, or are currently undergoing cancer treatment. If you have ever been diagnosed with breast cancer, please read on to learn more about what’s involved and who can participate.

Women have been diagnosed with breast cancer at some point their lives and identify as lesbian, bisexual, or as a woman who partners with women are eligible to participate. Participants will complete a 45 minute phone survey about their health, medical history, demographics, and sexual orientation.

Visit this page at Army of Women to learn more or sign up online to participate.

Breast Cancer Action is hosting free one-hour webinars on Tuesday, January 24th and Wednesday, January 25th to discuss the recent Institute of Medicine report on environmental risks for breast cancer, including how advocates can help move forward the report committee’s recommendations for better understanding and managing these risks.

BCA will discuss some of their concerns about the report, as well as focus policy changes required to reduce exposures to potentially cancer-causing agents.

The report, commissioned by Komen, explores the difficulties of studying how environmental factors affect breast cancer risk, recommends future research, and makes recommendations for steps women can take to reduce their breast cancer risk. Unfortunately, many of the clear actions provided in the report for reducing risk are well-covered things like “quit smoking,” while the strongest conclusion that could be drawn on many other exposures (like cosmetic and personal care products, plastics and other pollutants) was that more research was needed.

If you’re interested, you can register for register for 2pm-3pm (PST) on the 24th or 10am-11am (PST) on the 25th.

You may have seen recent news coverage along the lines of “BRCA variants not tied to worse cancer outcomes.” This story refers to a recently published study about changes in the BRCA1 and BRCA2 genes that affect breast and ovarian cancer. Women with mutated versions of the genes have greater risks of breast and ovarian cancer than women with typical versions of the genes.

In the new study in the Journal of Clinical Oncology, researchers tried to figure out whether women with BRCA1 or BRCA2 mutations who do develop cancer have worse outcomes than women without the mutations. They compared records for women with breast cancer and one of the mutations with those of women with breast cancer who did not have these gene changes.

Overall, they found that women with BRCA1 mutations had similar rates of metastatic (“distant”) cancer recurrence and death as women without it. Women with BRCA2 mutations had higher risks of recurrence and death, although the risk was similar when the women got adjuvant therapy (additional treatment to help prevent recurrences). Other factors like age and stage of the cancer also made a difference.

However, this study should be interpreted with caution. Bigger studies are probably still needed to properly understand any effects of these genes on women’s cancer therapy outcomes. The similarity of outcomes between women with and without the mutations may have to do, in part, with what we have learned about therapies for women with those mutated genes – which therapies don’t work as well for them, and which therapies might be added on for better outcomes. The researchers for the current study do say that women with mutated BRCA1/2 genes were more likely to have received adjuvant therapy, and the authors were unable to look at women’s results by how much chemotherapy they received.

While women who have BRCA1/2 mutations may be advised to have earlier or more frequent cancer screenings than other women, it’s not yet completely clear who should get tested for these mutations or if women should be tested once they’re diagnosed with breast or ovarian cancer.

As we learn more about how our genes affect our cancer risks and therapy outcomes, I expect we’ll see more and more news on these topics, and it may take some time to figure out how to assess risk, guide cancer therapies, and how our outcomes change based on this knowledge. Here are a few helpful resources for this growing area of study:

• Genetics Home Reference – Cancers – information from the National Library of Medicine on genes related to a number of cancers
• General Cancer Genetics Information – information from the National Cancer Institute on genetic (hereditary) risks for cancer, gene testing, a dictionary of genetics terms, and other resources
• My Cancer Genome – information intended to help inform physicians about tumor (not hereditary) genes and their effect on cancer therapy. Disclosure: I work with the team that produces this site.

Tara Parker-Pope at the New York Times’s Well blog begins a recent post with a provocative question: Has the power of the mammogram been oversold?

It’s not a question that has been completely ignored – considerable debate erupted in late 2009 when the US Preventive Services Task Force released new guidelines recommending that women without higher risk wait until age 50 to begin routine mammograms.

Our Bodies Ourselves, the National Women’s Health Network and Breast Cancer Action all have previously raised concerns about the right timing and use of mammograms, especially in women without an elevated risk of breast cancer, but working against a popular myth that more mammograms sooner are always better for women’s health is a challenging task.

