Are ads that display a young svelte woman's body mutilated by two mastectomy scars shocking? Of course they are. But, I assure you, a diagnosis of breast cancer is far more jolting.

When the Breast Cancer Fund, a highly respected breast cancer advocacy organization, plastered such ads on billboards and buses, they ignited a firestorm of protest. The good news is that the San Francisco Bay Area received an alarming wake-up call. But many people complained the ads were too offensive, too obscene, even pornographic.

People are debating the wrong question. The real issue is not whether the absence of breasts is too shocking, but whether this campaign will encourage more women to make that difficult call and go get an annual mammogram.

Sadly, the answer is probably no. Most women are terrified of getting a diagnosis of breast cancer. And any campaign that intensifies women's fears, however well-intentioned, is likely to reinforce women's fears of losing their breasts.

The truth is, it's quite difficult to frighten most women into getting mammograms. Frightened women find all kinds of reasons to procrastinate, and such denial cuts across class and racial lines. One friend, a highly respected scientist and nutritionist, with a PhD and M. trailing after her name, tells me, "I just can't stand the thought of breast cancer, so I never get mammograms." Another friend, a distinguished feminist writer, says, "Mammograms can't reveal everything, and I'm afraid I'll receive too much radiation."

In fact, she knows that the absence of a mammogram reveals even less and that today's machines emit very small amounts of radiation. And she certainly knows that mammograms cannot be compared to the eight weeks of daily radiation you receive after a lumpectomy. Yet another woman, a scientist who has spent her life dedicated to the women's health movement, laughingly confides that she hasn't had a mammogram in five years.

But this is no laughing matter. Procrastination and fear do not prevent breast cancer. In 1999, columnist Molly Ivins* disclosed that she had been diagnosed with breast cancer. "If you want to know what stupid feels like," she said, "think about waiting in a surgeon's office, with a lump in your breast, unable to remember when you last had a mammogram." Many racial and ethnic groups have quite specific reasons for avoiding screening. African-American women, for example, cannot erase memories of life in the Deep South, where breast cancer meant a certain death sentence. Without adequate medical care, black women rarely received either screening or treatment. Today, the daughters of that historical legacy, many of whom now live in Northern California, explain to health workers, "Who wants to find out if you are going to die?"

To get women to pick up that phone, we need to raise their hopes, rather than deepen their fears. In Contra Costa County, health workers recently created a stunning calendar filled with the glowing faces of community women who had survived breast cancer. We need to spread the same message -- that most women survive early detection of breast cancer, without requiring a mastectomy.

Another reason that many poor and uninsured women procrastinate is that they have no guarantee they will receive treatment. Not too long ago, California used to pay for screening women but not for treatment. Can you imagine anything worse than being diagnosed with breast cancer and then having no way to pay for treatment? Thankfully, though, times have changed. California now pays for breast cancer screening and treatment for low-income women through its Breast and Cervical Cancer Treatment Program. Unfortunately, not all states have screening and treatment programs like California’s.

Scars from mastectomies are shocking and a scare tactic that may prove to be counterproductive. But what is truly obscene is that some states procrastinate in providing easily accessible, free treatment for low-income women diagnosed with breast cancer.

Ruth Rosen, a professor of history at the University of California at Davis, is the author of the just-published book, "The World Split Open: How the Modern Women's Movement Changed America."

Readers who have questions about the Breast Cancer Fund's "Obsessed with Breasts" ad campaign may want to visit its site at http://www.breastcancerfund.org/campaign.htm .

A version of this story first appeared in the San Francisco Chronicle.

*Molly Ivins died of cancer at age 62 on January 31, 2007.

First published February 14, 2000
Last updated September 14, 2007
Copyright © 2000 Consumer Health Interactive

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