Pink Ribbon Research Articles

がん教育プロジェクト推進とジュニアピンクリボンアドバイザーへの期待

第３期がん対策推進基本計画でがん教育は，がん予防，がん医療の充実，がんとの共生を支える基盤と位置付けられ，学校におけるがん教育に外部講師を活用した授業が推進されるようなった。当会では２０１８年に「ピンクリボンアドバイザーによるがん教育プロジェクト」を立ち上げ，活動を推進している。ここまでで実施した授業は２０２１年６月現在で１４校，１９８８名への授業を行った。 文部科学省による『外部講師を活用したがん教育ガイドライン』では，目標を１．がんについて正しい理解，２．健康と命の大切さについて主体的に考えること，と定めている２）。本プロジェクトではこれに「未来の検診受診率アップ」「保護者世代へがん検診受診率アップ」を加えた授業展開案を学校に提示している。また認定講師９８％が乳がん経験者であることから，自らの体験として乳がん検診について語っている。 授業後のアンケートでは『将来がん検診を受けようと思うか』の問いに，９３．５％が「ぜひ受けようと思う」または「なるべく受けようと思う」と回答している。『身近な人にがん検診を進めようと思うか』には９１．６％が「ぜひ勧めようと思う」または「なるべく勧めようと思う」と回答している。がん教育を行うことにより，がん検診に関する意識の向上や行動変容が起きると考えられる。そして，同様に乳がん検診にも起きると考える。今後さらに一過性の関わりでなく，継続的な関係を築き，啓発活動への参画を促したい。

Breast awareness in the Pink Ribbon movement 21 years of history and its development in 10 years

Breast awareness in the Pink Ribbon movement 21 years of history and its development in 10 years

All-women theatre in Saudi Arabia

The subject matter of women’s creative experience and contribution to the theatre in Saudi Arabia is challenging, as it relates to the reality of Saudi society. Women were not entitled to participate in the theatre based on the cultural and social values of Saudi society: during the emergence of modern arts in the country, its conservative society refused to allow women’s appearance on stage. The social ban resulted in an institutional ban, which made many male playwrights take the female component out of their texts. There is no doubt that, to an extent, this resulted in the delay of women’s direct involvement in the Saudi Arabian theatre and is what prompted women to take an interest in finding a theatre that suited their needs. This article investigates the appearance of the so-called all-women theatre, its successes and shortcomings, and presents an argument about the role of official and commercial venues in assisting this unique theatrical experience. It also applies a critical analysis to two plays by Wafaa Al-Tayeb, who wrote mainly for the all-women theatre: After Me, The Deluge and With a Pink Ribbon, both published in a collection in 2016. It is hoped that this article can trace most of the cultural, social and commercial aspects that shaped these plays and gave them their characteristics.

Every Cloud Has a Silver Lining Lived Experience and Coping Strategies of Breast Cancer Survivors in Sarajevo

This study explored how women breast cancer survivors who underwent radical mastectomy experienced stress and adversity and managed their diagnosis and treatment. This study is based on semi-structured and in-depth interviews with a convenience sample of 22 participants. Qualitative analysis and discussion groups were conducted in the participant’s homes over 18 months. Thematic analysis resulted in four overarching categories that illustrated how being a woman was challenged and restructured from the participants’ personal experiences. The participants’ coping strategies were primarily reflected in their spirituality, optimism, the embrace of healthy lifestyles, and pink ribbon activism.

Laughing at pink ribbon culture: Tig Notaro’s comedic subversion of the she-ro

ABSTRACT In this essay, I conduct an ideological performance critique of Tig Notaro’s now-famous 2012 stand-up comedy performance, Live, in which she discloses her recent breast cancer diagnosis. Doing so places her firmly within the realm of dominant pink ribbon culture, which valorizes the she-ro, an attractive, all-conquering superhero. I argue that Notaro utilizes the literary and rhetorical trope bathos to subvert the she-ro ideal. Her subversion demonstrates the potential power of stand-up comedy to intervene in harmful and oppressive ideologies on behalf of marginalized and misunderstood populations and renegotiate these populations’ positions in the dominant culture.

