The following is a guest blog post by Sally James, a Seattle-based freelance writer who is also one of our regular story and news release reviewers. She tweets as @jamesian.
A recent campaign by the Centers for Disease Control is called Bring Your Brave and aims to get younger women between 18 and 44 to pay attention to their risks for breast cancer.
But some in the breast cancer advocacy community are calling foul on the campaign’s use of language, which they say is uncomfortably reminiscent of the “war” metaphor that has long pervaded cancer discussions. Several wrote to us via email to express their objections to the “brave” messaging.
“As a woman who was diagnosed with breast cancer at a relatively young age and is deemed a ‘survivor,’ I can affirm that there was nothing heroic or brave about my facing breast cancer,” wrote advocate Beth Gainer, who is on Twitter as @bethlgainer.
Gainer and others suggested that the CDC’s framing would exclude many women for whom the “brave” message, and its strong links to soldiering, simply does not resonate. Gainer further questioned the factual information provided by the extensive video and texts at the site, particularly the emphasis on living “a breast-healthy lifestyle.”
Does this mean “that women who are diagnosed with breast cancer did not live a healthy lifestyle?” she wondered.
We contacted the CDC and received a written response to some of the criticism from Temeika Fairley, PhD, who is an epidemiologist in the Division of Cancer Prevention and Control, and a health scientist helping to lead efforts at prevention.
“We acknowledge the many challenges that women and their families face with a breast cancer diagnosis. … So, it takes a measure of bravery for women with a family history of breast cancer to talk with their doctor about risk and whether genetic counseling and testing is appropriate because of the implications of a potential diagnosis. We understand that not every woman will identify with this language or relate to these feelings. However, many women identified with having to be brave about taking that first step with their doctor. That’s why we chose to frame our campaign in this way.”
There is a long history of patients complaining about the language of the “war” on cancer, for many reasons. They think it’s inappropriate to suggest that someone who’s died from cancer has somehow “lost” a battle — one that maybe they could have “won” had they fought harder. And they worry that violent language may encourage some cancer patients to choose overly aggressive treatments that offer little benefit and can cause debilitating side effects.
There is even research demonstrating that such metaphors may thwart prevention efforts. A University of Michigan study showed patients were less likely to take preventive efforts if “war” was the guiding metaphor. A news release on that study said: “Exposure to metaphoric language relating cancer to an enemy significantly lessens the extent to which people consider cancer-prevention behaviors.”
Patient-advocate Lori Marx-Rubiner, who is on Twitter as @regrounding, wrote, “There’s quite a debate about the continued use of war metaphors by, for and about cancer patients.” She believes each patient can choose their own language, but objects to society using war labeling. While presumably well-intended, the war metaphor prevents a healing atmosphere that allows patients to accept their own range of emotions, Marx-Rubiner wrote. She longs for a time when fear is accepted as a natural response.
“Rather than expect fear to be shoved down or pushed aside, it’s long past time that the reality of fear be given its due respect – patients, ‘previvors,’ and others need space to recognize and confront the myriad of emotions that come when facing disease. Bravery may come, but if we truly want to support women and men facing breast cancer, it, like any other emotion, must be an authentic of the individual, and not one that we are pressured into feeling. Isn’t it time?”
Another critic of the metaphor is Annette Bar-Cohen, MPH, who directs advocacy training programs at the National Breast Cancer Coalition, and who has been involved in public health for many years. She commented that the slogan didn’t make sense to her, and she also felt the campaign did not prominently display the fact that what are known as BRCA mutations are present in only 5-10 percent of all breast cancers.
Alicia Staley is one of the founders of the social media phenomenon known as #BCSM, or breast cancer social media. The group holds weekly live chats on Twitter where thousands of patients and others discuss and debate issues around the disease. Staley is disappointed on several levels. She is @stales on Twitter.
“This is another example of using the war imagery to promote awareness. What happens when you don’t feel brave? Why the hyper-focus on BRCA/previvor issues when metastatic continually gets swept under the rug? … I think it falls way short of what the CDC could and should be doing.”
Addendum 2 hours after this was first published:
Three people, including Dr. Otis Brawley of the American Cancer Society, recently co-authored a Viewpoints article in the journal JAMA Oncology entitled, ” Advancing a Quality-of-Life Agenda in Cancer Advocacy: Beyond the War Metaphor.“
Editor’s note: The National Cancer Institute hosted a Twitter chat on July 22 about the psychosocial aspects of cancer. Click here to see a transcript of the discussion, which used the hashtag #copingcancer.