This year, October-as-breast-cancer-awareness-month seems a bit off, post-peak, tired. It's been like this for a while now, waning over years. As National Breast Cancer Awareness Month (NBCAM) ages it may appear unnecessary – as in no longer useful, unwanted, old. And I suppose it – awareness – has become that, dated. It no longer seems fresh (even with pink make-up). Rather, it comes on like a mediocre advertisement, over-played. A has-been. For those of us who advocate for the "cause" – as I see it: the need for more breast cancer research and better care for all affected – a calendar-based theme feels gimmicky and commercial, even manipulative. At best, it's useful for fundraising. In some parts of the world, including a few U.S. communities where believe-it-or-not stigma about having cancer persists, NBCAM may lead a few women who are hesitant to seek care for breast tumors to go and get it. The fact is, we're saturated, bombarded, blasted with cancer news – and often conflicting information, at that. For many people grappling with a serious disease year-round, the notion of promoting awareness for one month, and labeling it pink, verges on absurdity (or crosses that line). But not everyone feels that way. For some, cheerful walks and other activities provide an opportunity to find camaraderie and demonstrate support for those affected. Patients have different preferences and needs; advocates have different style and priorities. The issue about October is that for all the genuine enthusiasm and generally good intentions NBCAM brings together, at some levels an uplifting vibe runs counter to the devastating nature of malignancy. But patients need support, and researchers need funds. I do think we, at a community level, still benefit from an occasional reminder that breast cancer is not a solved problem − that it's not "gone," nor cured or a condition to ignore. Rather, each year 40,000 people in the United States, mainly but not exclusively women, and over 520,000 people worldwide die from breast cancer. Today's message of awareness might adjust to the date, 2014, and shift focus: Emphasize the unmet needs of people living with metastatic breast cancer. They – whose number goes untallied even in the U.S. – go about their lives with an incurable condition; they receive treatment until death. It's not pretty. Far from it. Point to critical areas for research , including these: breast cancer's causes – that it might be prevented; metastases – that those might be prevented too, or better managed when and if they do arise; better, more effective and less harmful treatments for all molecular subtypes of the disease; improvements in pathology (diagnostics), so that patients with "slow" or minimal tumors can safely avoid overtreatment. Know that patients have options, and should be informed of those and able to ask questions of their physicians. The best medical care happens when patients participate in decisions about their care, when they're educated and can enter the doctor's office or clinic with a reasonable understanding of their condition and choices. Recognize that the world is disease-ridden. Awareness demands perspective, including the fact that breast cancer is one of many illnesses from which all kinds of people suffer and some die. Cancers do not enter contests of severity or merit. More generally, there is no international tournament of sicknesses. Each condition, every person, deserves good medical care – provided respectfully and with access to pain medication, if needed. Be aware of the day, even cloudy ones like this. Time is precious. Value what you've got.