Breast cancer photography and the turn-of-the-century studium. Two case studies to illustrate a paradigm shift

ABSTRACT In 1993, The New York Times Magazine published a story entitled ‘The anguished politics of breast cancer.’ The image on the cover was a self-portrait of artist and model Matuschka showing the physical consequences of a radical mastectomy. The picture elicited heated reactions, and the protagonist became an icon of the Women's Health Movement. Twelve years later, another model and photographer, Lynn Kohlman, published Front to back, which included portraits of her body after treatments for breast and brain cancer. Although free of the marks of pink ribbon culture, Kohlman's work was framed within the dominant discourse of breast cancer in the twenty-first century, characterized by individualism, positive thinking, and the idea of consumer's choice. This paper discusses Matuschka's and Kohlman's cancer photography within a comparative diachronic framework, focusing on the turn-of-the-century politics of representation. We argue that, despite their common traits, their respective productions are signs of a radical shift in the cultural paradigm of breast cancer. Through an analysis of the studium of their photographs and the preferred meaning that they suggest, we conclude that Matuschka's project feeds into the feminist battle for equity in health initiated by the early Breast Cancer Movement, whereas Kohlman's strengthens the postfeminist stance that is prevalent in the current panorama of neoliberal capitalism.

Pink Matters: Impact Of Cause-related Marketing Campaign On Intentions To Test Breast Cancer

PURPOSE: The role of the charity sport event on health promotion has been radically significant. In addition, cause-related marketing (CRM) is one of the most prominent strategies for event organizers to maintain the financial stability of the organization. Although many literatures focus on the business side of CRM, there is a lack of theoretical models that explains the association between CRM predictors and health campaign outcomes considering health behavior. Considering the importance of corporate sponsorship of philanthropic sport events, it is necessary to investigate how a health campaign in the sport event have an impact on stakeholders, especially those who participate in the event. Thus, the purpose of this study is to examine how the campaign is associated with the participant’s health belief and ultimately change their health-promoting behavior using an extended model of CRM campaign. METHODS: The structural equation modeling (SEM) was used to investigate the direct/indirect effects of the campaign on sponsor image and breast cancer test. This study was conducted with 1,000 females (18-56) who participated in the Pink Ribbon Marathon. RESULTS: The overall structural model’s goodness of fit showed excellent (χ2 = 15489.377, p<.01; RMSEA = .049, 90% CI =.046-.052; SRMR =.075; TLI =.910; and CFI =.918). SEM revealed that the following factors of Sponsor Fit (β = .736, p <.01). However, sponsor image, product reputation, and CSR were found to have no significant association with the campaign impact. Also, the findings of the results indicated that the impact of the campaign was found to have statistical significance with Perceived Barriers (β = .151), Perceived Threat (β = .-0.168), Self-Efficacy (β =.405), and Cues to Action (β =.650). All four factors regarding health belief positively influence on the intention to participate in breast cancer test. CONCLUSIONS: The results show that the pink ribbon campaign led to a higher level of the intention for breast cancer test by mediating participants’ existing health beliefs. Also, the effect of the campaign was expanded to creating a positive sponsor image. The findings provide insights into designing their cause-related marketing initiatives for practitioners. More detailed explanations concerning theoretical and practical implications will be presented.

Battling Breast Cancer: Women’s Narratives of Struggle, Family Support and Survival from Rural Sindh, Pakistan

Breast cancer poses a major health risk to Pakistani women causing 40,000 deaths annually in Pakistan (Pink Ribbon 2019). Based on 40 in-depth interviews with women who have been treated for breast cancer from rural Sindh, this study explores the extent to which families, living in rural and less developed areas with poor socio-economic conditions, provide support to the patients. The results show that women as well as their husbands’ level of education and awareness is correlated to delayed access to medical services. Our findings show that husband’s support and empathy has a therapeutic effect on cancer patients. Women’s well-being and self-esteem was strongly associated with how men saw and dealt with their disease. Based on the findings, we recommend introducing awareness raising programmes and a well-integrated social support system to help the patients and particularly men who control women’s lives.

