Pink is Amy Wadsworth's favorite color. But when she entered a wig store decorated pink for October -- Breast Cancer Month -- in 2010, she felt that the "awareness" display was revolting.
She was undergoing chemotherapy at the time for breast cancer and had just buzzed off her hair in anticipation of losing it all.
"It doesn't feel like a pretty pink ribbon, is what it kind of amounted to. There's nothing pretty about this," says Wadsworth, 31, of South Thomaston, Maine, remembering her cancer journey. "It's traumatizing. It leaves a little hollow place."
Now that Wadsworth is cancer-free and feeling healthy after seven rounds of chemo and a double-mastectomy, her attitude flipped. She loves the prominent appreciation for breast cancer awareness this month and hopes to one day have her own breast cancer fund to focus on holistic treatments.
Awareness is a tricky thing.
Some women who have been through breast cancer embrace the outreach activities this month, participating in races and other fundraising events. Susan G. Komen for the Cure is perhaps the most recognizable player here, using the color pink and pink ribbons to promote various ways of raising money and "awareness."
Not everyone feels part of the pinkness.
Women with metastatic cancer, which has spread beyond the breast and is more likely to be fatal, sometimes feel left out when the focus of awareness is on curable, small tumors, says Christopher Friese, an oncology nurse and assistant professor at the University of Michigan School of Nursing.
"The clear message is that breast cancer is not a single, or a simple, story," Friese said. "Depending on the stage and the involvement of the tumor, the story could be very different for women at various stages of breast cancer."
There are women such as Ann Silberman of Sacremento, Calif., who aren't necessarily on a road to recovery.
Silberman got her breast cancer diagnosis in 2009 and underwent treatment and surgery, but the cancer spread to her liver. She runs a blog called "Breast Cancer? But Doctor .... I hate pink!" and tells people to "stay far away from anything that says awareness" and instead look to support the organization Metavivor, which focuses on metatastic cancer, StandUp2Cancer, and the American Cancer Society.
Silberman is 54, and her cancer is stage IV. Her goal is to live long enough to see her 15-year-old son go to college.
"The fact is that awareness does not stop cancer," she said. Silberman and some others with metastatic breast cancer are passionate about funding research, believing there is too much money spent on advertising.
The other side of the argument, of course, is that awareness does stop cancer in the sense that educating women about mammography recommendations and self-checking can help detect tumors early.
For Wadsworth, awareness means "get out there and check yourself." She discovered her own tumor; so did Silberman, who thought it was just a cyst.
But Silberman and others feel that the money needs to go toward finding out why cancer spreads, rather than "everyone making a dollar on our disease."
In Friese's view, awareness should focus on the gaps in knowledge that research has demonstrated exist. One study found that many women who receive breast cancer diagnoses do not have an accurate understanding of the disease or of the risk of death or recurrence after treatment.
Some underestimate how likely they are to have a recurrence or die from their tumors, while others overestimate. "What you want to do is get everyone on the same playing field," Friese said.
What progress awareness gets
The biggest player in the breast cancer awareness world is Susan G. Komen for the Cure. On its latest financial statement, the organization claimed credit for helping reduce breast cancer mortality in the United States by 33 percent since 1991.
According to the latest data from the American Cancer Society, death rates from breast cancer among U.S. women have gone down 2.2 percent each year between 1990 and 2007, with larger declines among women younger than 50. Advances in treatment and early detection are thought to be the underlying reasons.
Despite the pink-tastic visibility of breast cancer awareness every October, the raw numbers of women with breast cancer haven't plummeted over the past 30 years. That could be because of increased use of mammography.
The incidence of localized breast cancer, which did not spread to other organs, went up during most of the 1980s and 1990s. Localized tumor rates went down by an average of 2.6 percent, "and have since stabilized," the society says.
Regional-stage disease, where the cancer has spread to surrounding tissue or lymph nodes nearby, has decreased by 1.5 percent a year on average since 2000.
The news isn't terrific for metastatic breast cancer, which involves spreading to distant organs and is often fatal. For white women, the rates are stable; for African American women, the rates have been going up 0.7 percent a year since 1975.