Oktoberfest

The month of October used to be associated with many positive things, at least for me; sunny and cool autumn weather, the turning of the leaves, seeing beautiful fall colors at their peak, and football, lots of football. I also appreciate the transition to different menu items this time of year; at last week’s farmer’s market, I bought sweet tango apples, a large butternut squash, and bright green brussels sprouts. I look forward to a crock pot of soup or chili at the end of the day; I also enjoy German food, and I miss the usual invites we’ve had in years past to a friend’s backyard for an Oktoberfest celebration. But wait, it could still happen–even with the pandemic and the delta variant; outdoor location, picnic tables, masks, 6 feet apart? Ah, well, maybe not quite the same…

But now, I am definitely much more aware of the fact that October is also National Breast Cancer Awareness Month. We’ve all heard this phrase, repeatedly, and we’ve seen the color pink or the infamous ribbon being used on everything over the years from the White House to the wings of jet airplanes to the stockings worn by NFL football players. It’s a lot of hype, and tough to ignore. As a survivor, over five years out, I tend to have mixed feelings about this.

On the one hand, raising awareness is a good thing, generally speaking. In terms of screening and earlier detection, reminding the public of the benefits of mammography seems very positive, considering the incidence and prevalence of breast cancer. And because it is so prevalent, almost everybody knows somebody who has been affected by it, and as a result, they can relate when they hear about a fundraising event or watch a news program discussing breast cancer. For many, it brings to mind a personal connection, it’s not just an abstract disease.

Still, some of the messaging meant for good almost borders on utilizing guilt, the fear factor, or scare tactics. Such as billboards and public service announcements warning that delaying mammography is risking your health, your loved ones, your family–which may have happened more this past year during covid. However, we know full well that many cancers arise mere months after a normal mammogram or in a patient who falls outside the guidelines for routine testing. It almost implies that a patient diagnosed with breast cancer must have done something wrong; she didn’t take care of her health, didn’t get her mammogram, or delayed evaluation. Most of the time, this is simply not the case.

Another particularly bothersome aspect of this month is using the color pink or the symbolic ribbon simply to make money or “sell stuff.” I recently saw a bottle of red wine for sale in a liquor store that was decorated in this fashion; how ironic and sad, given the known association between alcohol intake and breast cancer risk. In my opinion, the wine bottle with the pink ribbon would be similar to marketing a package of cigarettes with a picture of healthy lungs on it. Doesn’t make sense, does it?

Speaking of selling stuff: part of me wonders, with all the hype and publicity and fundraising events and sales, where does the money go? There is a saying applicable to numerous life situations and that is, “follow the money.” Transparency would go a long way in establishing the public’s trust and endorsement of the efforts to raise awareness. It seems that over the years, the emphasis has been on promoting screening mammography. Around the Twin Cities, I’ve seen mammogram trucks in parking lots and on city streets with almost as much frequency as the popular food trucks during the month of October. But given the fact that 30% of early stage breast cancers will present later as metastatic disease, we also need to consider more research and treatment for that condition, as well.

On a related note, it has occurred to me that perhaps raising awareness and investing in research should be directed to more rare cancers, such as sarcoma, melanoma, renal cell carcinoma. Or towards malignancies that tend to present late or behave more aggressively: pancreatic cancer, esophageal cancer. To quote one of my oncology colleagues: “I’m not sure we need more breast cancer awareness. Everyone seems very much aware of it.”

And then, on a more personal level, I must admit at times, I simply don’t want to be reminded (over and over again, for 31 days) that I am a breast cancer survivor. Thankfully, I am doing well, and sometimes I feel so healthy, I almost forget that it ever happened. Or maybe part of me wants to forget, and put it out of my mind as a coping mechanism.

When I rode the Chainbreaker, a long distance cycling event and fundraiser to benefit cancer research in 2017, at the finish line, I forgot to write my name on a big white board meant for survivors. Perhaps I was just thrilled to have finished the 50 miles. At the 2018 event, I instead wrote the names of three of my colleagues who were also battling cancer at the time; two, unfortunately, have since already succumbed to their disease. I did collect two new badges for my bike jersey: “survivor” and “living proof” but honestly, I felt a twinge of guilt at the time, knowing others could have worse outcomes than me. This kind of inner conflict and emotional turmoil occurs that much more during the month of October, given the very public reminders left and right.

At the beginning of this month last year, I asked a group of MDs who are also cancer survivors what they thought about “pinktober.” I had a wealth of responses in return; many of these women have the same thoughts and concerns listed above. It was validating in a sense, to know that I was not the only one with mixed emotions or a generally reluctant response to the entire idea. But after seeing a few positive responses, I also began to appreciate the underlying benefits. Including a reminder that if just one more woman gets her mammogram that particular month, if it leads to an earlier diagnosis and a better chance for more effective treatment, it’s probably worth it.

Still, if I am being perfectly honest, I long for the days when October meant fall leaves and football, lederhosen and a beer garden. Both c-words have changed that perspective for me: cancer, and covid-19. But today, as I write this post, we have bright sunshine and 70 degrees for the next three days. So, it is time to get out and enjoy it—perhaps on a long bike ride. Maybe not 50 miles, but certainly, a long one. And that would be the perfect activity in this era of ongoing social distancing.

Here’s to October.