Airbrush, whitewash or accident? Older women missing from another breast cancer campaign.

The cancer research charity Breast Cancer Campaign has launched a new... ummm.... campaign. You can see it here. The call to action is ‘email your MP’. Then the MP gets information that raises their awareness of secondary breast cancer, the importance of increasing survival and improving service delivery. It boils down to ‘There’s an election next year. Keep women with secondary breast cancer in mind’.

This is another link to the main image alone, in case the weblink gets broken or is removed at the end of the campaign.

It's this image that bugs me. It's not wrong or wildly inappropriate, or a lie. It's certainly indicative of one woman's personal and family tragedy, as the woman pictured in it appears elsewhere with her little boy as well as advanced breast cancer. Those families' stories should be told.

I'm bothered about the other additional details the image appears to communicate and some detail it manages to exclude. 

Most women who die of breast cancer will die as a result of secondary cancer, the ones that have spread, so the campaign is important to the charity lobbyists and women with breast cancer. There’s no question of that. The email campaign for MPs says that each year in the UK about 12,000 women die of breast cancer. But what does the Breast Cancer Campaign’s choice of image communicate, beyond the effects of secondary cancer?

That it's relatively young women who are affected, mostly. And a side order of Caucasian ethnicity.

Of the 12,000 women who died most of them - around 10,500 – were over 50; and 5,000 of those were way past 50, as they were aged 75 and over. In the last year for which statistics are available, a small proportion of women who died of breast cancer which spread were under 50 - about 1,200 of them - 10%, more or less.

I am concerned that a breast cancer charity has, again, chosen a youngish and white woman for their imagery. What does her relative youth, compared to most women with secondary breast cancer, communicate? The wrong but obvious conclusion for the audience to draw, is that most women who get secondary cancer are young. The numbers show most women are not young, some not young at all, with c.42% of deaths in women aged 75 and over.

The other assumption the imagery invites audiences to accept subconsciously is that secondary breast cancer is, of course, of more concern in relatively youthful women than it is in older women.

If that was true, that’s the kind of ageism I want a charity for, largely, women - to change, not to go along with and even publicise. I can see there is terrible injustice in the situation as the featured woman is a parent – but I don’t recall agreeing that the injustice of secondary breast cancer was ranked and we had all agreed on how. It is not OK to exclude older women as beyond, or beneath, concern. 

Older women might be economically active, be employers, or deliver unpaid care for spouses or their own very elderly parents, care for grandchildren, be volunteers, be cornerstones of a family or housebound frail women with no family remaining. All women have intrinsic value for what they do or what they have done in the past and for all the relationships their continued existence supports, or deserves. A breast cancer charity knows this, surely.  

I rail against using the default of images of younger women to publicise breast cancer issues in a way that consistently removes older women from the picture.

It's ageist.

It happens all the time. It's why we now need adverts to advise older women of the risks of breast cancer in later life. They have consistently been given the impression that breast cancer is a younger woman's disease, a younger woman's risk. 

As older women go out and actually vote, the email appeal from Breast Cancer Campaign might have missed a trick with their imagery. Older women voters might be key in the upcoming elections. If MPs had been sent a picture with a more representative older woman they might connect the dots and spot breast cancer as an issue for their older voters/constituents and pay attention.

The breast cancer lobby keeps on losing sight of older women. A breast cancer charity, of all organisations, should consciously value all women equally and check their imagery rigorously for evidence of exclusion. 

Then there’s ethnicity. Black and other ethnic minority women get breast cancer too. MPs need to know this and have no chance of learning this from the Campaign as shown. Have women from BME communities supported Breast Cancer Campaign’s activism because they know secondary cancer could be their story too?

Possibly.

Do they want to #spreadtheword to their local MP, as Breast Cancer Campaign hope, through the medium of a picture of a white woman?

I suggest maybe not.  

Unfortunately, the ostensible audience of MPs might also need different imagery involving balance, accuracy and something a bit more objective. I’m going to have to say ‘typical’, though whether there is such a thing is moot, as the experience of secondary breast cancer is individual to such a nasty degree it can be utterly isolating.

The mean age of death in women from breast cancer is about 71, so a picture of someone in their early or mid 60s would do very well as an honest illustration of the women whom secondary breast cancers are most likely to hit. The image is of a woman fully 20 years younger than that isn’t a common story but a personal one and I respectfully suggest that the common one is the story with which to enlighten MPs. The electorate can’t always blame MPs for being out of touch about everything if, some of the time, this might be as a result of  lobbyists’ misinformation or misrepresentation, however well intended.   

Let’s think more about the MPs. There are inner city constituencies with ethnic minority populations, and often an ethnic minority MP, who might pay closer attention to a non Caucasian face and thus strengthen and broaden the breast cancer supporter base. The absence of an older face means the campaign has compromised on picking up other supporters too. Some MPs join All Party Parliamentary Groups. Thus MPs in Groups for Ageing and Older People, Primary Care and Public Health, Integrated Health Care, Cancer or Carers might have seen a connection between their special interest and women with secondary breast cancers, if given a bit more of a pointer with an illustrative older face. An older face might also catch the eye of an MP interested in pensions, benefits or social care. Breast cancer does not have to be narrowly defined as a 'health and medicine' issue to garner MPs support.

How would I fix the image? I’d simply put an older woman alongside the younger woman, so we can see the many faces of secondary breast cancer by implying the reality of a range. l'd also have an alternate version including an older woman of non-white ethnic origin to hand, to be sent to particular, mostly urban, constituency MPs.  

The overarching campaign message is vague. I am unclear whether it’s a ‘more research’ campaign, an ‘improve services’ campaign or both. It’s weak as a ‘keep breast cancer on the agenda’ campaign since there is no hint to the MP of on which agendas women with secondary breast cancer might fit and relevant policy developed. Breast cancer links with the range of health, welfare and social policy areas from mothers of young children all the way up to care of frail elderly, housing, end of life care, across to the spend on science and technology and off away over the hills into the funding of the Research Councils.

If I must accuse Breast Cancer Campaign of something, it’s not that they deliberately set out to ignore older women in this campaign but instead, it wasn’t obvious they even gave a passing thought to them - in a disease of ageing. If there was deep discussion about the imagery and the choice of a younger woman was, in fact, far more calculated than I realise, I would like to see the calculations.

I doubt I'll agree with them but I’d like to know what they were. They would be grounds for an excellent campaign on breast cancer.