The Power of Pink: Cause-Related Marketing and the Impact on Breast Cancer Jennifer A. Harvey, MDa, Michal A. Strahilevitz, PhDb The pink ribbon is one of the most widely recognized symbols in the United States. It can symbolize strength, hope, responsibility, empathy, and permission to discuss breast cancer, though not all associations are uniformly positive. Cause-related marketing is an agreement between nonprofit and for-profit organizations to promote a product that provides benefit for the cause through increasing awareness and financial contributions from sales. For-profit organizations benefit through the association of the positive ideology of the pink ribbon. The relationship between the organizations should be mutually beneficial; the percentage of funds donated should be reasonable, and the organizations that benefit should be respected institutions. Many breast cancer organi- zations have obtained significant benefit from corporate partnerships in cause-related marketing. Certainly, breast cancer awareness is much stronger now than 15 years ago. However, not all products are appropriate for promotion, particularly products that may increase the risk for breast cancer, such as alcohol. No corporation is licensed to have exclusive use of the pink ribbon symbol, leaving it open to potential abuse. Backlash by consumers has raised awareness of the misuse of the pink ribbon and cause-related marketing. As marketing becomes more global, the impact of the pink ribbon in the third world may spur open dialogue and reduce the taboo associated with breast cancer observed in some cultures. Key Words: Marketing, consumerism, breast cancer, research funding J Am Coll Radiol 2009;6:26-32. Copyright © 2009 American College of Radiology October is easy to recognize. October is Breast Cancer of a cause as early as the Crusades and later in the tem- Awareness Month, and all things become pink and perance movement [1]. “Ribbon workers” encouraged adorned with ribbons. Grocery stores are awash in pink: men to sign pledges that they would give up alcohol and on the packaging of soup cans, breath mints, wine bot- then wear white ribbons as a sign of their pledges [1].In tles, diet meals, candy, deodorant, and even yogurt. Pink more recent times, yellow ribbons were used to promote apparel ranges from pink athletic shoes to finely tailored a cause from 1979 to 1981, when Americans were held suits adorned with pink ribbons. There are pink kitchen hostage in Iran. Throughout the country, yellow ribbons appliances, tweezers, cosmetics, and office products. A were tied around trees to symbolize support for freeing Ford Mustang can be special ordered with a pink ribbon the hostages. Later, red ribbons were used to promote motif. Even commercial airlines have planes adorned awareness of the AIDS epidemic. with pink ribbons. The pink season has become a stan- In 1990, Charlotte Haley, who had multiple relatives dard part of fall marketing, between the back-to-school with breast cancer, glued peach-colored ribbons to cards season and Halloween. that gave information stating that only 5% of the Na- tional Institutes of Health budget was apportioned to A BRIEF HISTORY OF THE PINK RIBBON breast cancer research [2]. She sent the cards to promi- Breast cancer is not the first cause to embrace the use of nent women and also sold them at local markets. Evelyn ribbons as symbols. Ribbons have been used in support Lauder, then-senior vice president of Estée Lauder, and Alexandra Penney, then-editor of Self magazine, worked on a special insert for Breast Cancer Awareness Month in aDepartment of Radiology, University of Virginia Medical Center, Charlottes- October 1991 [2]. A ribbon was included as a symbol, ville, Virginia. but the color of the ribbon was changed from peach to bDepartment of Marketing, Golden Gate University, San Francisco, California. the most universally recognized female color of all, pink. Corresponding author and reprints: Jennifer A. Harvey, MD, University of Virginia Medical Center, Department of Radiology, PO Box 800170, Char- Lauder arranged for pink ribbons to be distributed at lottesville, VA 22908-0170; e-mail: [email protected]. cosmetics counters throughout New York that same year. 26 © 2009 American College of Radiology 0091-2182/09/$36.00 ● DOI 10.1016/j.jacr.2008.07.010 Harvey, Strahilevitz/The Power of Pink 27 To date, the Estée Lauder Companies and their retail part- development of visual culture regarding breast and ovar- ners have distributed more than 70 million pink ribbons ian cancer because people are less able to visualize and and informational brochures around the world. They have thus identify with internal organs. The association of also raised more than $25 million for the Breast Cancer cervical cancer with human papilloma virus, which is a Research Foundation [2]. Many companies, both for profit sexually transmitted disease, may also contribute to its and nonprofit, have since embraced the pink ribbon and