The Selling of Breast Cancer Is corporate America's love affair with a disease that kills 40,000 women a year good marketing--or bad medicine?
By Susan Orenstein

(Business 2.0) – In the summer of 2000, ice cream and frozen yogurt maker Dreyer's decided to try to link its name to the hugely popular cause of fighting breast cancer. It had watched other companies conduct campaigns backing the search for a cure--and had seen their logos displayed at well-attended rallies and their products festooned with the cause's signature pink ribbons. Dreyer's figured it might sponsor the Susan G. Komen Breast Cancer Foundation's Race for the Cure events, which are highly emotional and popular--in other words, a marketer's dream. But when Dreyer's approached Komen, it ran into an unexpected snag: Yoplait was already a big sponsor and had an exclusive contract to be the only yogurt manufacturer involved in the races. Dreyer's, the Komen people suggested, could create some sort of in-store promotion, but it was frozen out of the high-profile Komen events. Dreyer's wasn't interested in in-store promos. "We would have been out of the loop," says Julie Linting, who handles the ice cream maker's special promotions. "It wasn't worth our while to do that."

Dreyer's had just encountered one of the many pitfalls in the increasingly crowded and competitive realm where business and charity meet--and discovered, as many companies have, that people play rough in there. More and more, U.S. businesses see tying their corporate identities to good causes as a powerful marketing tool, and breast cancer has become the queen of all good causes. It generates a staggering array of promotions and company tie-ins: During Breast Cancer Awareness Month in October, for instance, you could "Cook for the Cure" using a pink KitchenAid mixer, "Clean for the Cure" with a Eureka vacuum cleaner, be "Fit for the Cure" through a custom Wacoal bra fitting, "Sip for the Cure" with the Republic of Tea's pink grapefruit green tea blend, and "Charge for the Cure" with your American Express card. You could've shopped for the cure until you dropped.

Corporate America's taking up of the breast cancer banner has meant that hundreds of millions of dollars have been raised for research and awareness about the disease. No one knows the exact dollar figures; companies provide their own unaudited numbers and count contributions in different ways. But the corporate embrace of the cause has spawned a lucrative market for companies eager to build valuable brand loyalty. Charity or not, this is a market with many of the features of elbows-out battling for share: turf struggles, digs at the competition, one-upmanship, and a fierce drive for results. Those results have to be about more than finding a cure. As one manager who has been involved in a high-profile breast cancer campaign puts it, "When you're spending from your marketing budget and not your philanthropy budget, you have to look for that return on investment."

All of this raises questions about just whose purposes are being served, and how well. For one thing, the jockeying by so many companies to lash their images to breast cancer drains resources away from many other worthy causes, including other diseases that kill far more women. And while corporate marketing efforts have no doubt raised awareness of breast cancer, the packaging of the disease may have oversimplified some of the complex medical and social issues surrounding it, and even influenced the direction of research in potentially damaging ways. Some companies, for their part, now see breast cancer as too crowded a cause and have rejected it in favor of others where the competition is less likely to drown out their message.

"Over the past 10 years, breast cancer has become pink. It's pretty. It's not about the hard stuff, and it's not about controversy. And there's a lot of controversy," says Fran Visco, head of the National Breast Cancer Coalition, an activist group that recently launched a campaign to get women to lobby Congress--instead of just shopping--to fight the disease. Indeed, at a time when more companies than ever are eager to score points with a public sick of corporate scandal, the seemingly win-win equation of the business of breast cancer turns out to pose thorny challenges for almost everyone involved.

Not so long ago, breast cancer was something people didn't even talk about, much less splash all over glossy ads featuring the likes of supermodel Iman. The very intimacy that now makes the disease so attractive as a marketing vehicle once made it a taboo subject. But in the late '80s and early '90s, inspired by the success of the AIDS movement, women started taking their cause to Washington and the public, and they weren't shy about hitting up corporate America. At the same time, high-wattage figures in the fashion and cosmetics world took up the cause. Among the earliest were designer Ralph Lauren, who had lost a friend to the disease, and Revlon chairman Ronald Perelman, who was inspired to act by his friend Lilly Tartikoff. Tartikoff's Fire and Ice Balls drew A-listers like Don Johnson, Bob Hope, and Barry Diller. And where celebrities go, mass marketers are bound to follow.

Spurring them along was the introduction of a small but highly valuable piece of symbolism. Marketers like to point out that no one owns the pink ribbon, and in fact there's disagreement about exactly when it turned up and who deserves the credit. The Komen Foundation has said that it was first, giving out pink ribbons--inspired by the red AIDS ribbon--around 1990 to participants in its Race for the Cure in New York. (Another story has it that Komen tried to patent the pink ribbon, but the foundation denies that.) In any event, Evelyn Lauder--the daughter-in-law of the founder of cosmetics giant Estee Lauder who was another early crusader--started handing out millions of the ribbons at her company's counters, and Avon began selling pink-ribbon pins. Soon the symbol was everywhere.