Parker-Pope explains:

…many doctors say it’s also time to set the record straight about mammography screening for breast cancer. While most agree that mammograms have a place in women’s health care, many doctors say widespread “Pink Ribbon” campaigns and patient testimonials have imbued the mammogram with a kind of magic it doesn’t have. Some patients are so committed to annual screenings they even begin to believe that regular mammograms actually prevent breast cancer, said Dr. Susan Love, a prominent women’s health advocate.

Her post also explains a study just released in the Archives of Internal Medicine, “Likelihood That a Woman With Screen-Detected Breast Cancer Has Had Her ‘Life Saved’ by That Screening.”

The Dartmouth researchers conducted a series of calculations estimating a woman’s 10-year risk of developing breast cancer and her 20-year risk of death, factoring in the added value of early detection based on data from various mammography screening trials as well as the benefits of improvements in treatment. Among the 60 percent of women with breast cancer who detected the disease by screening, only about 3 percent to 13 percent of them were actually helped by the test, the analysis concluded.

Translated into real numbers, that means screening mammography helps 4,000 to 18,000 women each year. Although those numbers are not inconsequential, they represent just a small portion of the 230,000 women given a breast cancer diagnosis each year, and a fraction of the 39 million women who undergo mammograms each year in the United States.

Do check out the rest of Parker-Pope’s post for further exploration of this controversial topic; the full text of the journal article has also been made available online for free.

Somewhat relatedly, Shira Sternberg writes at Public Responsibility in Medicine and Research’s Ampersand blog (no, not that Ampersand…) about breast cancer from her perspective as the daughter of daughter of “longtime PRIM&R friend” Pat Barr, who died of breast cancer eight years ago. Shira reminds us that there is still work to be done:

In 1991, 119 women died a day of breast cancer, today it is about the same, 110 women die daily of the disease. And this year alone over 230,000 women will be diagnosed with the disease. We gathered at the White House because we know we can do better.

Pinkwashing is the selling of potentially harmful or cancer-causing products through pink ribbon promotions, many of which were active in October, which is national breast cancer awareness month.

Breast Cancer Action is running their “Raise a Stink!” campaign in response to concerns about one particular product, the “Promise Me” perfume marketed by Komen. BCA raised concerns that some ingredients in the product could be potential carcinogens, and objected to the small amount of money donated for each bottle of perfume.

Komen released a statement saying that its ingredients meet industry standards and applicable FDA guidelines, but the organization apparently plans to reformulate the perfume next year.

The FDA does not require cosmetic products to be tested and approved before they go on the market, and relies on voluntary industry disclosures of ingredients.

BCA also published a list of additional questions after reviewing Komen’s response, and is asking supporters to send a letter to Susan G. Komen for the Cure’s CEO, Chief Marketing Officer, and Vice President to request removal of the perfume from the market. BCA is also asking Komen to more carefully evaluate which products are marketed with pink ribbon promotions.

Susan Love, the well-known breast cancer researcher and women’s health advocate, was a 23-year-old medical student when the first edition of “Our Bodies, Ourselves” was published, but the book’s impact was instant and permanent.

“It completely revolutionized how I and really the whole world looked at women’s health,” she said during an exclusive web-only interview with NBC Nightly News, which earlier this week broadcast a report on the 40th anniversary of “Our Bodies, Ourselves” and the new 2011 edition. (Also see the web-only interview with OBOS co-founder Judy Norsigian.)

Women were treated as “small men who have babies,” says Love, noting there was no effort made to understand how women’s bodies or brains might be different than men’s. “Men were the model, and women were sort of this extra thing.”

“Our Bodies, Ourselves” put forth the radical notion that women are worthy of study. Love recalls seeing the map of the cervix in the first edition of and thinking, “It was amazing, it was a miraculous thing! Who knew what was in there?”

Fast forward 40 years, and Love is still considering the differences between women and men in her medical research. While most of the medical community studying breast cancer is focused on cancer cells, Love focuses on the breast itself.

“Believe it or not, all these years after ‘Our Bodies, Ourselves,’ we know all the molecular biology of breast cancer. But we still don’t know how many holes are in the nipple that milk comes out of,” said Love. “We still don’t know the anatomy of the breast. We still don’t know what the breast is doing when it’s not making milk. So we still need ‘Our Bodies, Ourselves’ in our lives.”

Visit msnbc.com for breaking news, world news, and news about the economy

This weekend, the New York Times ran a lengthy article on “The Pinking of America,” framed as a discussion of pink-themed marketing campaigns related to breast cancer awareness.

