“Boobies.” I said it. Now, May I Have Your Attention Please?

There’s been a lot of talk about boobies lately especially in breast cancer awareness campaigns. Discussions erupted in the blogosphere in early March after Peggy Orenstein posted a set of pointed questions about the awareness tactics of an “I ♥ Boobies” campaign promoted by the Keep A Breast Foundation. Katie of Uneasy Pink was super uneasy about the situation, questioning why it was okay to sexualize women and trivialize the disease in the name of “awareness.” Jackie Fox, author of From Zero to Mastectomy, questioned the overabundance of quaint awareness campaigns and pink products of which the “boobies campaigns” are just one part. The Keep A Breast Foundation chimed in on Peggy Orenstein’s blog with apparent openness to a frank and earnest discussion. Unfortunately, when the discussion moved to the Feel Your Boobies Facebook page (which was also at the center of the controversy) the administrators deleted all of the discerning and critical comments they didn’t like.

Followups, questions, and comments mounted as the weeks progressed about fake awareness, censorship, commercialism, sexualization, and the use of funds to run programs that spread misinformation while failing to prevent breast cancer or save lives. People on both sides of the debate were increasingly riled and flabbergasted at the absurdity as they tried to determine where and how to draw the line about what is useful and appropriate. Despite the controversy there was a lesson to be learned about the rules of engagement when dealing with a serious matter like breast cancer. A lesson that all of us should consider if we want to see real progress on the disease front.

Last fall I had an opportunity to think about the “rules of engagement” as I prepared for an interview on Oprah Radio’s The Dr. Laura Berman Show. Dr. Berman’s producer sent me a set of guidelines about what I could not say on the show. I was not supposed to mention last names, brand names, or websites. I was not supposed to swear. Bummer! I was to avoid slang and use “clinical language” instead when talking about a body part. This particular rule was a tough one to follow. Many awareness campaigns — not just the “I ♥ Boobies” folks — use slang terminology and stylized imagery to gain publicity that in turn increases their revenues for breast cancer awareness programs.

Scoobies for Boobies

Keep M Lookin HOOTERrific

Feel Your Boobies.

Don't Let Cancer Steal SECOND BASE

There is no shortage of examples. A creative college breast cancer awareness event last year included a “Think Pink Poll” through which students could vote for their favorite Think Pink Advertisement: Hooters, Jugs, Knockers, Melons, Mosquito Bites, Mountains, Headlights, Rack, Twins. I don’t know which term won.

What is wrong with using slang terms and stylized images to draw attention to breast cancer?

Dr. Berman wasn’t keen on slang because these words detract attention from the seriousness of the issues that affect women and their bodies. If as a society we are light-hearted about women’s bodies and sexuality, then we are not likely to give them the depth of attention they deserve. Likewise, the informality surrounding breast cancer coupled with representations that highlight the fun-loving festivities of the cause tend to overlook the deep impact the disease can have on women’s bodies, their relationships, their work and family lives, their communities, their dreams, and their longevity. If this were not the standard of practice, it wouldn’t be so much of a problem. But this element of the culture has become the norm.

Two years ago, Jenna McWilliams noted in her blog that how women’s bodies are viewed in society matters:

Let’s face it: We’re really freaking immature when it comes to talking about breasts. Culturally, we treat them as dangerous; unless they’re on display as sex objects, we don’t want to see them at all (for more on this, google “breastfeeding in public”). We’ve imbued the breast with so much sexual power that serious cultural conversation about diseases and dangers is difficult, at best, to carry on.

Topless bars, yes; breastfeeding, no. Breast implants, yes; mastectomy scars, no; Cleavage, yes; lop-sidedness, no. Sexual object, yes; sexual subject, no? Titillation, yes; seriousness? Well, you get the point. There are double standards when it comes to societal appreciation of the breast.

Yet the objectification of the breast is everywhere, and it starts long before there are even breasts to be had. Check out the Abercrombie & Fitch kids line aimed at children ages 8 to 14. Buy your 8-year old daughter a padded string bikini. While you’re at it, get her an “I ♥ boobies” bracelet to signify an awareness that one day her little fun bags might kill her. Not too much fear. Just enough to get her geared up for full participation in that little pink consumption engine that could. She’ll learn to pathologize her boobies at a young age, think of them as objects for others, and submit to regular medical interventions that are not even guaranteed to save her life from that wicked pink beast.