Message From the Chair of the Council on Renal Nutrition

Do you know that feeling where you have a party all planned… you are excited for the decorations, all the invitations have gone out, and the food is already purchased? And then something happens and you have to cancel at the last minute? You feel sad and mad and disappointed. That is what 2020 feels like to me for the renal community. We had great forward momentum. The stars were aligned, and legislation was passed favoring the trifecta of chronic kidney disease (CKD) education, home modalities, and transplant goals. On World Kidney Day, the National Kidney Foundation was set to launch a marketing push to make people better informed about kidney disease and its risks. It had a goal of bringing kidney disease to people's “front of mind” in the way that pink ribbons mean breast cancer awareness and red dresses speak to women and heart disease. And then along came COVID-19 to spoil the party. Our world has changed in many ways. I'm writing this in the beginning of May, and undoubtedly the world will have changed again by the time it is published in July. I went into my tenure as the Council on Renal Nutrition Chair with a goal to push toward mandating Chronic Kidney Disease Education through Medical Nutrition Therapy in the same way registered dietitians care is mandated in outpatient dialysis. Currently, there are barriers in the way. Billing for Medical Nutrition Therapy can be troublesome. Going out on your own as a private practice registered dietitian can be daunting. And equal access to CKD care across the nation is not yet in place. But there are some rays of hope on the horizon. Dialysis and kidney disease were on the front page of the New York Times last month. Telemedicine has been approved to make care readily available. The medical community is gaining a new level of respect and admiration for their essential and heroic care. People are more aware of their food, where it comes from and what happens when there is scarcity. Perhaps innovation in the field will be the silver lining to the dark clouds that still hang over us. Perhaps patients will gravitate to home modalities when staying home is safer in times of emergency. Perhaps people will focus on improving access to nourishing food or even growing their own food. What can we do to further our cause? Make your thoughts known for what you want to see as the future of nutrition care in kidney disease. We need to work within our groups, both the Academy of Nutrition and Dietetics Renal Practice Group and the National Kidney Foundation Council on Renal Nutrition, to be clear about what goals support our patients both now and for the future. Contact your representatives and lobbyists. Push for change through the chain of command of the company you work for. Share innovative ideas and thoughts. I trust in the proactive nature of dietitians. Our jobs are based on looking ahead for preventative care for the betterment of all. Right now, the time is ripe for making change. Jump in and join the party.

Abstract GS4-07: Costs and effects in the first randomized trial comparing MRI breast cancer screening with mammography in women with a familial risk: FaMRIsc

Abstract Background: The large favorable stage shift, that MRI screening causes as compared with mammography has been published recently in Lancet Oncology as well as the disadvantage of more false-positive results with MRI. Here we want to present the first results of cost and effectiveness. Methods: In twelve Dutch hospitals, 1355 women aged 30-55 years with a cumulative lifetime risk (CLTR) of ≥20% without a BRCA1/2 mutation were randomized into two groups. From January 2011 until December 2017, women in the MRI-group received yearly MRI-screening, clinical breast examination (CBE), and mammography every other year; and in the Mx-group yearly mammography and CBE. We here present cost per group as well as per detected cancer in both groups, also by age group and breast density. Cost per life year gained can be presented in December. Results: After on average 4.3 screening rounds per woman, in the MRI-group (N=674) compared to the Mx-group (N=680) more breast cancers were detected (40 versus 15, p&amp;lt;0.002), invasive cancers were smaller (median size 9 versus 17 mm, p=0.01) and less often node positive (17% versus 63%, p=0.023) (Table). This resulted in lower cost for detection and treatment per tumor in the MRI-group compared to the Mx-group and lower mean treatment costs (MRI-group: €6,736; Mx-group: €10,128). In incident rounds fewer large or node positive cancers were detected with MRI, reducing the cost for adjuvant therapy, but there remained more false positive results and biopsies with MRI, increasing the cost for additional investigations. The total cost of MRI screening was nearly twice as high as for mammography-screening. Per detected cancer MRI screening was cheaper than mammography, especially above 50 yrs. and at density A-C (see Table). Cost per life year gained will be discussed. Conclusions MRI-screening advances the detection of breast cancer greatly, but with more additional investigastions. MRI-screening may be cost-effective in groups with sufficient tumor incidence, like women with familial risk. This study was supported by funds of: the Dutch Governement ZonMw grant no. 200320002, The Dutch Cancer Society (DDHK 2009-4491), A Sisters Hope, Pink Ribbon, Stichting Coolsingel, J&amp;T Rijke Stichting. Table 1. Characteristics of participating women, detected breast cancers, and cost according to study armParticipantsMRI-arm n=674Mx-arm n=680p-valueMean age - yr ± SD44.7 ± 6.344.7 ± 6.3Premenopausal512 (76%)505 (74%)BI-RADS density categorya A(entirely fat) B (scattered densities) C (heterogeneously dense) D (extremely dense)88 (13%) 248 (37%) 237 (35%) 98 (15%)92 (14%) 229 (34%) 243 (36%) 102 (15%)Mean age at cancer detection49,6 ± 7.150,8 ± 4,60.88No cancer - no. (%) Invasive breast cancers - no. (%) DCIS - no. (%)634 (94%) 24 (4%) 16 (2%)666 (98%) 8 (1%) 7 (1%)0.0017Median size of invasive cancers9 mm (5-14)17 mm (13-22)0.01Node positive4/24 (17%)5/8 (63%)0.023Biopsy nr.14954&amp;lt; 0.0001Total screening cost in FaMRIsc€ 1,094,241€ 516,440Cost per detected cancer€ 32,340€ 42,384Cost per detected ca. BIRADS A-C€ 28,945€ 39,964aDetermined by radiologists, according to the fourth ACR BI-RADS edition Citation Format: Madeleine MA Tilanus-Linthorst, H Amarens Geuzinge, Inge-Marie M Obdeijn, Emiel JT Rutgers, Ritse M Mann, Sepideh Saadatmand, Diderick BW de Roy van Zuidewijn, Robert AEM Tollenaar, Marc BI Lobbes, Margreet GEM Ausems, Martijne van 't Riet, Maartje J Hooning, Jelle Wesseling, Ingeborg Mares-Engelberts, Ernest JT Luiten, Jan C Oosterwijk, Eveline AM Heijnsdijk, Harry J de Koning. Costs and effects in the first randomized trial comparing MRI breast cancer screening with mammography in women with a familial risk: FaMRIsc [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr GS4-07.

