A Logical Defense of Komen aka What’s the Fuss All About Anyway?

This morning I defended arranged marriages and a mere twelve hours later, I’ve got another defense going! Here’s why:

Planned Parenthood is all a twitter! The Susan G. Komen for the Cure has pulled funds from the organization and Planned Parenthood is outraged!

For context I need readers to understand that I am a public health nurse who has worked for the past 10 years in preventive health, specifically breast and cervical cancer screening. I have worked in both Arizona and Massachusetts with low income women who are uninsured. Many of the health centers that I have been connected with receive Komen funds to work with this population of women. Rarely a day goes by where I don’t speak to someone on the phone who either needs to be screened or has breast cancer and cannot pay for treatment. This is a travesty.

“This money has saved thousands of women’s lives!”  is the rallying cry of Planned Parenthood in the wake of recent pulling of funds. Really? While I agree that since 2005 they have referred around 6,400 women for mammograms (a key to early detection of breast cancer) Planned Parenthood does not have the facilities anywhere in the nation to do mammography. Planned Parenthood does not focus on women over 50 where 95% of breast cancers occur. They cannot give direct services in relation to screening for breast cancer. It’s not what they are about.

Created for the love of a sister who died of breast cancer, the Susan G. Komen for the Cure mission is clear: “eradicate breast cancer by advancing research, screening, care and education.”  Their grant-funding reflects their mission and those who apply for their grants have to demonstrate a clear commitment to advancing the mission. I know. I have written several grants to the foundation and they go through a rigorous review process. (I’m happy to say the grants were funded!) The grant funding that people receive through Susan G. Komen for the Cure almost always goes to disparate populations to increase screening and early detection and decrease disparities that are present in our health care system. Anyone who ever receives grant funding knows that there is no guarantee of being funded forever. Funders can and do pull funding all the time for a lot worse reasons then being under a congressional investigation. And grant funding has always been politically motivated.  The money in question is almost $700,000, a minuscule percentage of the annual budget of Planned Parenthood of over a billion dollars.

But more than that, the reality is that Planned Parenthood doesn’t do breast cancer research or care. They serve a young population and focus on reproductive health. They are only able to offer one of the three prongs of early detection of breast cancer (clinical breast exams)and current research does not support clinical breast exams as an effective means to detect breast cancer. All told, there are thousands of other places that do reflect the mission of Susan G. Komen for the Cure, they are serving the underserved and they are desperate for funds.

Let’s look at the mission statement of Planned Parenthood: “Believes in the fundamental right of each individual, throughout the world, to manage his or her fertility, regardless of the individual’s income, marital status, race, ethnicity, sexual orientation, age, national origin, or residence. We believe that respect and value for diversity in all aspects of our organization are essential to our well-being. We believe that reproductive self-determination must be voluntary and preserve the individual’s right to privacy. We further believe that such self-determination will contribute to an enhancement of the quality of life and strong family relationships.”  There is nothing in this mission statement that demonstrates a commitment to eradicating breast cancer. Nothing to show any sort of commitment to early detection and screening. Nothing that would correlate with a foundation dedicated to not just finding a cure for breast cancer, but also finding the cause.

It is also critical to look at the prevalence of breast cancer. Breast cancer is most common in women over 50 years old. In fact, only 5% of breast cancers occur in women under 40!* Now how many 50 year olds do you know who are going for reproductive health visits to Planned Parenthood? Maybe then, the question to ask is not “Why are they pulling funding?” but “Why did they fund in the first place?”

In light of these facts it is illogical for Susan G. Komen for the Cure to continue funding Planned Parenthood for breast cancer screening and detection. Pure and simple, this is not where the money belongs – other organizations do it better and more seamlessly. If you want to fight for something, pick an issue that makes sense – like fighting for more funding for preventive care for the uninsured! Now that makes sense.

Bloggers Note: I was incorrect in my statement about breast cancer awareness information on the website of Planned Parenthood and the information is clear and factual. I hold to my original defense on this being an inappropriate place to go for breast cancer information and emphasize that most patients are in their teens to early twenties.

*American Cancer Society. Breast Cancer Facts and Figures 2011-2012. Atlanta, GA: American Cancer Society, 2011.

33 thoughts on “A Logical Defense of Komen aka What’s the Fuss All About Anyway?

  1. What about there pulling funding from stem cell research? What do you thing their reasons were for that. and why did they make such a huge announcement of the one and not for the other?

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    1. Hi Lynn – thanks for reading.They didn’t make a huge announcement. The decision was made in December and they quietly pulled both funds. The problem was that they had no PR strategy – the story only broke this week and they were unprepared for the onslaught. One could use this as a case study for poor public relations but I hold to the fact that they were strange bedfellows to begin with. There are hundreds of places that are better equipped where women can go for breast cancer screening. My follow up post gives tht information. https://communicatingacrossboundariesblog.com/2012/02/02/so-where-do-low-income-women-go-for-breast-cancer-screening/

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    1. Thank you Jay! I stand corrected and appreciate the information. I obviously didn’t look as closely as I should have. I had an interesting conversation with a colleague earlier and although we agreed to disagree on continued support of Komen – we both agree that the age range is still out of line with their primary mission.

