the typical participant in the breast cancer movement, and therefore the advertisers' target audience, is a white, middle-aged, middle-class, well-educated woman. some corporate sponsors are criticized for having a conflict of interest. for example, some of the prominent sponsors of these advertisements include businesses that sell the expensive equipment needed to perform screening mammography; an increase in the number of women seeking mammograms means an increase in their sales, which has led critics to say that their sponsorship is not a voluntary act of charity, but an effort to increase sales. the regulated drug and medical device industry uses the color pink, positive images, and other themes of the pink ribbon culture in direct-to-consumer advertising to associate their breast cancer products with the fear, hope, and wholesome goodness of the breast cancer movement. this is particularly evident in advertisements designed to sell screening mammograms. social role of the woman with breast cancer a woman being treated with docetaxel chemotherapy for breast cancer. she keeps ice packs on her hands and feet to reduce temporary damage to her fingernails and toenails. the marketing of breast cancer awareness allows people to incorporate support for awareness into their personal identity or lifestyle. socially aware, pro-woman individuals, businesses, politicians, and organizations use pink ribbons and other trappings of breast cancer awareness to signal their support for women, health, and mainstream medicine. the she-ro the term she-ro, derived from hero, is used in discussions of breast cancer to refer to women who have been diagnosed with breast cancer, and sometimes to those who have survived breast cancer. the term describes an "idealized" patient who combines assertiveness, optimism, femininity and sexuality, despite the effects of treatment, and as a "paragon uses a diagnosis of breast cancer as a catalyst for a personal transformation". sociologist gayle sulik analyzed the she-ro's social role and ascribes it qualities that include being an educated medical consumer with a brave, pleasant and optimistic public appearance and demeanor, who aggressively fights breast cancer through compliance with screening guidelines and "disciplined practice of 'breast health'". in america the she-ro is diagnosed early due to adherence to early screening recommendations, and, by definition, she survives her diagnosis and treatment. the role emphasizes the femininity and female gender role of the she-ro, offsetting the masculine characteristics of assertiveness, selfishness and "fighting" cancer by cultivating a feminine appearance and concern for others. during and after treatment, the she-ro regains her femininity by using breast reconstruction, prosthetic devices, wigs, cosmetics, and clothing to present an aesthetically appealing, upper-class, heterosexual feminine appearance and by maintaining relationships in which she can nurture other people. following the proper feeling rules of the breast cancer culture is encouraged, including remaining optimistic of a full cure, rationalizing the selfishness of treatment as a temporary measure, and feeling guilty that it forces her to put her needs momentarily above the needs of others or due to her perceived inadequacy in caring for her family or other women with cancer. also included in the role is a form of the have-it-all superwoman, cultivating a normal appearance and activity level and minimizing the disruption that breast cancer causes to people around her. consequences the effort of maintaining the role of a she-ro can be stressful. the role encourages women with breast cancer to care for others rather than themselves. some of them find this comforting, but it may lead to them feeling reluctant or unable to ask for the help they need or want, and this can lead to bitterness that their friends and family did not offer these services unbidden. the success of their efforts to look and act normally may paradoxically increase their dissatisfaction, as their apparent ability to handle it all discourages people from offering help. the breast cancer culture celebrates women who display the attitude deemed correct, which implies that their continued survival is due to this positive attitude and fighting spirit. while cheerfulness, hope, and good social support can be advantageous to health outcomes, it cannot determine survival rates. women who reject the she-ro model may find themselves socially isolated by the breast cancer support groups that are nominally supposed to help them. support from "the sisterhood" favors the "passionately pink", and tends to overlook women whose response to being diagnosed with breast cancer is incompatible with the pink ribbon culture, because they feel angry, unhappy, or afraid. the breast cancer culture is ill-equipped to deal with women who are dying or who have died, and their experiences may not be memorialized, validated or represented as part of the movement, instead being ignored or shunned as failures and as hope-destroying examples of reality. they may feel like treatment failure is a "dirty little secret" that others want to make invisible. similarly, the culture is also ill-equipped to deal with the news that a previously hyped treatment or screening procedure has been determined to be ineffective, with women advocating for the acceptance and promotion of inexpedient activities and inefficient or even sometimes harmful drugs. breast cancer culture breast cancer culture, or pink ribbon culture, is the set of activities, attitudes, and values that surround and shape breast cancer in public. the dominant values are selflessness, cheerfulness, unity, and optimism. it is pro-doctor, pro-medicine, and pro-mammogram. health care professionals are sources of information, but the rightness of their advice is not to be seriously questioned by women with breast cancer. patients are not encouraged to ask where research money is going or if the research industry is making progress in finding the "cure". the emphasis on cheerfulness allows society to blame women for developing breast cancer and limits their responses to certain culturally determined scripts. the requirement of cheerful optimism arose from the then-popular theory that cancer had a psychosomatic origin and that people who were diagnosed with cancer had a "cancer personality" that was depressed, repressed, and self-loathing. psychotherapy was therefore considered an adjunct treatment used to produce a cheerful, self-affirming identity. this theory was predominant among psychiatrists through the 1970s, but has since been discredited. in a process called benefit finding, the