In it, they describe the numerous pink products on sale, especially in October, which is Breast Cancer Awareness month, noting that these campaigns have “become a multibillion-dollar business, a marketing, merchandising and fund-raising opportunity that is almost unrivaled in scope.” NFL teams, tires, mascara, blenders, and many more products have gotten a pink makeover to raise money for screening and treatment research.

As we’ve written here before, and as Breast Cancer Action’s Think Before You Pink campaign works to remind us, there are many criticisms of these pink campaigns, including the relatively small amounts actually being contributed through each pink purchase; pinkwashing – the selling of potentially harmful or cancer-causing products through pink ribbon promotions; the focus on mammograms and treatment rather than prevention; and the possibility that promoting aggressive early screening may lead to harm from unneeded treatments.

The Times piece, however, gives relatively brief and shallow coverage to these criticisms, each one counterbalanced by news of new Komen initiatives and remarks like, “Until we make more progress on the treatment side, on the understanding of what’s causing breast cancer, what would people like us to do, stop talking about it?”

Of course not. But there’s a tremendous gap between asking people not to talk about breast cancer and questioning whether the existing marketing machine is really channeling its efforts in the best possible way. I was heartened, however, by the comments, which raise critical questions not explored in the article. A few examples:

Komen’s willingness to help the NFL avoid the consequences of it’s players’ behavior toward women should not be excused.

I am a breast cancer “survivor” (so far) and I too dislike the pink. Emphasis on “the cure” and no emphasis at all on the cause: pollutants in the air water, food — caused by the same corporations who donate to the pink campaign….Fact is: if you don’t have health insurance, you won’t be able to afford the cure. And many insurers no longer pay for some of the most effective (and expensive) cancer treatments.

Instead of asking grown women to lick the lids of yogurt containers and mail them in like some school fundraising effort, companies that want to donate money can just do so—explaining to consumers that X% of sales for October will go to disease research.

Unless you’re close to someone who is suffering or has been suffering from breast cancer, you don’t see the emotional trauma that is brought on by chemo, hair loss and mastectomies. It’s time that Komen makes the reality of breast cancer less taboo. It shouldn’t just be about cute pink teeshirts and umbrellas.

As a final note, this quote from Komen’s CEO just grossed me out (emphasis mine): “America is built on consumerism. To say we shouldn’t use it to solve the social ills that confront us doesn’t make sense to me.” Ugh.

A new article in the journal Environmental Justice provides a compelling overview of a topic we have covered several times here – pinkwashing, or the pink-drenched efforts of corporations to be seen as doing something about breast cancer at the same time as their products or practices are possibly contributing to the disease.

In Pastel Injustice: The Corporate Use of Pinkwashing for Profit, authors Amy Lubitow and Mia Davis provide an introduction to the concept of pinkwashing, talk about environmental factors in breast cancer, and explain the problem of having corporations generate public goodwill from pink-themed breast cancer campaigns. They argue:

Funds raised from breast cancer walks and runs undoubtedly serve to further treatment and early detection of breast cancer (which saves more women’s lives). However, corporate entities marketing to cancer patients and their families develop brand loyalty, generate free advertising on the part of women who participate, and discourage questions about the role of chemicals used in consumer products in cancer incidence.

The authors go on to call pinkwashing a form of social injustice, and decry the focus solely on cancer treatment rather than on prevention. In critiquing the “buy something pink” model of responding to breast cancer, they outline how this approach excludes both many types of women at risk for cancer and prevention efforts that don’t focus on finding “a cure.”

Questions about disease causation, feelings of anger, frustration, or sadness do not meld with the dominant imagery of women who have conquered—or must be made to feel that they can conquer—the disease. Notably, this mainstream image is effectively a white, middle class model which excludes women of color, who are not only less likely to survive the disease than white women, but who may not connect with the hegemonic model of survivorhood that centers on fundraising walks (some of which require $1,800 as a baseline for participation), and which are heavily populated by white women.

Thus, women’s time, energy, and passion are diverted from efforts to prevent the disease and reduce its occurrence, and instead are focused on raising money (often by spending money on pre-assigned pink ribbon products, and cloaking themselves entirely in pink clothes with corporate logos). Everyone is told to keep their eyes on the prize: the elusive cure. This lost time and money, and more importantly, the physical pain and emotional hardship that families and communities endure with every breast cancer diagnosis is not accounted for or honored when we seek only ‘‘the cure.’’