Solarpunks &amp; Storytelling in the Capitalocene

Solarpunks & Storytelling in the Capitalocene Phoebe Wagner (bio) and Brontë Wieland (bio) Throughout his work on the theory of slow violence, Rob Nixon asks how writers can portray the indirect and protracted violences of capitalism, particularly when the medium of the novel does not lend itself to the temporal needs of depicting slow violence in a world of political and media spectacle. In a similar vein, Imre Szeman asks scholars to consider the sustainability of publishing a book in an energy-scarce world. Since the formation of solarpunk as not only a literary genre but a lifestyle, we’ve considered how storytelling will develop as the climate crisis becomes more immediate for corporate and wealthy culture producers, especially after the Barham Fire in the Hollywood Hills. While activism can be an important part of popular culture (or become popular culture, in the case of the much capitalized pink ribbons, blue puzzle piece, or resist imagery), there’s a distinct monetary element that is not as evident in something like, say, a Black Lives Matter march. Can publishing a novel in today’s capitalist system be an act of activism, and what might that look like in the anti-capitalist future that solarpunk envisions? As a genre, solarpunk literature actively wrestles with these ideas. Solarpunk literature imagines new futures in the shadow of and in opposition to environmental change and collapse, then works to create those futures. A solarpunk doesn’t just have ideas and beliefs; a solarpunk enacts. On paper, being a solarpunk might sound like being a Marxist, a municipalist, or another ideology entirely. Yet, a different kind of necessity turns solarpunk thought into action. Mainly extinction. In other words, solarpunk literature is not just about solar. Neither is it beat poetry for the new millennium. The emphasis on solar reminds us of environmental interconnectedness. Human-nonhuman-sunlight-nightlight-mineral-oilocean-and-and-and. It’s a nice idea — and plenty of advertisements capitalize off connection — but the climate crisis demonstrates this connectedness on the grandest scale available for human eyes. A solarpunk novel might approach contemporary problems with the following questions: How do this character’s actions impact the novel’s human and nonhuman community? What intentionality fuels this story? Do the characters’ actions dismantle a damaging system like capitalism in a realistic or relatable way? Does this character enact radical care of self and others? Solarpunk stories aim for a unity of theory and practice, showing not only that a better world is possible, but also how we can work toward it. Solarpunk — as a lifestyle and literary genre — sprouted online sometime in 2008 but became more widely recognized with the publication of Solarpunk: Histórias ecológicas e fantásticas em um mundo sustentável edited by Gerson Lodi-Ribeiro in 2012 and Adam Flynn’s “Notes toward a Solarpunk Manifesto” in 2014. Foundationally, solarpunk rejected the dystopian hopelessness of speculative literature trending after 9/11. This rejection of dystopia did not mean embracing utopia, however. Rather, solarpunks aimed for something in the middle, such as the ambiguous utopias of Ursula K. Le Guin’s work. The goal of solarpunk was not to dream of perfect worlds but to strive for something sustainable and resilient in the Capitalocene. This origin of the solarpunk genre foundationally questions how we tell stories. It’s difficult to point to new novels that would fit the definition of solarpunk, particularly from major presses. The most popular expression of solarpunk remains short fiction, often in collections such as the aforementioned and the independent World Weaver Press’s multiple collections. We are still waiting for the quintessential solarpunk novel, though many solarpunks point to Cory Doctorow’s Walkaway (2017) as the closest example. Walkaway focuses on an ensemble cast of people who walk away from capitalism, essentially. What forms beyond the city limits are different fluid communities, usually anarchic, that have decentralized power and utilized post-scarcity technology to create intentionally anti-capitalist gift economies. Ultimately, the characters find themselves in a technological utopia where death has been conquered, bodies may be left behind at will, and “humanity” takes on new definitions. While much of the content features a solarpunk ethos — such...

