I want to share with you part of a conversation I have quite regularly. It usually begins when someone says to me, "Did you hear, such-and-such has cancer. Isn't it terrible?" and I might say something like,"I heard. Did you know I had cancer?" "Oh really? When was that?" "In July 2003." "Oh my God. Are you all right now?" "Yes, thanks, I am." "Did you have treatment?" "Chemotherapy and radiotherapy." "Wow, and you have how many children?" "Four." "Oh, that's awful. I can't believe it." And then, the inevitable. "And which breast was it in? Did you have to have a mastectomy? Do you have a prosthesis?" "Well, no, actually, it wasn't breast cancer." Blank expression. "Oh.......really?" Because everyone knows; the only cancer women get is breast cancer, right?
Please do not misconstrue me. I bestow well-deserved kudos of heroic proportions to the millions of men and women who have campaigned and still campaign to increase awareness of breast cancer worldwide. God knows, it needs to happen. Breast cancer is an insidious, sometimes disfiguring, always frightening cancer that can rob families of their mothers, partners, wives and daughters. Breast cancer is a horrific disease that, thankfully, we are learning more and more about every day, due to the billions of dollars raised by communities all over this planet, and thanks to ever-improving early screening and detection programs. The lives of breast cancer patients are not just being saved but also salvaged, thanks to greater understanding of the psycho-social effects of breast cancer on women, their carers and their communities, lives, livelihoods and relationships.
Having said that, I will return to the point, because everything I have just mentioned isn't actually my point. Increasing public awareness of breast cancer, it could be said, has been a resounding triumph overall. It could also be said that breast cancer and all the various products and services related to it now have such a high media profile that breast cancer has become almost commodified in itself. Associating your event or brand with breast cancer in some way is likely to increase your profits and positive consumer sentiment toward your product like few other actions could. Unlike a lot of very disgruntled prostate cancer advocates, I stop short of calling breast cancer the 'sexy cancer', but you have to admit it has all the hallmarks. When I worked in advertising, I learned that either fear or sex will sell just about anything. Somehow combine the two and you have an advertisers dream. The female breast holds a veritable hemisphere of marketing power in our society. However, unlike ads which are aimed at increasing awareness of the link between lung cancer and smoking, we never see a single image of an actual diseased breast. We save boobies for the beer ads. It's all about brand association, and the brand for breast cancer is the colour pink.
Long associated with all things pertaining to youthful, sweet, feminine innocence, pink has been universally substituted for any actual physical images pertaining to the disease of breast cancer. Pink ribbons, pink t-shirts, pink logos and cricket stumps and bandannas. Now, as I see it, two obvious problems associated with identifying everything to do with breast cancer with the colour pink are: 1) Not all women who get breast cancer can identify with the colour pink and what it represents - submissive, baby-like femininity. And 2) Not all people who get breast cancer are actually female. Some of them, more than you probably think, are men.
Here's another conversation I'd like to relay to you. My friend Gary has something resembling the following interchange every other day of his life. "Did you hear? Frank just got told he has cancer.""I heard. Did you know, I had cancer?" "No way, really?" "Yes, actually, I've just finished treatment." "That's terrible, mate, I'm sorry to hear that. What kind of cancer was it? Prostate? Bowel?" "Actually, I had breast cancer." Incredulous stare, awkward silence. Do men really get breast cancer? As a man, where do you go with a conversation after that? Because men most certainly do get breast cancer. And Gary has really nowhere to go with it, in just about every sense. Nowhere in conversation, nowhere in the community, and certainly nowhere for the most part in terms of supportive care and services for his type of cancer.
Many hospitals in this country (Australia) now have, thanks to the militant fundraising efforts of outfits like the McGrath Foundation, breast cancer or breast care nurses on staff. Female nurses; attuned primarily to the issues female breast cancer patients have with their disease, Gary feels. Issues such as body image, as concerning women in a society where breasts are worshiped and commodified. But male breasts have no such commodifiaction attached, except perhaps for the negative social connotations of man-boobiness, which can be made even worse when telling someone you have what is primarily considered a womens disease.
Gary has been lobbying the local breast cancer support group to allow men to join in their meetings. The groups management were initially resistant, and Gary believes only changed their minds when they realized the legal implications of excluding him and other men like him. He came back to the general cancer support I facilitate to report to us that they had, in the end decided to allow men to attend their previously exclusively female meetings, and had even changed the wording on their brochure. But Gary decided he felt more comfortable in our group, because we are not cancer or gender specific or exclusive. Yes, there is such a thing as cancer snobbery, believe me.