What's behind corporate America's love affair with the pink ribbon? While it stands for a deadly illness, its color renders it nonthreatening and feminine. It's "a do-good kind of seal," says one merchandiser who's eager to put it on his new line of fabric softener sheets. Other diseases--notably heart disease and lung cancer--kill far more women than breast cancer, but they aren't linked to one of society's prime symbols of womanhood. What's more, breast cancer is free of sin, not clearly tied to overeating, sex, or smoking, and can strike the young and beautiful. And no woman is untouched: Everyone either has had the disease, fears she'll get it, or knows someone who has. "If you can translate that emotional response to a feeling about your business, that's powerful," says Joanne Mazurki, who helped develop Avon's campaign.

That kind of thinking came into vogue just as breast cancer was breaking into public consciousness--and as companies were beginning to see the marketing power of allying with a noble cause. Today such alliances have grown into a mainstay business discipline known as "cause-related marketing." Recent studies show that consumers favor products tied to a good cause, and a full 78 percent believe that companies should support causes, according to research by Cone Inc. in Boston. But not all causes have equal allure, to either consumers or businesses. Companies tend to reject a cause like Alzheimer's because it's "so sad" or child abuse because it's "very ugly," says Cone CEO Carol Cone.

Breast cancer is ugly too, obviously, but from a marketing viewpoint, it has bottom-line advantages few other causes can match. Earlier this year Eureka launched its WhirlWind LiteSpeed vacuum cleaner with a pink-ribbon promotion. The connection? "Because so many women head households, breast cancer affects a lot of people who own vacuum cleaners," explains Kathy Luedke, Eureka's PR director. Wilson Sporting Goods wanted to expand in a flat market and, in the late '90s, decided for the first time to market a shoe directly to women. Rick Kerpsack, then Wilson's footwear director, happened to see a breast cancer promotion on a flight from New York to Chicago and decided to launch his new Pro Staff Intrigue with a pink-ribbon campaign that "talked about how the shoe helps women's feet and their heart." Loews theaters picked breast cancer as a cause, in part, because "it's proven to put more people in stores and drive more people to theaters," says marketing director John McCauley. But that's not all. "We're establishing an emotional connection with the customer," McCauley says. "You can't put a price tag on that."

From the start, companies aimed to stake out turf in what fast became a crowded field. Savvy nonprofits understand that their corporate partners have competitive issues to consider; in fact, they cater to them. "We're sensitive to the fact that this is a marketing relationship, not a philanthropic relationship," says Cindy Schneible, head of sponsorships at Komen, which more than any other group has turned breast cancer into a corporate darling. Nancy Brinker, who founded Komen in 1982 in memory of her sister, was married to Norman Brinker, the wealthy Dallas restaurateur, and leveraged her considerable high-society connections to bring CEOs into the fold. She also offered exclusivity to top sponsors, lending a special air to their campaigns. You won't see any airline other than American sponsoring Komen's Race for the Cure, or another carmaker besides Ford.

Komen limits its national Race for the Cure sponsors to seven--who in some cases pay more than $675,000 a year. But it devises more creative arrangements for other companies wanting to get in on the action. Today it says it has about 50 corporate partners. BMW, for example, couldn't sponsor the Race for the Cure because Ford got there first, but in 1997 it began the Ultimate Drive, which features two fleets of cars traveling across the country, with stops for a special test-drive promotion for breast cancer. BMW spokeswoman Amy Quarmby got defensive when asked about the Ford situation and wouldn't discuss it other than to snap, "Our cause is the Ultimate Drive."

In fact, competition for consumers' attention drives a kind of pinker-than-thou battle between rival companies, and their efforts to outdo one another mean that, with each passing year, the ads get bigger, the stars glitzier, the campaigns wackier. "I don't know what we'll do to reinvent it," McCauley says of the Loews campaign, which this year featured an eBay auction of celebrity-designed popcorn buckets. "I was going to have Ford drive a movie screen across the country in a big pink Ford Focus. Maybe I'll get studio seats designed by Calvin Klein or Stella McCartney, to take you to another level of the theater experience." If Revlon had its Fire and Ice Balls, which were choreographed by designers like Isaac Mizrahi and Armani (and once featured models in their underwear), Ralph Lauren put on an annual Super Sale, a celebrity-studded shopping event attended in 1996 by Princess Diana.