she-ro uses the emotional trauma of being diagnosed with breast cancer and the suffering of extended treatment to transform herself into a stronger, happier and more sensitive person who is grateful for the opportunity to become a better person. in particular, she sees breast cancer as an opportunity to give herself permission for necessary personal growth that she felt she was prohibited from or unable to make before. breast cancer thereby becomes a rite of passage rather than a disease, with pink ribbon culture honoring the suffering of its she-roes by selecting them based on the amount of misery they have experienced, and leading women whose treatment is less painful or debilitating to feel excluded and devalued. the suffering, particularly the extended suffering of months of chemotherapy and radiation treatment, forms a metaphorical type of ordeal or rite of passage that initiates women into the inner circle of breast cancer culture. barbara ehrenreich describes it this way: understood as a rite of passage, breast cancer resembles the initiation rites so exhaustively studied by mircea eliade: first there is the selection of the initiates—by age in the tribal situation, by mammogram or palpation here. then come the requisite ordeals—scarification or circumcision within traditional cultures, surgery and chemotherapy for the cancer patient. finally, the initiate emerges into a new and higher status—an adult and a warrior—or in the case of breast cancer, a "survivor". mainstream pink ribbon culture has aspects that are trivializing, silencing, and infantilizing. women with breast cancer are surrounded by childish kitsch such as pink teddy bears and crayons, but there is no equivalent gift of toy cars for men diagnosed with prostate cancer. women who choose not to conform to the culture may feel excluded and isolated; those who cannot conform to the prescribed triumphant script report feeling unable to share their stories honestly. anger, negativity and fatalism transgress the feeling rules, and women with breast cancer who express anger or negativity are corrected by other women with breast cancer and members of the breast cancer support organizations. appearing unattractive—such as going out in public with a bare, bald head if treatment causes temporary hair loss—transgresses the approved, upper-class style of pink femininity and provokes shaming comments from strangers. programs such as reach to recovery and look good, feel better inform breast cancer patients of this cultural standard and help them conform to it. this standard is not universally adhered to in every detail. ehrenreich says that "he question of wigs versus baldness ... defines one of the few real disagreements in breast-cancer culture." some women have avant garde aesthetic tastes: "one decorates her scalp with temporary tattoos of peace signs, panthers, and frogs; another expresses herself with a shocking purple wig; a third reports that unadorned baldness makes her feel 'sensual, powerful, able to recreate myself with every new day'". regardless of whether the transformation is towards a radical, natural or cosmetically enhanced appearance, treatment is always "a makeover opportunity". since the beginning of the 21st century, breast cancer culture has become more sexualized, and many awareness campaigns now reflect the old advertising truism that sex sells. the "booby campaigns", such as "save the tatas" and the "i ♥ boobies" gel bracelets, rely on a cultural obsession with breasts and a market that is already highly aware of breast cancer. this message trivializes women and reflects a belief that breast cancer is important because cancer and its treatment makes women feel less sexually desirable and interferes with men's sexual access to women's breasts, instead of because cancer and its treatment kill and disable women. these sexualized campaigns tend to attract a younger audience than traditional campaigns. at the same time, breast cancer culture tends to overlook men with breast cancer and women who do not fit the white, middle-class archetype. african-americans involved with breast cancer organizations often feel like their role is to be the token minority. the primary purposes or goals of the breast cancer culture itself are to maintain breast cancer's dominance as the preëminent women's health issue, to promote the appearance that society is "doing something" effective about breast cancer, and to sustain and expand the social, political, and financial power of breast cancer activists. the breast cancer culture tells women with breast cancer that their participation in fundraising, social support of other women with breast cancer, and appearance at public events are critical activities that promote their own emotional recovery. because of this message, some women begin to believe that refusing to raise money for breast cancer organizations or to become mentors for newly diagnosed women with breast cancer is an unhealthy response to breast cancer. feminism and the breast cancer wars the breast cancer wars were a series of conflicts between advocates and others about the causes, treatments, and societal responses to breast cancer. women in the late 1980s and 1990s followed the successful approach used by act-up and other aids awareness groups, of staging media-friendly protests to increase political pressure. prominent women who made the "wrong" choice were publicly excoriated, as when nancy reagan chose mastectomy over lumpectomy followed by six weeks of radiation therapy. the abortion–breast cancer hypothesis was formulated when an early study showed a connection between voluntary abortions and the development of breast cancer in premenopausal women, which pitted breast cancer advocates against abortion rights advocates. advocates for women's issues have said that breast cancer is special because of its status as a largely female disease, society's response to it is an ongoing indication of the status of women and the existence of sexism. breast cancer activist virginia soffa wrote that "s long as it is not a national priority, the breast cancer epidemic will remain a metaphor for how society treats women". barbara ehrenreich writes that, before the feminist movement "medicine was a solid patriarchy", and women with breast cancer were often treated as passive, dependent objects, incapable of making appropriate choices, whose role was to accept whatever treatment was decreed by the physicians and surgeons, who held all of the power. because of sexism in education, female surgeons were far outnumbered by their male counterparts, and until the 1990s, when susan love of the university of california, los angeles breast center published