On the 14th of May 2013, Hollywood actress, filmmaker and humanitarian, Angelina Jolie announced that she had undergone a double mastectomy to reduce her risk of developing breast cancer because she carries a mutated gene that left her at an 87% risk of the disease. In an op-ed in the New York Times she outlined her reasons behind the preventive surgery and catapulted the issue of breast cancer and prevention once more into the media spotlight. The news received international attention and was followed by a variety of editorials, columns and opinion pieces providing advice to the reader on how to check oneself, how to avail of screening services and reiterating the importance of early diagnosis to the success of any breast cancer treatment. In the UK, this pronouncement has been followed by other high profile breast cancer announcements from, for example, Loose Women presenter Carol McGiffin and the BBC journalist Sian Williams. Victoria Derbyshire, another BBC journalist, announced her diagnosis and double mastectomy in July of 2015 and took the decision to record five video diaries of her treatment over the following year to try and demystify the process and raise awareness of the disease.
These revelations from well-known women have served to once more increase the public visibility of the disease and in the case of Derbyshire’s video diaries emphasise the place of the NHS in the treatment of the disease in the UK. Following her last radiotherapy session, Derbyshire revealed that ‘there are so many people I want to thank. And most of them work for the NHS’. This was a sentiment she had repeated in a number of her video diaries, clearly linking her breast cancer experience with the NHS. While the NHS has long played an important role in the treatment of breast cancer, it has only been in more recent decades that it has provided a screening programme aimed at early diagnosis and begun to support more generalised attempts to capture individualised experiences of breast cancer.
This week marks the beginning of Breast Cancer Awareness Month, an event that originated in the United States in 1985 and later spread worldwide. This offers us a good opportunity to consider the place of breast cancer treatment, screening services and awareness campaigns within the NHS. While breast and cervical cancer received widespread local educational attention in the interwar period, during the 1950s the momentum slowed in the face of GP resistance and policy preference for improving service provision first. Before the late 1960s, national newspapers, magazines and radio and television programming all generally highlighted biomedical research and the availability of new equipment rather than any commitment to discussing symptoms, treatment or experiences.
This slowly began to change as the increasing evidence that smoking caused lung cancer received increased educational and media attention. Indeed, by the early 1960s cervical smears were being emphasised in the national media, in part because of the campaigning efforts of women’s groups to make screening a national priority. However, while this marked an improvement in terms of the public visibility of cancer, there was still very little coverage of treatment or personal experiences of cancer. By the late 1960s this was beginning to change. As Elizabeth Toon has discussed, in 1968 education journalist Caroline Nicholson briefly discussed her personal experience of breast cancer within the pages of the Guardian. In March 1973 Nicholson conducted an investigative piece on her own and other women’s personal experiences of breast cancer and outlined her view of treatment options at home and abroad in the women’s monthly magazine, Nova. The following year Women’s Own took the subject to a broader audience. One of the first mainstream televisual accounts of the experience of breast cancer treatment was the BBC1 teleplay Through the Night starring Alison Steadman. Watched by eleven million viewers, the programme opened up the discussion of breast cancer to a wide audience and served as an early example of fictional accounts of breast cancer that showed the experience of the sufferer.
While cultural change towards the discussion and depiction of breast cancer in the media was changing rapidly during the 1970s, the decision to develop a screening programme for breast cancer in the 1980s demonstrated a political will to commit the NHS to cancer detection. In 1986 the Forrest Report recommended that breast screening be introduced in the UK. Its recommendations were accepted and in 1988 a NHS breast cancer screening programme was launched in the UK, inviting women aged between 50 and 64 to have a mammogram every three years. In 2004 the upper age limit for invitees was increased to 70 (with those over 70 entitled to request a screening) and currently the NHS is trialling extending the programme for those aged between 47 and 73. Because survival after diagnosis and treatment is directly related to the stage at which the cancer is diagnosed, an earlier detection of breast cancer results in better survival rates. Indeed it is the goal of Breast Cancer Now, the UK’s largest cancer charity, to ensure that everyone who contracts the disease will survive by 2025. Screening is an important process in this.
A variety of national and international initiatives have been designed to raise awareness about such screening programmes and encourage women to become more attentive to the measures available for earlier breast cancer diagnosisr. In particular, the dedication of October as breast cancer awareness month has gained continued momentum and support in Britain and beyond. It aims to educate women in the importance of mammograms and self-examination for the early detection of breast cancer. Awareness weeks and months now almost fill the annual calendar, concentrating on topics as wide-ranging as urology, sexual health, suicide, men’s health, OCD and mental health. Yet none have managed to capture the media as effectively and with such continued longevity as breast cancer. In particular, campaigners have been very successful at utilising single identifiable characteristics, with the use of pink ribbons as recognisable objects of support for breast cancer sufferers particularly effective.
Building on the campaigning impetus secured by AIDS awareness in the 1980s and early 1990s, breast cancer awareness modelled the pink ribbon on the red ribbon of the AIDS campaign. Designed to show support and solidarity with women suffering from breast cancer, the visible pink ribbon was also designed to create a talking point around the disease. In this it has been remarkably successful on an international stage with numerous national cancer charities and breast cancer support organisations adopting the pink ribbon within their own fundraising activities. While most of these activities operate outside of the NHS, they provide important ancillary sources of information and research funding, advising women on how to check for signs and symptoms, when to visit their GP and how to avail themselves of screening services.
Breast cancer awareness has continued to receive, and indeed maintain, high levels of public publicity through annual events such as ‘wear it pink’, moonwalks and coffee mornings. Corporate sponsors such as Marks and Spencer, Avon and Asda have all allowed for the creation and success of tailored lines for breast cancer awareness month with the colour pink once again used as an identifier. In this respect the responsibility for creating awareness of breast cancer has fallen to the charity and media sectors with the NHS the secondary institution of care upon which all these initiatives look to. Breast Cancer Now, Macmillan Cancer Support and Breast Cancer Care in particular have been particularly successful at harnessing the media for publicising breast cancer as well as promoting patient experience. It has become a reciprocal relationship with the NHS choices Be Clear on Cancer not only providing its own information but directing patients to other sources of information, largely from the charity sector. In that respect breast cancer awareness in the twenty-first century has become increasingly focused on the experience of the sufferer. It has utilised the power of the mass media and the charity sector to support the NHS in providing information on symptoms, treatment and the place of NHS screening prevention. In this way it continues to encourage early detection as the best possible way to reduce mortality.