Lauren also chucked the pink ribbon and came up with a symbol even more potent--at least in his view. As the driver behind "Fashion Targets Breast Cancer," an initiative of the Council of Fashion Designers of America, he designed a T-shirt featuring a bull's-eye. The campaign, launched in 1994, was promoted in 50 magazines with ads featuring Cindy Crawford and Claudia Schiffer, the movie Clueless, and the TV show Mad About You. "The pink ribbon was considered derivative," sniffs Tony Staffieri, the fashion council's executive producer. He adds that Lauren's symbol comes with trademark protection, making it all the more exclusive. It is, he says, a "huge" draw for "pink-ribbon-weary sponsors" both in the United States and abroad.

Avon was perhaps the most aggressive in trying to "own" the cause on a grand scale. Breast cancer is core to the image Avon tries to promote as "the company for women." Even when it was planning its campaign 10 years ago, Avon counted 18 companies already involved in the cause. It saw its strength in its army of 500,000 sales representatives, who reached 13 million to 15 million customers a week. "That was our point of difference," Mazurki says. Cone adds bluntly, "Avon would never replicate what Revlon was doing." (The feeling is mutual. A Revlon spokesperson, in an obvious swipe at Avon's "Kiss Goodbye to Breast Cancer" promotion, says Revlon would never sell lipstick to raise money because it would "cheapen" the cause.) According to Cone, Avon spent millions on its 1993 launch, sponsoring an hour-long special on PBS, another on ABC, national TV ads, and local programs in YWCAs across the country. Over the years, it has taken direct aim at the competition, most notably the sponsors of the Komen Race for the Cure. In 1998, Avon started three-day walks, which made a 5-K run seem like, well, a stroll in the park. The events called for walking 60 miles and "becoming a hero to all who know you," according to promotional materials. They generated huge sums and press attention, especially since Avon provided participants with press kits to help them land stories in their local newspapers. Avon boasted in a recent brochure that it is "by far the largest corporate supporter" of the cause.

In the last few years, the competition has gotten too intense for some companies. From 1994 to mid-2001, J.C. Penney was Komen's "presenting sponsor," the top spot held by just one company. Even so, it felt that companies like Ford got more attention. Ford became a Komen national sponsor in 1995 to counter its image as a male brand and has since spent more than $50 million on everything from sponsoring episodes of Murphy Brown dealing with breast cancer to running TV commercials filmed by Academy Award-winning director Barbara Kopple. In 2001, Penney dropped its Komen sponsorship, in part because it realized it couldn't spend enough to "own" the cause in consumers' minds. As one former Penney employee familiar with the situation puts it, the company did a calculation: "What would it take to knock Ford off that place? Years, and millions of dollars. We didn't want to wait that long." Inside Penney, the decision to drop breast cancer in favor of after-school programs was "a very emotional and political issue," says another person with inside knowledge. "It's a very hard thing being a company serving primarily females and walking away from breast cancer." (A Penney spokesperson says the company made a "tough call" on breast cancer at a time of tight finances, and chose school programs as a cause the company "could gain strong identification with.")

Yet some companies, like Dreyer's, are still trying to elbow their way into the breast cancer cause. Despite not being able to sponsor Komen's Race for the Cure because of Yoplait's exclusive deal, Dreyer's went on to create a pink-ribbon campaign; in fact, it wrote its own exclusivity clause when it partnered with the National Alliance of Breast Cancer Organizations. Committing to a contribution of up to $250,000, Dreyer's is clearly not competing with Ford. But so far, no other ice cream maker has taken up the cause, so Dreyer's is satisfied. "The wear-out factor is not there," contends Yulanda Young, the company's marketing chief. "It's a disease that people are aware of and have passionate feelings about. I don't see how that can go wrong."

There are no pink ribbons in Barbara Brenner's office. Instead the activist, who runs San Francisco's Breast Cancer Action, sports a button that says "Cancer Sucks." Brenner is fighting, in a sense, to get her cause back. She tells everyone who'll listen that companies are exploiting breast cancer for profit, and Breast Cancer Action ran its own ads in October calling on consumers to "think before you pink." Brenner herself projects an image that is anything but pink; she's angry, points out unpleasant facts like how all the self-exams in the world might not save you, and never lets up. "Some good is being done" by all the corporate attention, she acknowledges. "But as a society, we have no idea how much good this really is doing, and we shouldn't trust the companies to tell us. Their business is selling products."