Increased awareness around breast cancer is a double edged sword; it seems the very changes in perception and awareness concerning breast cancer that continue to save lives have also created a set of assumptions which are perhaps as dangerous as the initial ignorance ever was. Many women seem to assume breast cancer is the only kind of cancer women are in danger of dying from. However, cancers previously mainly associated with men such as lung cancer are killing increasingly more women, as young women continue to take up smoking in greater numbers. It is interesting to note that while breast cancer is a disease which threatens to physically disfigure, many other cancers such as bowel and lung cancer are perhaps perceived to have invisible and perhaps less disfiguring consequences. Women don't seem to believe a diagnosis of lung cancer or bowel cancer would affect them the way breast cancer might. The fact is that survival rates of breast cancer detected early are good, compared to survival rates of lung cancer overall. Research actually shows that many women continue to smoke because they believe it will keep them thin and attractive. I can tell you, I lived with a woman who had mouth cancer during the last few months of her life, and while she certainly kept her trim figure, it was mainly because she could no longer eat solid food through the rotting crevasse that was her mouth. I find it to be a peculiar conundrum that despite the graphic pictures on cigarette packets, women are more afraid of losing their breasts than having lung, head or neck cancers.By the time most lung cancers are diagnosed, survival rates are fairly dismal and treatment options limited. They don't tell you that on the cigarette packs.
Women these days are very well-trained to check their breasts, but I wonder if this has given women generally a false sense of confidence regarding the early self-detection of cancer. While we are busy feeling ourselves up in the shower, are we ignoring that weird mole, or pretending we didn't see the blood in our bowel motions? I think women may be being programmed to believe that breast cancer is the only cancer they need to worry about, particularly if they are young and otherwise healthy. I was diagnosed with stage 3B (there are only four stages, and B means it had begun metastasizing) Non-Hodgkins Lymphoma in my mid-thirties, and even my doctor was unable to be convinced there was anything wrong with me...until I presented to the emergency department of my local hospital on the verge of collapse. I had a perfectly healthy pair of D-cups - pity about the tumour the size of a saucer lying 3cm deeper under my sternum. But no one thought to check there. I'd had a mammogram just a few months before the massive tumour in my chest - just a few centimentres away from my breasts - was finally found.
I have a friend who, like me, was diagnosed a few years ago with cancer in an advanced state. However, unlike me, she can't talk about her diagnosis in general conversation, because no one wants to talk about vulval cancer. She didn't even know there was such a thing. However, gynecological and blood cancers are not considered to be statistically rare in women. Not rare....just unheard of - literally. Many are offended by the idea that some cancers have a more "sexy" image than others. If you're one of these, then think about discussing at your next dinner party having had your clitoris amputated, and then we'll talk about it again. Taboos still exist, and so does ignorance, despite everything we've done to raise the profile of cancer. There's awareness, and there's awareness.
So, this month being official breast cancer awareness month, I would like to advocate another kind of awareness. While we are pinning on pink ribbons and passing around sentimental chain emails, I would like everyone to remember that not all the cancers women are diagnosed with are breast cancers. Check your boobies by all means, but check your moles and your motions too. Check your rashes, your rude bits, your lumps and your bumps, where ever they may be. Take that funny cough off to the doctor too, and for crying out loud, stop smoking. Also, please be aware that not everyone diagnosed with breast cancer is female. Many breast cancer patients are men and will never be acknowledged, serviced, celebrated or lauded the way many female breast cancer patients and survivors are. They are more likely to be isolated from support services and treatments, marginalized by stigma, and sometimes even ridiculed because of their disease. They face many of the same issues that women breast cancer patients do, but in reality have access to fewer resources and less information which is gender specific to their disease.
Personally, I will be thinking of the many friends I have lost to breast cancer, the amazing and heroic people I am blessed to count as friends who have survived, and those I know who are currently having treatment. I will also be remembering the hundreds of people I know who have journeyed through many different kinds of cancers, some of which you may never have even heard of; people who are not pop stars, or wives of cricket players or even particularly special or brave. Their cancers will be just as unfair and tragic and disfiguring and painful as the ones you'll see on TV this month. I actually wish there were a month for every kind of cancer, but there aren't even enough days in a year for that.
I ask of you all just two things: 1) That you may remember not every person diagnosed with breast cancer is female, and 2) That not every woman diagnosed with cancer has breast cancer. I actually hope to increase awareness that increasing awareness of cancer is only one side of the story. The other side is the responsibility we all have to become aware of the scope and effect all kinds of cancer have on a diagnosed person's family and friends, on the community and on our society as a whole. Now that's what I call cancer awareness.
(Jo Hilder is a cancer survivor, having been diagnosed with Non-Hodgkins Lymphoma in 2003, and has since worked for the NSW Cancer Council in Australia as a Programs Coordinator and Relay For Life Coordinator. She also facilitated a volunteer advocacy network for cancer patients, and was facilitator/speaker for several cancer survivorship programs and support groups. Jo currently works in the area of mental health.)