"Think pink" is America's mantra in October, as breast cancer awareness takes center stage in sports stadiums, advertising campaigns and even religious worship services.
For faith communities, the month is an opportunity to highlight the experiences of survivors, hearing personal testimonies about the disease and offering prayers for past and current sufferers.
Church participation in Breast Cancer Awareness Month is particularly valuable in the African-American community, where women die from the disease at higher rates than their white counterparts.
In 2010, an average of 30.9 per 100,000 black women died of breast cancer, compared to 22.1 white women. The New York Times reported on this racial divide in 2013, calling it "one of the most troubling disparities in American health care."
Health educators believe that church leaders are an important tool for increasing awareness of the value in regular mammograms among black women and thereby improving outcomes. The U.S. Food and Drug Administration's Office of Women's Health and the Susan G. Komen Foundation both have programs targeted at faith communities, helping equip churches to host "Pink Ribbon Sunday" events or "Worship in Pink" services.
"The church has been the central organizing structure of (African-American) communities throughout history, and so it really makes sense" for them to be the focus of efforts to reduce the gap, said Gwen Barker, director of mission programs for Komen's Los Angeles county affiliate.
The information gap
As the racial disparity in breast cancer mortality rates grew during the 1990s and early 2000s, advocacy groups became aware that their typical methods of information distribution were missing the African-American community.
Widespread campaigns about the benefits of regular mammography screenings went unheeded by black women, Barker said, because of a variety of factors complicating the community's relationship to America's medical system.
She said mistreatment in the past, such as the infamous Tuskegee study where black patients were only tested but never treated for syphilis, remains fresh in many women's minds, explaining that she hears "more fear coming from this community than from other communities."
Additionally, several myths about mammography persisted, such as the procedure actually caused cancer or that mobile van facilities were not certified to offer the services, said Marsha Henderson, director of the FDA's Office of Women's Health. She explained that this confusion wasn't helped by a pervasive lack of medical resources within minority communities.
Aware of these challenges, health educators began brainstorming new, innovative solutions. Faith-based initiatives emerged as a solution at the local level before gaining national attention because of the importance of religion in black communities.
The FDA's "Pink Ribbon Sunday" program, for example, began as an initiative of a public affairs specialist in Houston. Her connections to local faith leaders eased the planning process, and the event was successful enough to make an impression on national leaders.
"We picked churches because we recognize the role churches play in black women's lives," Henderson said.
The role of the church
In 2009, Pew Research Center published a "Religious Portrait of African-Americans," exploring the high level of religiosity reported by black men and women. The study showed that "nearly eight-in-10 African-Americans (79 percent) say religion is very important in their lives, compared with 56 percent among all U.S. adults."
Barker said that such figures illustrate how valuable faith communities can be in spreading messages about breast cancer. After all, the hardest part of health education is capturing people's attention, and churches already have that covered. "People are (in pews) to pay attention," she said.
People are also in worship services to share their struggles and pray about their pain, Henderson explained. "Churches are hubs for support groups, so there is a built-in support network."
Sondrea Tolbert, director of the Nashville chapter of the National Consortium of Black Women in Ministry and assistant pastor at Fairfield Missionary Baptist Church, founded the city's "Pink Sunday" initiative eight years ago, using the "Worship in Pink" model to involve community churches in the fight against breast cancer.
As the event has grown more popular, it has expanded to include a community-wide interfaith church service where participants can pray and sing together and hear testimonies from breast cancer survivors and women receiving treatment. She said that the goal of the worship is not just to empower people to be proactive in scheduling mammograms, but also to prepare faith communities to serve as support systems for women diagnosed with breast cancer.
Tolbert explained that people in pews are not the only captive audience to the messages shared by organizations like the FDA or Susan G. Komen foundation. Pastors are also excited to learn this new way to minister to their congregations.
"Pastors are most certainly looking for ways to have their congregation live healthy," she said. "These services are a kind of ministry."
Unlike a billboard or fact sheet about breast cancer, events in faith communities can get to the heart of people's fears about the disease, allowing them to express their concerns or share their experiences.
"Breast cancer is a sensitive topic. Most people know and have possibly lost someone (to the disease)," Barker said. "There's so much benefit to having information presented about something that emotionally charged in a faith community. There's an openness that you don't experience in other communities and people are willing to talk about deep losses and deep fears."
Spreading the message
Rather than simply drop off pamphlets of information on church doorsteps, both the FDA and the Susan G. Komen Foundation have developed a people-centric approach that allows churches to become involved at their own speed.
"The idea is that we train people who will then train others," Barker said. This year, she supervised the instruction of just under 100 new "Worship in Pink" ambassadors.
Similarly, the FDA's "Pink Ribbon Sunday" is less about providing a cookie cutter approach to integrating information about breast cancer into church services than it is about empowering church members to be creative in their own context. Its "Pink Ribbon Sunday Study Guide" leads interested event hosts through the five steps of planning a themed service.
"You have to get support from your church leadership, choose an activity (for attendees), spread the word, implement your program and then follow-up (with participants)," Henderson said. "And we actually offer examples based on your resource capabilities."
As the FDA's guide explains, breast cancer awareness events don't have to be held during regular services or even on Sunday to be effective. Success is measured, instead, by simply starting a conversation.
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