Year-round breast cancer awareness: Empowering young women in the fight against breast cancer

The association between women’s health and breast cancer (BC) is undeniable, as BC at large and breast cancer in young women (BCYW) under 40 yr have emerged as the most prevalent cancer affecting women in India and globally1-3. Addressing this pressing issue in women’s health necessitates a further focus on promoting awareness, self-breast healthcare, prevention, risk factors, lifestyle variables and advancing research for superior screening strategies and treatment. Over the decades, Breast Cancer Awareness in the month of October, often called Pink October4, has raised awareness about BC related matters, bolstered research funding and demonstrated solidarity with those affected by BC5. However, it is imperative to acknowledge that Pink October month has faced criticism for several reasons, including increased infiltration of commercial activities in the campaign, not sufficiently highlighting the issues and unique challenges faced by younger women with BC and protecting the lives of healthy young women from BC6-10. BC can strike unexpectedly, emphasizing the importance of daily awareness in this battle and not only during the designated October month. Therefore, this perspective seeks to go beyond a designated month and explore BC awareness and unique challenges faced by younger women with BC as an evolving forum. To fully appreciate the potentially long-lasting impact of these issues on BC, reflections on historical turning points in shaping BC awareness today have been discussed here as the current events will be adding to the future trajectory of BC awareness.

Genesis of October as the awareness month and the pink ribbon

Breast Cancer Awareness Month was pivotal in raising awareness and promoting mammography for detecting early BC starting in 1985 when the American Cancer Society and Imperial Chemical Industries organized week-long breast cancer awareness in October5,11. The event was kicked off by First Lady Betty Ford, who was herself a BC survivor. It aimed to draw social attention to BC and its early detection through mammography. Inextricably linked with October’s Breast Cancer Awareness motto the iconic pink ribbon, symbolizing BC awareness and support for those affected by BC12,13. The notion of using a symbolic ribbon to draw attention to BC and its limited research funding goes back to 1991 when a BC survivor named Charlotte Haley used her favourite peach colour to switch and distribute peach ribbons to promote BC awareness14. Later in the same year, the Susan G. Komen Breast Cancer Foundation gave away the pink ribbon during the New York City race for cure. A colossal turning point followed this in 1992; another BC survivor Evelyn Lauder from Estée Lauder cosmetic companies and Alexandra Penny from the SELF magazine launched a nationwide awareness campaign5,12-14. Recognizing the significance of the national breast cancer campaign, the United States president George W. Bush proclaimed October as National Breast Cancer Awareness Month in 199015.

Transforming impact of the October awareness campaign

The quantum leap of awareness achieved through the October campaign since its inception in 1985 has successfully achieved its objectives, becoming a driving force in bringing BC awareness and early detection to the forefront of society. It has provided vital empowerment and support to patients and survivors, instilling hope in recently diagnosed women. The campaign’s impact goes beyond individual lives, as it has raised substantial funds for research, catalyzed policy and legislative changes, engaged communities and provided a model for other cancer types16-19. In the past, some often viewed BC diagnosis as a potential death sentence; now, many individuals especially those whose cancer was detected early on could be managed with a longer survival rate. The campaign’s impact is palpable, as BC awareness has become deeply ingrained in society. Women now feel much more open to discussing issues about BC, treatment and risk factors with their doctors and others affected by the disease, whether in informal settings or formal support groups.

Advocating focus on year-round awareness on BC in young women

The importance of the Breast Cancer Awareness Month in breast health is undisputed. However, it has also faced criticism on several grounds. Some of these issues include pink washing and the oversaturation of pink, diluting the focus on essential aspects of BC awareness, not sufficiently addressing the risk factors and preventive measures, limited awareness about available screening methods and limited advocacy of the issues germane to BC in young women6-10,20-23.

BC rates among young women are rising in India and worldwide. According to the 2020 data from the World Health Organization24, the incidence of BC among women in India is nearly equal to the global average, accounting for 26.29 per cent of all women’s cancer cases in India and 24.5 per cent worldwide. However, a significant disparity emerges when examining new cases in women under 39 yr. In India, these cases constitute 15.69 per cent of all BC diagnoses up to the age of 85+ yr, whereas globally, this age group accounts for 10.96 per cent of all BC cases24. Younger women with BC face unique challenges1-3 and are often overlooked during the October campaign. BC is sometimes perceived as an older woman’s disease, leading to misconceptions about the risk for younger women. This can delay diagnosis and result in more advanced cancer stages at diagnosis. The focus on post-menopausal women in BC research may also neglect the need for more research in the younger age groups. BC in young women tends to be more aggressive if diagnosed later1-3, highlighting the importance of early detection and awareness. The lack of awareness among younger women, limited guidelines and healthcare insurance coverage for spontaneous BC diagnosis contribute to many such cases being diagnosed at an advanced stage. Raising awareness among younger women is hence crucial to improve outcomes and reduce the burden of BC in this age group. Emphasizing the importance of early detection, self-breast examination and addressing the unique challenges younger women face should be integral to BC awareness efforts beyond October.

The pink-purple ribbon for BC in young women

For years, the pink ribbon has stood as a universal emblem for raising awareness about BC and honouring the lives touched by this ailment. However, a distinct set of challenges arise for young women confronting BC due to their early diagnoses2. In response, the BCYW Foundation has introduced the pink-purple ribbon logo (https://breastcancerinyoungwomen.org/about/#purple) to spotlight the rising instances of BC among young women and the distinct challenges they confront as compared to those diagnosed later in life3. The pink-purple ribbon is a tribute to the fortitude of young women grappling with BC and the unique obstacles woven into their journeys, distinguishing them from those diagnosed later in life. Its purpose is to empower individuals with knowledge, enabling them to identify the disease in its early stages when treatment holds the highest potential for success.

Moving forward

It is essential to reflect on the challenges faced by young women with BC, and emphasizing the importance of early detection remains crucial. Bridging the gaps in understanding and supporting the issues discussed here during the Breast Cancer Awareness Month and beyond can impact the lives of young women diagnosed with BC. Undertaking a campaign to promote BC awareness throughout the year is vital to promote evidence-based information, supporting research priorities, and supporting patients during and after the disease. Engaging in ongoing discussions addressing the challenges associated with population screening, early detection and BC treatment beyond October can help sustain awareness and foster a continuous effort to detect BC at the earliest possible stage. By recognizing the diverse experiences and needs of all individuals affected by BC, a more inclusive and impactful Breast Cancer Awareness Month can be created that supports and empowers everyone on their journey through this disease. Together, we can work towards a future where BC is better understood, prevented and treated, ultimately leading to improved outcomes and a better quality of life for all those affected.

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