Breast cancer is the most common cancer in the world. It is also the most publicized and capitalized on in the United States. Pakistan has the highest percentage of both breast cancer patients and deaths caused by this disease annually in Asia. While the disease has the same symptoms for patients in the U.S. and Pakistan, the experience of women with breast cancer in the two countries is extremely different. In Pakistan, the word “breast,” itself is taboo. Modesty is extremely important and gender equality is a concept that is far from reality. In a nation where simply saying the word “breast,” is seen as shameful, how can there be adequate treatment for patients that experience an illness that concerns this part of their body? As seen by data showing the effects of breast cancer both in the U.S. and Pakistan and by phrases and images used to discuss the topic in the different countries, it can be seen that there is a severe difference in the portrayal of breast cancer. Community and culture play a substantial role in the experience and education of individual patients with the same disease.
Education in Pakistan, while having improved substantially throughout the past few years, is extremely limited for females, especially those not part of wealthy families. For this reason, many women don’t know about any of the symptoms related to breast cancer and aren’t able to detect it at an early stage. Most women aren’t aware that this is an inheritable disease and are unaware of the existence of critical tests, such as mammograms. Furthermore, the small percentage of women that know of the importance of regular testing are too embarrassed to get tested because of the lack of female physicians in the country, causing them to avoid examination for the fear of having to face a male doctor.
According to a study done by the Journal of the American College of Radiology in which 200 randomly selected women on the streets of Karachi, Pakistan were surveyed, “Only 20% of women knew that breast cancer occurs in women of all economic and racial backgrounds, and 37% understood that a family history of breast cancer is a risk factor for developing the disease” (JACR).
This shows a clear lack of understanding of the topic and it is evident that this educational disparity is a large part of the reason why there is such a large percentage of Pakistani women that die of the illness. In addition, only about 25% of the women surveyed knew how to perform a self-breast examination (JACR). This survey was done on women in Karachi, Pakistan; one of the biggest, most educated cities in the country. If women in one of the most advanced, educated parts of the country don’t understand the risk factors of cancer, and how to detect it early on their own, then it is obvious that women in small villages, where there aren’t schools for girls to study past the age of 12, are at a clear disadvantage.
On the other hand, in the U.S., programs such as the National Breast and Cervical Cancer Early Detection Program have been funded by the government in order to educate American women about the risks, symptoms, and early detection methods for breast cancer. During the year 2007 alone, the NBCCEDP served 1.02 million women at a total cost of $255.53 million, not counting the estimated value of in-kind donations (US National Library of Medicine National Institutes of Health). There is a clear difference in the education that the populations of these two countries have regarding breast cancer and early detection. In contrast to Pakistan, where most women are never officially diagnosed and aren’t aware of how to detect the problem on their own, in the U.S. there are programs that are funded with millions of dollars for the sole purpose of educating the population and increasing the rate of early detection of breast cancer.
While education is one factor that affects the rates of deaths due to breast cancer in the two countries, there is also the stigma that surrounds cancer in Pakistan. In a patriarchal culture in which modesty is emphasized, girls with breast cancer are unable to speak up and inform anyone about their illness, simply because the word “breast,” in and of itself is taboo. “Breast cancer is associated with women’s sexuality so it becomes a taboo subject in Pakistan,” says Omar Aftab, from the breast cancer charity Pink Ribbon Foundation. “Rather than seeing it as a disease, it’s a sexuality issue” (BBC News). For women such as Silvat Zafar, whose mother passed away at an early age, there is no other woman in the family to speak to, and telling a male family member is simply not possible. For such women, it is difficult to get treatment as many don’t work and must depend on the earnings of their fathers, brothers, or husbands, to whom they cannot share the news of the illness because it concerns such a private body part. Zafar, for example, was only able to visit a doctor six months after she initially noticed the growth in her breast and by then the cancer had reached stage three. For young girls especially, this topic is extremely sensitive because of the fear that it will affect marriage. In Pakistan, most marriages are arranged by parents and suitable proposals are judged on looks, wealth, caste, and most importantly, health. There is often the agony of enduring the illness, and then if you’re lucky enough to survive, there is the risk of never being able to get married. Zafar explains that she gets many proposals, but as soon as it is revealed that she has or previously had breast cancer, they are canceled, because no one wants to marry someone with cancer (BBC News). Zafar is not the only person that has experienced this. 51% of Pakistani women surveyed believed that diagnosis of breast cancer would be a family disgrace, while 38% thought that if their husbands were to find out about such a diagnosis, it would end in divorce (JACR). When it comes to having to deal with such a life-threatening illness, it is important to have a support system to help the patient get through what it is that they are experiencing. For Pakistani women, however, support is far from what they are receiving. Many are afraid to be disowned by family or divorced by their husbands for something that they simply cannot control.
The taboo associated with breast cancer is also evident in the way that awareness is spread about the topic in Pakistan. While there was no real awareness of the topic before, there are now foundations trying to spread the word about the effects of the illness in the country. The Shaukat Khanum Cancer Awareness Foundation began a breast cancer awareness campaign in early 2019. The campaign consisted of Pakistani actresses starring in TV advertisements and billboards encouraging young women to do routine self-examinations and for women above 40 to visit a doctor annually because the occurrence of breast cancer is more likely after that age. The writing on the advertisements, as seen in Figure 1, was all in the national language of Urdu, so that more women, whether extremely educated or not, would be able to read it. However, not once is the word “breast,” mentioned in any of these advertisements. It is instead referred to as “Women’s Cancer.” The fact that a foundation dedicated to spreading awareness for the illness refuses to use the word “breast” shows the clear taboo that surrounds the subject, reinforcing the idea that many women with breast cancer are seen as a disgrace to their family. The women shown in the advertisements are young, attractive, fully-clothed women that aren’t being provocative in any way that would offend people that see the poster, yet are still idolized enough to convince women to want to learn more about self-examination.