Cancer awareness crusades-pink ribbons and growing moustaches.

Flipping the calendar, Pinktober, the breast cancer awareness month, turns into Movember, the annual global campaign focused on raising awareness of men's wellbeing, prostate cancer, and testicular cancer. On the cries of “Changing the Face of Men's Health”, thousands of men grow their moustaches to sensitise people to men's health issues.

Don’t give US pink ribbons and skinny girls: Breast cancer survivors’ evaluations of cancer advertising

Breast cancer related promotions, advertising, and pink ribbons are now ubiquitous in October, yet comparatively little is known about how this advertising impacts breast cancer survivors specifically. The present research uses an embodied knowledge perspective to explore the impact of cancer advertising on female breast cancer survivors. Five focus groups were conducted with 42 participants, and the discussions were analyzed to find common themes. The survivors expressed a desire for cancer advertising to be representative, informative (particularly regarding detection and treatment options), hopeful, and transparent about the organization’s motivation and support. Implications and recommendations are also discussed.

MRI versus mammography for breast cancer screening in women with familial risk (FaMRIsc): a multicentre, randomised, controlled trial.

Approximately 15% of all breast cancers occur in women with a family history of breast cancer, but for whom no causative hereditary gene mutation has been found. Screening guidelines for women with familial risk of breast cancer differ between countries. We did a randomised controlled trial (FaMRIsc) to compare MRI screening with mammography in women with familial risk. In this multicentre, randomised, controlled trial done in 12 hospitals in the Netherlands, women were eligible to participate if they were aged 30-55 years and had a cumulative lifetime breast cancer risk of at least 20% because of a familial predisposition, but were BRCA1, BRCA2, and TP53 wild-type. Participants who were breast-feeding, pregnant, had a previous breast cancer screen, or had a previous a diagnosis of ductal carcinoma in situ were eligible, but those with a previously diagnosed invasive carcinoma were excluded. Participants were randomly allocated (1:1) to receive either annual MRI and clinical breast examination plus biennial mammography (MRI group) or annual mammography and clinical breast examination (mammography group). Randomisation was done via a web-based system and stratified by centre. Women who did not provide consent for randomisation could give consent for registration if they followed either the mammography group protocol or the MRI group protocol in a joint decision with their physician. Results from the registration group were only used in the analyses stratified by breast density. Primary outcomes were number, size, and nodal status of detected breast cancers. Analyses were done by intention to treat. This trial is registered with the Netherlands Trial Register, number NL2661. Between Jan 1, 2011, and Dec 31, 2017, 1355 women provided consent for randomisation and 231 for registration. 675 of 1355 women were randomly allocated to the MRI group and 680 to the mammography group. 218 of 231 women opting to be in a registration group were in the mammography registration group and 13 were in the MRI registration group. The mean number of screening rounds per woman was 4·3 (SD 1·76). More breast cancers were detected in the MRI group than in the mammography group (40 vs 15; p=0·0017). Invasive cancers (24 in the MRI group and eight in the mammography group) were smaller in the MRI group than in the mammography group (median size 9 mm [5-14] vs 17 mm [13-22]; p=0·010) and less frequently node positive (four [17%] of 24 vs five [63%] of eight; p=0·023). Tumour stages of the cancers detected at incident rounds were significantly earlier in the MRI group (12 [48%] of 25 in the MRI group vs one [7%] of 15 in the mammography group were stage T1a and T1b cancers; one (4%) of 25 in the MRI group and two (13%) of 15 in the mammography group were stage T2 or higher; p=0·035) and node-positive tumours were less frequent (two [11%] of 18 in the MRI group vs five [63%] of eight in the mammography group; p=0·014). All seven tumours stage T2 or higher were in the two highest breast density categories (breast imaging reporting and data system categories C and D; p=0·0077) One patient died from breast cancer during follow-up (mammography registration group). MRI screening detected cancers at an earlier stage than mammography. The lower number of late-stage cancers identified in incident rounds might reduce the use of adjuvant chemotherapy and decrease breast cancer-related mortality. However, the advantages of the MRI screening approach might be at the cost of more false-positive results, especially at high breast density. Dutch Government ZonMw, Dutch Cancer Society, A Sister's Hope, Pink Ribbon, Stichting Coolsingel, J&T Rijke Stichting.

