What Breast Cancer Awareness Month & The Pink Ribbon Get Wrong

When I got breast cancer at 25 years old, I didn’t know anyone else my age who’d gone through it. I definitely didn’t know anyone young and queer and racialized. The mainstream images of breast cancer patients didn’t exactly resonate with me, either. You know the ones I’m talking about, the pretty white woman, smiling, running for the cure. It’s the image we often see when Breast Cancer Awareness Month (aka Pinktober) rolls around every October.

Before I got sick, I was only mildly peeved by Pinktober’s simplistic portrayal of patients and its capitalistic bent (buy a pink ribbon bottle of shampoo and cure cancer). Now, the whole thing makes me grimace because it's supposed to represent me, support me. And it doesn’t. It feels straight. And white. And feminine. All things I’m not. One in eight women in the U.S. are expected to develop breast cancer. But by focusing on only one demographic’s experience of this disease, and then wrapping it rose-colored branding, Pinktober drowns out the lived reality of countless others and perpetuates inequities in our health-care system.

I think back to the support I tried to find five and a half years ago when I was working through my own experience with estrogen positive breast cancer. I went looking for other patients who could help me process my diagnosis, as well as my required treatment, which included being put into medically induced menopause. I figured I’d feel out of place in a standard breast cancer support group, so I went more niche — trying out a lesbian cancer support group and one for people in their 20s and 30s. While these groups provided valuable connection with other patients, a bond over cancer doesn’t mean you’re politically aligned.

So, I looked further afield, searching for like-minded people writing on their experience. Again, I found very little I could relate to. The exception being The Cancer Journals by Black feminist writer Audre Lorde. Published in 1980 before the disease underwent its current branding, the book details Lorde’s own struggles with the lack of representation in the standard breast cancer narrative: “I’m a Black lesbian feminist poet, how am I going to do this now? Where are the models for what I’m supposed to be in this situation? But there were none. This is it, Audre. You’re on your own,” she wrote. Lorde also wrote about sexuality and gender expression, detailing the pressures to wear a prosthesis breast after her mastectomy: “Where were the dykes who had had mastectomies? I wanted to talk to a lesbian, to sit down and start form a common language, no matter how diverse. I wanted to share dyke-insight, so to speak.”

I’m not Black, so I cannot possibly understand what Lorde went through, but as a queer woman of color craving connection with other breast cancer patients, in the early days of my diagnosis and treatment, I would’ve loved to share “dyke-insight” with other patients. Also like Lorde, whom it was assumed would wear a prosthesis, my doctors just assumed I’d want breast reconstruction surgery if I required a mastectomy. When it turned out that I only needed a lumpectomy, a less-invasive procedure where the lump is removed but not the breast, my surgeon offered breast enlargement. In none of these discussions was I asked about my relationship to my breasts. It was automatic — remove breasts, add breasts. I know I’m not alone. I’ve heard stories of patients who, despite saying they didn’t want reconstruction, awoke from surgery with extra skin left for future reconstruction.

To be clear, breast reconstruction and enlargement are totally valid routes for patients. The problem is that it’s a foregone conclusion that all patients would want either or both despite there being a whole host of reasons people choose to stay flat. I personally wasn’t keen on any non-medically necessary surgeries. Plus, I already felt cute looking like a teenage boy with my typically hidden breasts. Basically, I have a loose affiliation to my breasts and I wasn’t going to go out of my way to re-create them.

That my doctors didn’t ask me about any of this doesn't surprise me. Doctors, too, often have a singular conception of who a breast cancer patient is. This is isolating for those of us outside the mold but, even more than that, ignoring the breadth of the breast cancer experience can have dire consequences.

When doctors have a singular patient model, they miss things. Gaps in care emerge. Mortality rates change. Unsurprisingly, this is particularly pronounced amongst Black women. In the United States, Black women under 60 years old experience breast cancer at a higher rate than white women yet continue to be diagnosed in later stages, and the death rate for Black women with breast cancer is 40% higher than their white counterparts. (One can only imagine the devastating impact that COVID-19 is having on these rates.)

The problem exists in Canada, too. Recent research out of the University of Toronto drew attention to anti-Black racism in the health-care system, including that Black women are under-screened for cervical and breast cancer. And, while we lack race-based data on incidence and mortality rates, this doesn’t mean that we don’t have the same issues. (It’s also worth noting most stats are based on “women” without differentiation based on trans or non-binary gender identities, which is an issue unto itself.)

These disparities cannot all be laid at the feet of Pinktober, of course. The problem runs far deeper. But it’s also no answer to simply say Pinktober is well-intentioned and therefore exempt from criticism. Intention should only matter so much. What matters more is the harm caused by its exclusionary marketing and the possibility for something better.

When I was diagnosed, I wish that I’d seen queers and trans folks and Black women telling their stories; I wish that my doctors had understood diverse gender expressions; and I wish that there’d been a whole lot more lobbying for equitable breast cancer care instead of courting companies for donations and selling blush-colored water bottles. It would’ve made the experience just a bit more bearable.

It’s not too late, though. Before you re-post that easy, ubiquitous message about it being Breast Cancer Awareness Month, look for folks offering a more nuanced take and amplify their voice. One suggestion: Ericka Hart, a Black queer femme who seeks to expand the visibility of queer and trans people of color in the breast-cancer community. Or, if you want to donate, think about whether a cancer organization is where your money is most needed (these organizations already get a disproportionate amount of charitable donations), or if there’s an under-resourced organization in your community that you can help out.

It’s time to move beyond Pinktober. There are a lot more inclusive ways we can broaden awareness and improve care. No pink ribbon required.

Kimiko Tobimatsu is the author of the graphic memoir Kimiko Does Cancer released this month by Arsenal Pulp Press. Check out the book’s website, or follow along on Instagram, Twitter and Facebook.