In contrast, breast cancer campaign advertisements in the U.S. are often a lot more direct. As shown in Figure 2, an image published by the American Cancer Society, there is less secrecy regarding the disease. The woman photographed is topless and poses in a provocative manner compared to the model in the Pakistani campaign, who simply holds her hand above her heart. In this American poster, the subject holds her arm up, with her hand behind her head with pictures printed across her torso. Such an image catches the attention of the American audience and the word “YOUNITED,” printed in large, pink letters across the chest of the model makes the audience feel a sense of inclusion in the campaign. The Pakistani advertisement, on the other hand, is a lot more discrete. It does not give a sense of unity, because Breast Cancer is not something most people there are comfortable enough to discuss, let alone join the campaign for. It is also notable that the only color shown in the entirety of the American poster is the pink of the letters, which brings attention to the breasts of the model, on which the letters are printed. In the Pakistani advertisement, the model covers her chest area with her arm and wears large, loose clothing. There is no attention being brought to her breasts. These differences in the way that these campaigns work to attract attention and the level of modesty that is used in both shows a clear distinction between the attitude toward breast cancer in Pakistan in comparison to that of the U.S.
While in Pakistan, women die because of the inability to speak of the existence of illness in their body because the name of the illness itself is taboo, the U.S. seems to make money off of it.
Barbara Ehrenreich, a survivor of breast cancer and the author of the article, “Welcome to Cancerland,” describes the breast cancer community as a “cult of pink kitsch.” She brings to light how being a patient of breast cancer in the U.S. has become less about your health and treatment, and more about the pink ribbons, teddy bears, and hopeful sentiment that has become the fluff that surrounds the larger problem that is an extremely detrimental illness. While brands such as Revlon, Estee Lauder, and Ralph Lauren have “breast cancer lines,” which showcase clothing and makeup of distinct shades of pink, other department stores, such as JC Penney and Macy’s, have months which feature breast cancer awareness campaigns, in which a minuscule percentage of sales are donated to breast cancer foundations. In the U.S., breast cancer has become such a common topic and there is so much involvement of manufacturing companies that surrounds it, it takes away from the actual experience of being a patient of the illness and suffering actual legitimate pain. As Ehrenreich describes it, the community is so guarded and set on only portraying a hopeful, positive experience of being part of a large community of supporters, that if someone, such as Ehrenreich, showed any feelings of frustration or anger towards being ill, or felt some jealousy of those patients that had less severe symptoms than her, there was nowhere to go for some real reassurance and advice (Ehrenreich). She describes how everyone put a silver lining around things and wanted to portray breast cancer as something that everyone would get through with enough support, positive thinking, and reassurance from the community.
This false and overly positive representation of breast cancer is reflected in the “Save the TaTas Foundation,” which has become one of the biggest providers of financial support to breast cancer research. The campaign raises money for breast cancer research and early prevention education by selling merchandise with the “save the ta-tas” logo on it, as well as sponsoring breast cancer marathons. It is important, however, to question why one of the most famous breast cancer logos in the U.S. is one that does not even say the word “breast”. Whereas the phrase to replace “breast cancer” in Pakistan is “women’s cancer,” because of the taboo surrounding the word “breast,” the American replacement of the word “breast,” is a lot more playful, almost childlike. The use of the word “ta-tas” instead of “breast,” shows the influence that gender has on the popularity of breast cancer campaigns. Most of the breast cancer “marketplace,” consists of “feminine” products, such as cosmetics and jewelry, alluding to the idea that breast cancer has “disastrous effects,” on one’s looks, according to Ehrenreich. The use of words such as “ta-tas,” and the distribution of things such as crayons and teddy bears in breast cancer “care packages,” in addition to feminine products, portrays the current popular gender ideology which indicates femininity as, by nature, childlike and incompatible with adulthood. The word “ta-tas,” as well as the color pink indicate the childlike nature that is associated with being a woman, as they are seen as more “emotional,” and in need of the help of toys and crayons in order to cope, while also indicating how much of a woman’s existence is characterized by her looks, which are compromised with the existence of cancer.
While the vocabulary that surrounds breast cancer in Pakistan is used as a way to not acknowledge the existence of the illness, in the U.S. words and images are used in order to draw a larger audience and bring attention to the issue in a way that will make money, but not at all legitimize the pain and suffering of a breast cancer patient. The childlike, ultra-feminist depiction of the illness in the U.S. discounts the experiences of actual patients, as the deadly disease is characterized by the color pink and bright teddy bears with cute slogans on them.
Being the most common cancer in the world, it is evident that breast cancer gets an immense amount of attention in terms of government campaigns and media representation. Although it is universally detrimental to the female population of the world, it is obvious that there are social factors when it comes to things that we sometimes see are purely scientific, such as cancer. The extreme difference in societal norms in the two different cultures of the U.S. and Pakistan affect not only the representation of breast cancer in the two countries but also the way that it is treated and regarded. The narratives of women that experience breast cancer in the U.S. differ greatly from those of women in Pakistan. While one group worries about whether or not to get implants after a mastectomy, the other group debates whether or not to even consult a doctor about it in fear of bringing disgrace to their family. The difference in these concerns is emblematic of the greater societal norms of the two regions and how much a single idea or concept can differ across different cultures, as shown by the language surrounding it, the narratives of women who experience it, and the images that are used to depict the issue.