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  2. I’m going to echo Jen’s argument that part of the problem is the reason Komen gave for pulling the funding. You bring up some valid points, but they didn’t. The arguments they used to pull this funding has probably done more damage to the Komen reputation than it has to Planned Parenthood’s, and there’s no way that Komen’s decision can’t be perceived as a political one.

    I also want to point out that Planned Parenthood takes on increasing responsibilities in rural and other underserved areas where women have less access to healthcare providers. Planned Parenthood states in its 2007-2008 document “Planned Parenthood Matters” that cancer screenings and other women’s health care make up more than 25% of all of their health care services. I couldn’t find information on the average and median ages of Planned Parenthood patients, but I think it’s quite possible women over 50 in underserved regions are visiting PP for a variety of healthcare concerns. This Washington Post article (attached below, I hope) also states that in the Hampton Roads, VA area, PP was expanding its service to educate and screen women at risk for breast cancer.

    I think at the very least Komen’s decision to pull out their funding speaks to a missed opportunity that could have long lasting consequences for many communities.

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    1. Hi Rachel – thanks for adding to the dialogue! The article didn’t post so feel free to try again. You add important information about those who live in rural areas and the increasing disparities that we find present in these populations. The primary cancer screenings that planned parenthood does are pap tests. They serve the age range where HPV is particularly prevalent and the lesions can be caught. They can’t do breast cancer screening because they don’t have mammography facilities. Federally Qualified Health Centers that serve rural areas can provide more seamless care around breast cancer screening. https://www.cms.gov/mlnproducts/downloads/fqhcfactsheet.pdf
      But regardless – your point is well taken that the reasoning feels insufficient for many people causing a lot of anger. Thanks again for reading.

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  3. Thank you Marilyn! You wrote this in such a calm and level-headed way. Just stating the facts. I agree with you that Komen’s money can be much better used at facilities that provide true breast cancer screenings. I have been trying to write something about this, but your words state it best. I will forward your blog instead of my discombobulated thoughts and ramblings. lol

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  4. Hmm, I was a little nervous when I made the decision to read this post, as I am someone who has had to rely on the services of Planned Parenthood on a number of occasions. All I knew going in to reading this was that some funding had been pulled.

    Thank you for clarifying the situation, and I can easily say (even as a supporter of PP) that if the funds are meant to be for breast cancer research and support, that’s what they should go toward! A low-income woman at age 50 is equally as important as a low-income woman at 20, and it seems only logical that funding should go toward the women who are most at risk.

    It is certainly a breath of fresh air when someone can logically argue a point, thanks for this post!

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    1. Thank you for this vote of confidence – wow! I really appreciate you taking the time to do this. I just went to your site and look forward to reading. You are a brave woman travelling a brave journey and being willing to share openly.

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  5. I do understand your point, but if anything, I feel that the small amount of money argues for funding PP. Even if PP mostly refers young women – that 5% of breast cancer patients who are under 40 still equals thousands of women per year. Plus, younger women often have more aggressive forms of the disease and are not as aware that they could get cancer, so may not be looking for it themselves.

    But the thing that bugs me is the REASON they cut the funding. They don’t claim they wanted the money to be used more effectively or for a different population. breast cancer affects all kinds of women, of all kinds of opinions – if a political hotbutton issue becomes the reason they defund — what’s the next issue they will use to defund? services to married gay women? women who have used drugs? women who are undocumented? it’s offensive to decide based on disapproval of non-breast cancer-related characteristics of the women or organization.

    The “investigation” excuse they are using is so transparent. Many hospitals, at one time or another, are investigated for financial malfeasance – i doubt Komen would end their programs at a hospital while an investigation is pending. and what a shame if the investigation shows no wrong-doing.

    Although I disagree with your article, i do appreciate what you had to say & am glad you are keeping the conversation going.

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    1. I really appreciate this comment – in fact I just had a long conversation with one of my colleagues who works in Domestic Violence who disagrees with me vehemently for the same reason you do. I don’t think it was ever an appropriate alliance simply because of the difference in ages of women served. Mammography for women under 40 is an inappropriate screening mechanism because the breasts are too dense. And even that points out a flaw in our system because we should be about health throughout the lifespan as opposed to health based on your life stage.
      You’re absolutely correct that the reason Komen is giving for the defunding is not the same as why I don’t think it makes sense to fund them. One of the things that I’ve learned in grant funding – it’s always politically motivated and none of us are ever assured of funds from one grant cycle to the next. I will say that the best grant I ever received came from the foundation – it was to treat undocumented women who were diagnosed with breast cancer. Talk about a hot topic! It was amazing to watch these women find out that they could get treatment…but I digress.
      Thank you for the spirit with which this comment was made – I thrive on respectful dialogue!