Men’s Lived Experiences with Breast Cancer: The Double Consciousness of Marginal Men

The present study investigated men’s experiences with their breast cancer diagnosis and post-mastectomy lives. It is based on the sociological tradition of investigating the “marginal man” who lives in two not merely different but incompatible cultures (e.g., the pink ribbon culture of breast cancer and the everyday ideals of masculinity and the male body). Seventeen mature and aging U.S. men who all lived with a breast cancer diagnosis and treatment, including a mastectomy, were interviewed. The principle finding reveals that they saw themselves as men and remain seen by others in terms of their gender, not their atypical illness. Two meta-themes underlying men’s breast cancer stories were identified: body talk and embodiment of their breast. Each of these themes had subthemes. Noticeable was how the historical era when diagnosed and men’s aging experiences influenced their illness journey and stories. For all, even the recently diagnosed, their journey was a lonely one. No man had known another man with breast cancer to consult. Only a few men felt their breast cancer was a stigma, and they too did not feel emasculated. Instead, in the process of embodying their breast cancer, they amended their identities and practiced softer, hybrid forms of masculinities.

Like, Share, Retweet: Testing Competing Models of the Theory of Planned Behavior to Predict Slacktivism Engagement

ABSTRACT Token support for social causes has been increasingly studied and commented on in recent years. Campaigns such as the Livestrong bracelet, the pink breast cancer ribbons, the Kony 2012 video, the ALS Ice Bucket Challenge, and the Facebook profile picture modifications for marriage equality and support for Paris after the terrorist attacks in November 2015, have been coined “slacktivism” and those who engage in such activities “slacktivists”; however, little empirical research has been done on the topic. Most of the research and commentary on slacktivism focuses on social media activity online. This research tests competing models of the theory of planned behavior in predicting an individual’s slacktivism engagement from their attitudes, norms, perceived behavioral control, and behavioral intention. The results suggest that although the theory may be a plausible representation of the data, behavioral control may not be important in the context of engaging in slacktivism.

EPR19-067: Effectiveness of Breast Cancer Awareness Campaign on Internet Search Activity Compared to Other Gynecological Malignancies

Background: Breast Cancer (BC) is common, with 1 in 8 U.S. women (12.4%) developing invasive breast cancer in their lifetime. BC is associated with the most awareness campaigns with pink ribbon as its symbol. October was earmarked as the breast cancer awareness month (CAM) in 1985. Cervical (CC) and ovarian cancers (OC) are associated with a high mortality as well and have awareness months dedicated to them. The aim of these awareness drives is to change public attitude and help in early detection and ultimately prevention of various cancers. Internet search activity can be used as a method to gauge interest and awareness in the masses. We aimed to assess the popularity of BC compared to other gynecological cancers, including OC and CC. Methods: We compared the relative frequency of search terms “Breast Cancer,” “Ovarian Cancer,” and “Cervical Cancer” between January 1, 2004 and December 31, 2017 (n=168 months) using Google Trends, a public web facility of Google Inc. The software designates a reference value of 100 for the point of highest popularity and it provides relative monthly popularity scores for all the terms, which we termed as comparative interest scores (CIS). Within each cancer, average CIS was then compared for their respective awareness months (n=14 months; October for BC, September for OC, and January for CC) to the remaining months (n=154 months). Results: The mean CIS for BC was significantly higher during its CAM, 70.5 as compared to other months 35.9; p&lt;0.001. However, for CC mean CIS during January (7.4) was not different compared to the other months (7.4); P=1.00. And for OC, CIS was significantly higher during its CAM (9.2) compared to other months (7.7); P=.0002. The peak of highest popularity for breast cancer was observed during October 2004 and all peaks corresponded to the CAM; other smaller peaks were seen during significant news events associated with BC, all of which surpassed OC and CC in those months. Overall BC CIS were significantly higher compared to CC (P&lt;.001) and OC (P&lt;.001). Conclusions: We conclude that BC awareness campaigns have succeeded in increasing internet search activity during its CAM but ovarian and cervical cancer campaigns especially when compared to breast cancer have not been as successful. There is still a need to increase awareness among masses. Google trends data also tells us which states in US have more internet search activity compared to others which can be used to target the relatively unaware public.

