Ambling along a New York street,  a poster grabbed me by the throat. A young woman with a mastectomy scar and pregnant.* “Breast cancer is not a pink ribbon,” it said. And, of course, they are right. But, the stark realism jarred. Breast cancer charities have been very successful with their society balls, pink ribbon days, fun runs, and mass bikini walks. They glamorise breast cancer to the point where the charity is almost dissociated from the disease. The ribbons are a desirable fashion statement, their events peppered with celebrities; they are the place to be if you want to be photographed with the glitterati. Their cause is much more trendy than stroke, Parkinson’s disease, dementia, and all those other diseases linked to dreary old folk. 

This was a picture that captured the misery of the disease, how indiscriminately it picks women off the street, and not just other women of a certain age. And not too far from the truth, for breast cancer doesn’t spare young and beautiful women.

Having been mugged by medicine on the sidewalk, I was shaken. Unexpected, out of context,  discordant. But, why, as a doctor, should it affect me? Medicine is life. But, on this occasion, the reality of disease had escaped from the consulting room, and without the usual professional defences, it was scary. In the street I was just a citizen. Was it because we prefer disease to be distant – packaged away as something for others. Billboards of geriatrics are easier to take – no one ever thinks of themselves as being old and so it doesn’t impact.

So is it right to use this image? Was this manipulation, marketing, mind management or is it a justifiable reminder of what this disease really means. It was an uncomfortable intrusion into my comfortable day. I even went back to photograph the billboard. It haunted me. It wasn’t a charity poster- it promoted a photographic exhibition, the Scar project Surviving Cancer. Absolute Reality. They got me. And it will get you too.

Domhnall Macauley is primary care editor, BMJ

*A factual error occured in an earlier version of this blog. The author stated that the photo was of a young woman with a mastectomy scar and ascites. This has been corrected as she was pregnant.