This article is bound to be somewhat controversial, provoking questions of whether small amounts of certain chemicals are likely to cause any harm, whether additional safety studies or regulations are needed, and how much influence environmental exposures have compared to other risk factors. Whether campaigns to buy pink products or focus primarily on treatment are the appropriate way to focus our energies on breast cancer, though, is certainly something worth thinking about and discussing. The article is available online for free.

An upcoming webinar may be of interest to readers:

Patients Before Profits: What You Should Know About the FDA, Big Pharma, and Breast Cancer
June 21, 2011 10:00AM – 11:00 AM Pacific (1:00 pm – 2:00 PM Eastern)

Featuring Miriam Hidalgo, BCAction Volunteer Program Coordinator and Jane Zones, Medical Sociologist and Former BCAction Board Member

We will focus on how the competing interests of pharmaceutical companies and regulatory governmental bodies can fail to deliver safe and effective drugs that patients need. If you sign up, you will learn about power players at the FDA, the origins of the accelerated approval process, and more.

You will need to register online for this webinar and then will receive an email with instructions on how to join in on the 21st.

On Friday, Christine posted, FDA Moves to Revoke Approval of Popular Breast Cancer Drug, with the news of and reactions to the FDA’s recent decision that Avastin (bevacizumab) should no longer be approved for use for breast cancer because “the agency has determined that the risks of the drug outweigh the benefits for this use.”

The FDA has posted a site with additional details about the recommendation, including their decision memo explaining the agency’s rationale, press release, questions and answers, and letter to the breast cancer community.

The FDA has begun the extraordinary process to revoke approval of the use of the popular drug Avastin to treat advanced breast cancer.

Avastin had received accelerated approval in 2008, but further studies have not shown that the drug improves either overall survival rate or quality of life.

Andrew Pollack of The New York Times notes that the approval is not without some controvery — as “various breast cancer patients and some patient advocacy groups have urged the F.D.A. to keep the drug approved and not deny patients a chance at what they say could be a life-saving therapy.”

Pollack also notes the financial stake the drugmaker Roche has in the drug: “Avastin is the world’s best-selling cancer drug, with annual sales of about $6 billion. Analysts have estimated that revocation of the breast cancer approval could cost Roche $500 million a year or more in lost sales.”

Some Republicans in Congress, moreover, have tried to portray the potential revocation as “an attempt at cost control, the beginning of rationing under the new health care law,” even though the FDA’s actions are part of the system set up in the 1990s to evaluate drugs that have received accelerated approval.

Breast Cancer Action, whose opinion we trust more than Republicans’ when it comes to advocating for the best interests of women, opposed Avastin’s original approval of the drug and sent a letter to the FDA this past July recommending approval be revoked. As BCA Program Manager Kimberly Irish noted in an e-mail concerning the latest news, the FDA’s decision is a matter of medical justice:

In 2007, BCA was the only breast cancer organization to actively oppose the use of Avastin for metastatic breast cancer patients because of its failure to improve overall survival or quality of life, its side effects and its high price tag. We applaud the FDA for recommending that Roche’s request for full approval of Avastin for advanced breast cancer treatment be denied.

The interests of patients must come before the profits of companies manufacturing the treatments. We need to continue to demand better drugs for people with metastatic disease. We have a long way to go to end this epidemic but the FDA’s decision to put patient needs before drug company profits is at least a step in the right direction.

We’ve written multiple times about pink ribbon-type breast cancer awareness campaigns — with good reason.

Concerns abound over whether the explosion of pink products for purchase promotes a false sense of doing something about breast cancer; whether the dollars collected by these pink campaigns are directed effectively; the gender stereotypes perpetuated by both the color focus and many of the product campaigns; and whether some of those pinked-out products may actually be harmful to women’s health.

Noted author Barbara Ehrenreich explores the issue more thoroughly in this still incredibly relevant 2001 Harper’s piece, and discussions of “pinkwashing” can be readily found online.

NPR dove into the debate recently with two interviews: one with Barbara Brenner of Breast Cancer Action, which has raised the concerns above for some time, and the other with Katrina McGee of Susan G. Komen for the Cure, which signs off on the majority of those pink ribbon product campaigns.

Brenner argues:

“Awareness we have, the question is, what are we doing about it? And when companies can just slap a pink ribbon on any product, then we’re in trouble, because many of those products don’t do anything for breast cancer. And many of them are actually harmful to our health.”

