Censoring breast cancer in San Francisco

San Francisco has been scandalized - by a health awareness campaign. The city, which barely flinched when the local zoo offered $40 "viewings" of mating animals on Valentine's Day, was rocked by bus shelter posters depicting provocatively posed women with mastectomy scars. FIGURE

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Transit authorities in Santa Clara County pulled all 17 advertisements there after receiving complaints in late January. Another 4 posters were removed in the East Bay. The company with exclusive rights to bus shelter advertising within the City of San Francisco initially agreed to accept the ads, but changed its mind when it saw them. "I looked away," the company's local director told the San Francisco Examiner, referring to a poster that parodied a Cosmopolitan magazine cover.

The ads were developed by the Breast Cancer Fund, an 8-year-old national nonprofit group (www.breast-cancerfund.org) based in San Francisco, which has one of the highest breast cancer rates in the world. Designed to resemble a Cosmopolitan cover, a Victoria's Secret catalog and a Calvin Klein perfume ad, the posters all show professional models with mastectomy scars superimposed on their chests.

The scars belong to Andrea Martin, the Breast Cancer Fund's 53-year-old founder and executive director. "The models, advertising executive and photographer donated their time. I donated images of my mastectomy scars," says Martin, a former lawyer and restaurateur who underwent mastectomies in 1989 and 1991.

The ads are intended to depict America's obsession with breasts as symbols of nurture and sexuality, pointing out the deadly, disfiguring effects of breast cancer. By early March, the Breast Cancer Fund had received thousands of letters and emails about the campaign, 80% of which supported the ads, Martin said.

In Canada, the ads provoked mixed responses among breast cancer survivors contacted by CMAJ. Karen DeKoning, president of the Canadian Breast Cancer Network, found some of the ads objectionable. "Using a photo of a woman's scars to make a point is acceptable, but bringing sex into the picture to me is prostituting the woman for the cause," said DeKoning, who emphasized that she was speaking as a survivor, not on behalf of her group. A member of her board, Lynn Macdonald of Kelowna, BC, supported the ads. "Some people may be offended," Macdonald said, "but the realities of breast cancer, when they hit home, are severe, devastating and in some cases deadly."

While many of the bus shelter posters were removed, another outdoor advertising company offered free billboard space to the Breast Cancer Fund.