Bhasha India

Bhasha India Siddharth Chowdhury (bio) The drive from Vasant Kunj in south Delhi to Sidhrawali on NH8, where I have a small farmhouse, takes about ninety minutes on Friday evenings. The run is just over sixty kilometers. I usually start about 7:30, after the rush-hour traffic on the Jaipur highway towards Gurgaon, Manesar, Dharuhera, and Rewari has abated a bit and the Khirki Dhaula toll plaza before Manesar is reasonably chaos free. On the drive I invariably take my old 2005 model white Maruti Gypsy King hardtop, which is perfect for the broken-down country roads which I have to negotiate for the last leg of the journey, about three kilometers through villages and fields of glorious mustard, after I turn left on the highway before Old Rao Hotel in Kapriwas. I love the drive, at a steady sixty to seventy kilometers per hour, as the Haryana and Rajasthan Roadways buses whizz past me at ninety to hundred kilometers an hour towards Rewari, Narnaul, Bawal, Kotputli, Jaipur, and Jodhpur. One marvels at the skill and control of these veteran drivers: the sudden split-second stops, the heart-stopping swerves, the consummate wrong-side off-roading skills. My own driving style on the other hand could be best described as sedate and overcautious. I rarely if ever use the top gear. Even when the highway is relatively devoid of traffic like on Sunday mornings and up ahead is only a column of fifteen Harley Davidsons from a bikers' club in Delhi returning from Tijara in Alwar, one can easily do hundred twenty to hundred forty kilometers then but I don't. My wife accuses me of having aged prematurely, mostly in a lighthearted way, but I never contradict her. I know there is a grain of truth in her exasperation. There is also the matter of the pride of the artist. Her own driving skills, I regretfully admit, are far superior to mine. Even her parking skills are legendary. On Sunday mornings neighbors regularly borrow her to extricate a stricken Honda Brio or a Hyundai Accent cowering behind a visiting Toyota Fortuner. Also moving sedately alongside would be the long, forty-foot vehicle trailers and cranes and heavy-machinery vehicles going towards Bilaspur, Tapukara, and Taudu, where Amazon India has a huge state-of-the-art warehouse, and other industrial towns along the long Rajasthan–Haryana border. Along with them would be the Tata 407s and the heavier vehicles of the movers and packers, [End Page 17] relocating families to new gated colonies in Dharuhera, Bhiwadi, and Neemrana over the weekend. These are the new suburbs of Delhi. Just after the Khirki Dhaula toll plaza, after I exit the Gurgaon city limits, I usually stop at the Indian Oil service station just before the McDonald's drive-in to fill up on diesel. Fifteen liters of it cost me about 750 rupees and I am good for the weekend and the Monday-morning drive back to Delhi. For city driving I use my wife's black 2012 model Volkswagen Polo. The publishing firm where I work, Peacock India, is in Green Park, about five or six kilometers from my 3bhk ground-floor flat in d-4. In the mornings my wife usually drops me off on her way to Chanakyapuri. In the evenings I take the metro's yellow line back to Chhatarpur, and from there a shared Uber to Vasant Kunj. Last Friday too I made the scheduled stop at the service station. There I noticed a brand-new maroon Maruti Alto, with the pink paper ribbons still pasted on its smashed bonnet, parked near the empty pollution-check cubicle. Four or five men stood near the damaged car, from which I could gather engine oil, brake fluid, and coolant were now steadily leaking. It would have to be towed to the nearest workshop for extensive repairs. Of the men gathered around the car, four of them looked to be service-station attendants; and the fifth, dressed nicely in a blue quilted jacket and black formal trousers and looking visibly shocked, must be the owner of the car, I reckoned. In the car itself, I could see through...