The stand-out line: “If shopping could cure breast cancer, it would be cured by now.”

KFC’s “Buckets for the Cure” campaign, says Brenner, sends the wrong message: “You can’t sell pink bucketed chicken that’s bad for your health to raise money to help breast cancer.” BCA has more info on its website concerning the implications.

McGee, in a separate interview, seems to argue that branding unhealthy products (such as fried chicken from KFC) with pink ribbons is OK, because the organization believes “in reaching people where they live, work and play.” She continues:

“KFC helps us do that in very small communities where they may be the only fast food restaurant in town, and in many large communities where the franchisees, and those are really the people who made the contribution, sent their commitment to breast cancer to race for the cure. They did education in their restaurants and a host of other things to support the partnership.”

When asked whether there is a certain amount of pink ribbon fatigue, and whether people are somewhat jaded about these campaigns, McGee answered:

No, I really don’t. I mean, first of all, you know, nearly 40,000 women die of breast cancer each year. And until we get to the point where less women are dying, we will never have enough pink. And as long as there are still myths and misperceptions in the market, we need Breast Cancer Awareness Month. We hear all kinds of things from underwire bras cause breast cancer, to promiscuous sex causes breast cancer, to, you know, if I use a hair relaxer, it will cause breast cancer. [...] It’s the reminder, the repetitive messaging that gets women to act.

Critics of the campaign would probably ask how much of those purchase-related donations actually contributes to education about such issues.

For further guidance on evaluating pink ribbon campaigns, see Breast Cancer Action’s list of questions for consumers to ask in order to “Think Before You Pink.”

It’s October, so the explosion of pink products at the grocery and other stores shouldn’t surprise us: it’s National Breast Cancer Awareness Month, the time of the year when we’re asked to eradicate breast cancer by buying pink-ribboned  products.

Over the years, many women’s health activists have criticized the pink ribbon campaigns, protesting that these efforts do little to fund prevention, are less useful than direct donations, and promote a false sense of doing something to cure breast cancer. The New York Times Well Blog yesterday included a piece on “Pink Ribbon Fatigue,” which nicely summarizes some of the objections to the overwhelming pinkification of October and breast cancer campaigns.

Breast Cancer Action, of course, has run a “Think Before You Pink” campaign for several years, encouraging consumers to ask how much their pink purchases actually contribute and whether any of those products may actually contribute to cancer risk.

New to the conversation is a recently published book by Gayle Sulik, Pink Ribbon Blues: How Breast Cancer Culture Undermines Women’s Health. I haven’t read it yet, but Sulik is interviewed in the Times piece linked above, where she talks about the kind of forced optimism associated with these campaigns, the associated gender roles and expectations, and potential financial conflicts “that keep the war on breast cancer profitable.” Sulik also  blogs on the issue.

If you’re a Facebook user, you may have seen recent “I like it on…” posts and wondered what they’re about. It turns out they’re an even less useful version of the earlier bra color meme, ostensibly intended to raise awareness about breast cancer through status posts. I think it’s clear enough that while social media tools may be useful for organizing and awareness-raising, mysterious status updates with faux titillation and no actual mention of breast cancer do little to promote real action on women’s health. As the blogger at Voxygen responded, “I like it without pinkwashing.”

Earlier this summer, we wrote about the President’s Cancer Panel report on environmental causes of cancer. Relatedly, the National Institutes of Health announced this week the formation of a committee to focus in part on environmental factors related specifically to breast cancer.

The committee will “develop and coordinate a strategic federal research agenda on environmental and genetic factors related to breast cancer.” It will apparently review current federal breast cancer research activities and make recommendations for improving these programs.

The committee is composed of representatives from the EPA, CDC, National Cancer Institute, the National Institute of Environmental Health Sciences, and other federal agencies, along with several physicians and scientists, and representatives from the advocacy groups Zero Breast Cancer, Breast Cancer Options, Academy for Cancer Wellness, Huntington Breast Cancer Action Coalition, National Breast Cancer Coalition, and the Breast Cancer Fund.

For more information, the National Institute of Environmental Health Sciences provides some (rather technical) resources on breast cancer and the environment, and has produced a report (most recently in 2008) on the State of the Evidence: The Connection Between Breast Cancer and the Environment [PDF]. The National Cancer Institute provides an online “understanding cancer” series which includes a set of slides and information on cancer and the environment.