This brings me to another unfortunate consequence. The objectification of the breast has lent itself very well to boobies campaigns in the name of awareness, particularly in terms of breast self exam (BSE). BSE is a popular awareness message even though BSE has not been found to find breast cancers early nor has it been found to provide any survival benefit for the diagnosed. The National Cancer Institute reports that there is no good evidence to conclude that BSE reduces one’s chances of developing an invasive breast cancer or reduces breast cancer mortality.

A large randomized, controlled study of 266,064 women found that after 10 to 11 years of follow-up, 135 breast cancer deaths occurred in the instruction group and 131 in the control group. Although the number of invasive breast cancers diagnosed in the two groups was about the same, women in the instruction group had more breast biopsies and more benign lesions diagnosed than did women in the control group.

Similarly the U.S. Preventive Services Task Force found in 2002 that the trials of BSE showed no reductions in mortality, but did result in increases in benign biopsies. The World Health Organization advises that national cancer control programs should not recommend screening by BSE because “there is no evidence on the effect of screening through breast self-examination.” The American Cancer Society also changed its recommendation to make BSE optional as a screening method. In 2003, The Journal for Cancer Clinicians published an update on the ACS Guidelines stating that:

Recent evidence reviews have focused on the absence of direct evidence of benefit…and data indicating that the rate of benign biopsy is higher in women who regularly perform BSE compared with women who do not regularly perform BSE.

For this reason the ACS states today that, “It is acceptable for women to choose not to do BSE or to do BSE occasionally. Women who choose not to do BSE should still know how their breasts normally look and feel and report any changes to their doctor right away.” The body of evidence for the last ten years at least has pointed to evidence of no benefit for BSE in terms of early detection or mortality reduction. To the contrary, there is strong evidence of harm through excessive biopsies.

BSE is considered to be optional for good reasons. Almost everyone agrees that it’s useful to be aware of your body. Notice your bumps and bruises, how you sleep at night, whether you digest your food well. Are you achy? Do you get headaches? How’s your breathing? Are you stressed? Notice. Be mindful. Yes, yes, yes! The problem in calling any of these actions screening modalities is that NONE of them are a sufficient way to find cancers early enough to reduce mortality. Women find lumps getting dressed, taking showers, putting on moisturizer, lying on the couch, being intimate with partners, and feeling their breasts. Some women never find lumps because there are types of breast cancer that are not palpable, ever. In both scenarios these actions will never solve the breast cancer problem. They do not result in early detection. To say that they do is a sad, unfortunate, and infuriating lie.

It may be fun or even empowering to feel boobies. It definitely sells a lot of t-shirts and bracelets. But it does not save lives in the long run. One third of breast cancers recur, whether they’re found accidentally, in showers, with mammograms, through BSE. One third of people who are diagnosed will eventually find themselves with a metastasis. When that happens, prognoses decline considerably. BSE may result in a diagnosis, just as the accidental observation of a lump or new feeling in the breast might. But it does not result in longer survival.

Please do not squander time, energy, and money promoting something so ineffective and futile. Please do not separate women into their body parts especially in the name of breast cancer awareness. If you need another visual to see what has become of commercialized breast cancer “awareness,” click here.

For other commentary on the “Feel Your Boobies” campaign and related issues see:

• Boobies, for fun & profit! by Gayle Sulik
• Sexy, Saucy, Sassy, Breast Cancer. Not. and Back on the Boobies Again by Peggy Orenstein
• Feel Your Boobies–OR ELSE, Following Up, and Booby Day 3 by Katie Ford Hall at Uneasy Pink
• Our Boobies, Ourselves and Whose Breast Cancer Is It, Anyway? by Jackie Fox
• Feel Your Boobies” Foundation–My Thoughts by Nancy Stordahl at Nancy’s Point
• Why It Matters by Stacie at Bringing Up Goliath
• Silence of the Spams by Sami at Dear Mom, Can You Get Letters in Heaven?
• Under Construction: An Alternate View by Kathi Kolb at The Accidental Amazon
• Sexualizing Breast Cancer by Beth Gainer at Calling the Shots
• Squeeze the Charmin, Not the Boobies… by Katherine O’Brien at I Hate Breast Cancer
• Breasts Are Not for Saving, Women Are by Kate-Madonna Hindes at GirlmeetsGeek

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