No one denies that. But activists question whether the win-win of companies backing the cause has become more of a win for big business. They ask, for instance, whether American Express might be spending more on its full-page ads in the Sunday New York Times and other publications inviting people to "charge for the cure" than the $500,000 it's giving to the Komen Foundation. Or if Yoplait is really trying to maximize the return to the cause when it asks people to spend 37 cents on a stamp to send in a yogurt lid--thereby enhancing their interaction with the brand--to yield a 10-cent donation. Or if certain companies get more than they give when they run campaigns that rely on collecting other people's money. Lee Jeans raised more than $6.3 million with its National Denim Day in 2001--but most of the money came not from Lee but from participants who gave $5 each for getting to wear jeans to work. (AmEx, Yoplait, and Lee say those criticisms miss the point: They're raising money that wouldn't otherwise go to the cause.)

And then there are Avon's three-day walks. More than half of the $250 million Avon says it has raised for the cause has come from the walks. But Avon doesn't pay for them; other than a modest subsidy, most expenses have been covered by proceeds raised by walkers. On average, the walks' overhead ate up 40 percent of the money raised, says Susan Heaney, head of Avon's Breast Cancer Crusade--more than the Better Business Bureau's Wise Giving Alliance's recommended maximum of 35 percent. Brenner argues that given the great PR Avon garnered, it should pick up the tab. "There's a cost to fund-raising," Heaney responds, noting that Avon is dropping the three-day walks in favor of short weekend events. "If we don't do well as a company, we won't be able to do well for charity." Avon, Heaney adds, spends $20 million on breast cancer a year--and doesn't consider its efforts to be about marketing. "Could I say that we sell one more mascara because of this? No." That seems to overstate the case: Avon's 2001 annual report says its "Kiss Goodbye to Breast Cancer" campaign helped fuel a 6 percent sales increase.

Other companies also claim to be oblivious to the cause's bottom-line impact, while some, like Dreyer's, are more open about tracking the "velocity" at which products leave the store during a promotion. Some activists don't really mind if companies profit. "Who the hell else is going to give money?" asks Cathie Bennett Warner, who sat on Komen's San Francisco board. "It's raised visibility tremendously and brought us so much closer to a cure."

Gauging the good that's been done, of course, isn't just about cash, and gets tangled in an emotional tug-of-war over ownership of the disease. In one camp are the feel-good popular breast cancer campaigns, whose focus is often on "awareness." (Breast Cancer Awareness Month itself was co-created by AstraZeneca, which makes the breast cancer drug tamoxifen.)

Komen puts a premium on educating the public, spending 33 percent of its overall budget on education, compared with 25 percent on research. But Brenner and others say "awareness" no longer needs raising and money could be better spent on, among other things, addressing the underlying causes of the disease. They have little patience with tip sheets on early detection, an area currently mired in controversy; a study published in October found no link between self-exams and lowered death rates. Even when money is spent on research, tracking exactly where it goes is daunting. Projects span different agencies of the federal government, not to mention a slew of state and private programs. Avon alone says it funds more than 200 researchers.

Amid all this, activists say that not enough attention is paid to environmental research, which is hotly contested, expensive, and not necessarily in the interest of companies that produce the very substances suspected of causing cancer in the first place. "Corporate America has conducted its breast cancer fund-raising and marketing in a way that is conservative and doesn't really challenge basic tenets of medicine or American society," notes Barron Lerner, an associate professor of medicine at Columbia University and author of The Breast Cancer Wars. But the complexities of the disease, as one activist puts it, "don't fit on a yogurt lid." And that has set back the cause, the activist says, because "it's been reduced to a simple message that gives the public the sense that breast cancer is taken care of." Komen, in particular, has come under fire for its extensive ties to corporations: Brinker sat on several corporate boards before her recent appointment as ambassador to Hungary, and the foundation has been headquartered in office space subsidized by Occidental Petroleum, one of Komen's big contributors. (Komen says its corporate partners play no part in funding decisions.)

But leaders of other causes are envious of breast cancer's corporate ties. Leslie Michelson, CEO of Cap Cure, a prostate cancer charity, is actively seeking to emulate breast cancer's success in attracting corporate partners, calling such collaboration "an unalloyed good thing." Nicole Russo-Okamoto, communications director at AIDS Project Los Angeles, sounds downright wistful on the subject. "We would love at this point to see a red ribbon on yogurt lids," she says. "It gives you more credibility if a company like Ford is behind you."

Ever the cynic, Brenner warns that companies will turn away from breast cancer when it suits their purpose--as J.C. Penney and some others already have. But for better or worse, business priorities are keeping the disease at the top of the public agenda. Ironically, the elusiveness of a cure has less to do with funding than with the sheer complexity of the science. As a company, Lerner notes, "you'd probably get more bang for your buck in funding research for another disease." Medically speaking, he might be right. But breast cancer still sells. "The consumer is the whole reason we do everything we do," Eureka's Luedke says. "And they are so sold on the idea that we are going to fight for the cause. They're true believers."