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    1. That’s an excellent question. In 1993 congress approved legislation that gave categorical funds for breast and cervical cancer screening. They made the funding available to all states and many tribes and territories. The rationale was simple – finding both of these diseases early saves millions of dollars in health costs and lives – cervical cancer is 100% preventable. This program is called the National Breast and Cervical Cancer Early Detection Program. It is specifically for women who are 250% of poverty level and below – to put that into context it means that a woman with a family of 6 can make just under $75,000 a year to be eligible. The limits are according to income and family size. The program has grown through the years to include funding not only for screening but also for diagnostic service and then in 2003 the funds expanded to include treatment. The parameters are that a woman has to be 40 years old or above, at or below 250% of poverty level, and a citizen of the United State. It is a great program and has saved millions of lives. (The funding is available to women under 40 for cervical cancer screening.) I’ve worked in the program off and on since 2000 and am currently trying to make it work in Massachusetts where we have undergone healthcare reform so it makes it tricky. You can find more information here: http://www.cdc.gov/cancer/nbccedp/ I think one of the questions to ask is why there was an alliance between PP and Komen in the first place. They are two unlikely partners given their different age focus. Thanks for letting me share this – it’s important to let people know.

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  6. I’m jumping into this convo late in the game. I currently work in grant-funded legal services (foreclosure prevention) and am going to be starting nursing school in the summer in order to become a nurse midwife. 1) I’m not compelled by the “drop in the bucket” argument as far as how this money doesn’t count to PP because they already have so much — currently my organization is making tough decisions in light of grant realities. We’re doing battle with the state legislature over a 25 million needed for foreclosure prevention advocates state-wide. Some of my colleagues call this a “rounding error” when it comes to the scale of the state budget. These dollars and cents *always* have an impact on both jobs and client services and no amount can be discounted. 2) While I see where Marilyn is coming from as far as PP not explicitly targeting services at the age-range where breast cancer becomes manifest, and that they also do not have the full complement of screening mechanisms available, this does not fully satisfy me. 3) I think that what PP is doing for the community of women needing health services overlaps dramatically with the Komen mission to eradicate breast cancer. My problem is that particularly in grant-driven environments, we are forced to pigeon-hole and categorize our work in ways that can never capture the truth of the matters at hand. While I see the pragmatic necessity in being laser-focused in mission and funding decisions, I think we lose sight of the ways that our present health issues and life issues layer upon one another. Cancer is a complex manifestation that whose roots we know to be, at least in part, found in our environment (i.e. pollutants), nutrition (i.e. hormone-laden meats, chronic inflammation, lack of plant foods), lifestyle (i.e. sedentary, over-nourished), and mental/spiritual state (i.e. stress, depression, isolation). PP is in the position to connect to, counsel and change the lives of vast numbers of women, who are often coming to them while on the brink. Beyond the breast health education, screening and mammography referrals, I think PP can set young women on a track of self-determination, empowerment and health-consciousness that could, in fact, spare them the suffering of breast cancer. 4) It is my hope that as a community, we take steps in considering the true interconnection and interdependence of life, and that these truths can manifest in our funding decisions, mission statements and public policies. It has not been working so well for us, being as fragmented as we are.

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    1. Thanks so much for the thoughtful response Sarah – as a side note, I am always chagrined at the astonishment of my friends from the UK in particular who read any of my health posts and are astounded by the fraught system that we term “healthcare!” But back to the comment – I could not agree with you more about the pigeon holing and giving categorical funding. It makes integration and the effort to systematically connect all aspects of health care (built environment, housing, schooling, clinics, nutrition and more, basically all the social determinants of health) not only a challenge but sometimes impossible. We are facing this right now in my work. In these areas I actually think both Komen and PP fail as PP is not working around built environment and community transformation (at least in our area) What I like about your comment is it brings up the complexity of these issues. I am delighted to hear that you are becoming a midwife – that would have been my dream! You may find this interesting http://www.canonballblog.com/?p=3376 Thanks much for enriching the discussion.

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  7. Good one marilyn.
    goes to show how politically motivated any rally and outcry really is.
    Some people just join cuases without really knowing the facts.

    And so glad to know that you are working with a community that needs much help.
    Glad to have come across your informative blog :)

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  8. There is a lot of misery, illness, illiteracy, hunger, suffering and death, and all this is not because of natural disasters, war, or famine and floods, poverty and overpopulation or epidemics or any other great ill on Earth but due to misused and misdirected funds.
    I like the way you have presented the case so even someone like me who is not aware of it can understand.

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    1. Wilma – just this week I spoke to three women who had cancelled doctor’s appointments in the middle of treatment because of no insurance. It’s unconscionable. Thankfully we were able to connect them to care but it’s still a process…they aren’t quite connected yet. This is where Komen money should go!

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      1. I am so thankful you and others like you are there to be advocates for women who may not have a voice. I pray you will ever be given wisdom and the guts to go to battle for those who need help.

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      2. As you know the women themselves are the real heroines! I guess that’s why I get so frustrated when people make a big deal out of less than 700,000 dollars that go to an organization that does not provide comprehensive care. Our healthcare system is in such crisis – we have much better things to put our time to. Things that will really make a difference. I love that I get your perspective on health care. It must seem totally confusing to you in the U.K.!!

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