the status as a more private illness. fight against breast cancer that it symbolizes. In addition, there have been strong public figures will- Today, the pink ribbon is one of the most widely ing to discuss their diagnoses of breast cancer. Beginning recognized symbols in the world. Like the World Wild- in the 1970s, the public announcement of Betty Ford’s life Fund’s logo, the pink ribbon logo carries great mean- diagnosis of breast cancer opened up public discussion of ing to many consumers. That fact makes it valuable to this disease. Since then, a wide range of celebrities, in- marketers who are willing to share profits with breast cluding Gloria Steinem, Suzanne Somers, Sheryl Crow, cancer-related nonprofits in exchange for a chance to link and Melissa Etheridge, have openly discussed their breast their brands to this well-known and highly valued cause. cancer diagnoses. In contrast, there has been a paucity of The ribbon now symbolizes more than breast cancer figures who have discussed their experiences with ovarian awareness. There are few data on what the pink ribbon or cervical cancer. With the possible exception of Gilda symbolizes to women or men. It likely symbolizes differ- Radner, many people would not be able to name a public ent things to different people. The pink ribbon may figure with either ovarian or cervical cancer. The current symbolize strength, hope, responsibility, empathy, and awareness campaign of the National Ovarian Cancer Co- permission to discuss the disease. Not all reflections on alition is called “Break the Silence” [6]. This is a strong the pink ribbon are positive, however. Some have voiced contrast to the crusade symbolism of breast cancer cam- concern that the pink ribbon and some of the associated paigns. products, such as teddy bears, are infantilizing [3]. The population that is afflicted with breast cancer may The use of pink ribbons may give the public a method also influence the popularity of the cause. Breast cancer is of identifying with cancer without having to visualize most common in women aged 40 years and older, who objectionable images of tumors, pain, or the side effects are frequently identified as wives, mothers, aunts, and of treatment [4]. The use of a ribbon symbol for breast grandmothers. This group of women signifies home and cancer has also drawn parallels to that of a crusade [1]. family. Thus, there may be a unique emotional response The language used to describe breast cancer reflects a war to breast cancer because of the potential threat to home state. We “fight” breast cancer. Those who succumb have and family. This may partially explain why, although “lost the battle.” Those who live are “survivors.” Indeed, breast cancer is predominantly a female disease, both the philanthropic arm of the Avon Company is the Avon genders are emotionally affected by breast cancer mortal- Foundation Breast Cancer Crusade [5]. In her essay ity. In contrast, cervical cancer is more common in “Welcome to Cancerland,” Ehrenreich [3] suggested that younger women, who are less likely identified as wives breast cancer-related products serve as amulets or talismans and mothers. serving to comfort sufferers and provide outwardly visible That said, the largest support for fighting breast cancer “evidence of faith” of others. She added that the numerous has come from women. This includes women of all ages, personal narratives available in print and online serve as backgrounds, and walks of life. In her book Marketing to testimonials, while gatherings such as Race for the Cure Women, Barletta [7] stated that marketing to women is events serve as pilgrimages. Clearly, a culture has developed largely about relationships. Women may join the breast around breast cancer that is complex and not well studied. cancer cause in part to become part of a community or “sisterhood” of women supporting other women. Participa- tion in breast cancer events may signify supportive relation- WHY BREAST CANCER? ships with other women, even though the nature of those The breast is an external symbol of femininity. Although relationships may be more symbolic than concrete. occurring in similar age populations as breast cancer, ovarian and endometrial cancer are far less common, and CAUSE-RELATED MARKETING: WHEN there is far less awareness of either disease. Women may BUSINESSES TAP THE POWER OF THE identify with others who have suffered from breast cancer PINK RIBBON because the breast is an external organ. The ovaries and Cause-related marketing has been defined by marketing uterus are internal organs that may engender less personal scholars Varadarajan and Menon [8] as identification. In her essay “Pink Ribbons and Public Private Parts: On Not Imagining Ovarian Cancer,” The process of formulating and implementing marketing activities Holmes [4] suggested that there has been an uneven that are characterized by an offer from the firm to contribute a spec- 28 Journal of the American College of Radiology/Vol.