Intended for healthcare professionals

Feature Commercialising Public Health

Backlash against “pinkwashing” of breast cancer awareness campaigns

BMJ 2015; 351 doi: (Published 12 October 2015) Cite this as: BMJ 2015;351:h5399
  1. Meg Carter, freelance journalist, Bath, UK
  1. meg{at}

Big business is keen to jump on the breast cancer awareness bandwagon but do its messages around screening do more harm than good? Meg Carter reports

Each October, breast cancer awareness month provides an annual focus for pink ribbon themed campaigns—many of which are backed by commercial partners eager to be seen to support a worthy cause.

The pink ribbon began as a grassroots movement, with survivors wearing ribbons to show solidarity with each other.1 But it was quickly appropriated by commercial businesses such as Estée Lauder and breast cancer organisations, led by the US based Susan G Komen Foundation, to show support ranging from financial donations to goodwill.2

The amount of cash raised with commercial backing can be substantial. America’s Breast Cancer Research Foundation, founded by former Estée Lauder senior vice president Evelyn Lauder, has raised £207m ($320m; €280m) in donations since 1993. Asda’s Tickled Pink campaign, meanwhile, has raised £44m for Breast Cancer Care and Breast Cancer Now since 1996.3

However, commercial involvement in breast cancer campaigning has drawn criticism from organisations such as US group Breast Cancer Action (BCA), which works to raise awareness of the more questionable cause related marketing activities by businesses, known as “pinkwashing.”

BCA, which runs an initiative called Think Before You Pink, is critical of the inappropriateness of some commercial partnerships—one engineering firm produced pink drill bits for fracking, for example4—and lack of transparency about how much money companies actually donate. And it condemns an overemphasis in campaign messaging on breast cancer screening.

Oversimplified messages

“Pink ribbon has come to be about selling products. To sell a product, a company needs to sell the disease. To sell the disease, they use upbeat messages about fighting, being positive, and staying strong,” says BCA executive director, Karuna Jaggar.

“Corporate marketers’ simple answer in their communications is: get a mammogram. But they overlook the tens of thousands of women who are overdiagnosed and suffer significantly from overtreatment,” she explains.

Ron Adler, associate professor of family medicine, and Steve Martin, assistant professor at University of Massachusetts Medical School, highlighted the dangers of pink ribbon campaigning in their joint presentation at last month’s preventing overdiagnosis conference in the United States.

“The danger is that pink ribbon campaigning is overly simplistic and dominates public opinion, which only has a limited amount of attention bandwidth for health related campaign messages,” says Martin.

“Our concern is that what we are seeing in too many public awareness campaigns is unilateral advocacy of annual mammogram screening with no thorough going into it, while research shows the benefits of mammograms are less than many people believe and the potential harm greater,” Adler adds.

“We are not saying mammograms are bad—they are an important tool—but that an individual should make an informed choice about if and when to have one. And a greater emphasis should be placed on educating women about the choices they have, and also the risks associated with being overdiagnosed and overtreated.”

Adler says that more frequent and earlier screening has led to increased detection and treatment of “indolent cancers” without sufficient discussion of associated health risks such as increased anxiety, increased depression, and the side effects of prolonged oestrogen suppression.

Pink ribbon campaigning in the UK is more about galvanising women to fundraise than simply buy a pink ribbon branded product. Even so, Lynn Ladbrook, chief executive of Breast Cancer UK, believes many pink ribbon campaigns reinforce misconceptions concerning breast cancer screening.

“The emphasis in campaigning in the UK is on breast cancer awareness and early screening with too little attention paid to reducing risk. We recognise treatment and cures are important, but incidence rates are not going down so we need more attention and research funding directed at preventing people getting it in the first place,” she says.

Gayle Sulik, medical sociologist at the University of Albany in New York state and author of Pink Ribbon Blues: How Breast Cancer Culture Undermines Women’s Health, identifies a recent shift in campaign messages from telling women screening “will” to “may” save their life, and now to an acknowledgment that every woman is different so to get advice from their doctor.

However, she is critical of what she sees as some marketers’ efforts to “reclaim pink” from pink ribbon critics by choosing a harder sell rather than more considered, fact based campaigning. One example she cites is a current marketing campaign for a US breast health screening and diagnostics supplier in which the word pink has been turned into a reassuring acronym: “P=Peace of Mind, I=Incredible Service, N=Not what you expect, K=Knowledge is power.”5

“What we are now seeing is the pink ribbon movement taking the language of those opposed to pink ribbon culture to reframe the pinkwash debate to their own advantage,” says Sulik. “Just what it will take for campaigners to move beyond awareness and fundraising to more critical thinking, however, remains to be seen.”

The commercialisation of breast cancer awareness campaigning is not confined to the US—and nor is its criticism, with independent BCA inspired campaign groups now established in other countries including Canada, Australia, Spain, and the UK. Although the concerns vary according to local culture and differences in legislation, they all agree that a shift in emphasis is needed in campaign messaging.


Cite this as: BMJ 2015;351:h5399


  • Competing interests: I have read and understood BMJ policy on declaration of interests and have no relevant interests to declare.

  • Provenance and peer review: Commissioned; not externally peer reviewed.


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