Loss: When yearning is pleasure

19 Longing is itself a pleasure. Sometimes it’s the greater pleasure. I once yearned for a stu≠ed rabbit, embraced and adored it every time I went to The Moon and Sixpence, the gift store in Newton Upper Falls that lay on the route of my family’s weekend errand run. The rabbit cost about fifteen dollars, which was a lot for an eleven-year-old in 1985. It had a pink silk ribbon around its neck and movable limbs and fuzzy white fur resembling the poufs of the angora rabbit, Precious, that hopped around the grounds of my summer camp in Maine. Part of the appeal of the rabbit, both the real one and the one in the shop, was that I had to go to it; that I did not, could not, possess it. Then one day at camp I got a package. My parents had bought me the rabbit. They might as well have boosted a religious icon from a church and shipped it to Camp Three Pines in a cardboard box. O≠ the altar, out of context, the icon was just a picture, and the rabbit was just a toy. I didn’t play with it. I’d never wanted to play with it, I understood as soon as I lifted it out of its tissue-paper bed. I’d wanted only to want it. Loss When yearning is pleasure Sarah Manguso essay 20 | SARAH MANGUSO Perhaps I was hungry for religious experience; what I had then was Sunday school at a Reform Jewish synagogue, where we were taught to read and sing Hebrew phonetically and assured that Jews didn’t need to believe in God. But I wanted to believe in magic, hence the pewter crescent moon I pinned on my jean jacket, hence the silver bell that quietly gonged when it bounced on my chest as I walked. Hence all the little sacred things I bought at The Moon and Sixpence, the tarot cards and the woven mandalas. I didn’t want to erase the distance between me and the great mysteries. I wanted to maintain them, and to wear and possess the things that reminded me that I was surrounded by powerful forces I couldn’t change. I wanted the great mysteries to swirl around me more than I wanted success, or possessions, or boys to kiss. I wanted to write a love letter and never send it; I wanted to keep my feelings to myself and never tell anyone, never relieve any of their thrilling pressure. I didn’t need to try to psychologize my yearning or eliminate it or hide it. I wanted to harbor it for myself. In the Boston of my childhood, where everyone seemed to be at least a little bit Italian and a little bit Irish, the Pats and Celtics and Bruins and Sox, especially the Sox, were revered as gods. It was impossible to live in my corner of the world without gaining some understanding of its dominant culture, of what it is to follow a team with unwavering attention. Even if I didn’t understand it, I saw the e≠ect of it on the faces and lives of the true believers like my father and the flocks depicted in the stands, on television, in the rain. The Sox symbolized all that could yet couldn’t be. Believing the Sox could win a World Series was an irrational choice made deliberately. I asked my friend Jimmy, who was from Boston and was the sort of sports fan who wore team jerseys and endured a baseball season as a spiritual voyage, about the Soxes’ six pennants and subsequent failures to win the Series. Why did they always lose? “Let’s take ’em in order,” he said in his radio voice, perfectly calm. And over the next several minutes, without stopping, he recited the litany from Johnny Pesky’s slow throw home in 1946 to Bill Buckner’s LOSS | 21 losing the ball between his legs during Game 6 in 1986. I sensed his comfort in the certainty that the Sox were the team that could play well but would always lose. And then it was...

A Patient- and Assessor-Blinded Randomized Controlled Trial of Axillary Reverse Mapping (ARM) in Patients with Early Breast Cancer

Background: Axillary lymph node dissection (ALND) in breast cancer patients is infamous for its accompanying morbidity. Selective preservation of upper extremity lymphatic drainage and accompanying lymph nodes crossing the axillary basin - currently resected during a standard ALND - has been proposed as a valuable surgical refinement. Methods: Peroperative Axillary Reversed Mapping (ARM) was used for selective preservation of upper extremity lymphatic drainage. A multicentre patient- and assessor-blinded randomised study was performed in clinical node negative, sentinel node positive early breast cancer patients. Patients were randomized to undergo either standard-ALND or ARM-ALND. Primary outcome was the presence of surgery-related lymphedema at six, 12 and 24 months post-operatively, measured by the water displacement method. Secondary outcomes included patient reported and objective signs and symptoms of lymphedema, pain, paraesthesia, numbness, loss of shoulder mobility, quality of life and axillary recurrence risk. Results: No significant differences were found between both groups using the water displacement method with respect to measured lymphedema. ARM-ALND resulted in less reported complaints of lymphedema at six, 12 and 24 months postoperatively (p<0.05). Postoperative numerical differences of arm/shoulder pain, necessity to wear a compressive arm sleeve favouring ARM-ALND were only significant at six months (p=0.039 and p=0.043 respectively) as compared to 24 months (p=0.076 and p=0.066). No axillary recurrence was found in both groups. Interpretation: In contrast to results of volumetric measurement, patient reported outcomes support selective sparing of the upper extremity lymphatic drainage using ARM as valuable surgical refinement in case of ALND in clinically node negative, sentinel node positive early breast cancer. If completion ALND in clinically node negative, sentinel node positive early breast cancer is considered, selective sparing of upper extremity axillary lymphatics by implementing ARM should be carried out in order to reduce morbidity. Trial Registration Number: The trial is registered in the Dutch trial registration (TC 3698). Funding Statement: Pink Ribbon foundation (currently KWF) and the Maurits and Anna the Kock foundation Declaration of Interests: The authors have no financial of non-financial competing interest to declare. Ethics Approval Statement: Ethical approval for this study was provided by the medical ethics committee (METC) of Maxima Medisch Centrum, Veldhoven, The Netherlands. Informed consent was obtained from each participant prior to the operation. This study was carried out in compliance with the Helsinki Declaration.