Nancy Goodman Brinker of Peoria, Illinois was only five years old and her sister Susan was eight when her determined, community-minded mother ordered them out of the car en route to a promised day at the swimming pool.
"Girls," she told them. "I want you to promise that you will help people and fix things that are wrong!" Eager to swim but clueless as to what their mother wanted them to do, the sisters agreed, and they were allowed to get back into the car. Not long after - at their mother's suggestion - the sisters did a benefit show for polio victims and invited 64 neighbors, each of whom paid a dollar.
"Suzy sold the tickets and I sang, but she said that next time, she would sing and I should sell the tickets. So I got to be a fundraiser."
Nancy Brinker, founder of the Susan G. Komen Breast Cancer Foundation and a former US ambassador to Hungary, was forced by unfortunate circumstances to carry out her mother's instructions on a large scale. Susan, at 33 a married woman and mother of a son, contracted breast cancer that metastasized and soon ended her life. Nancy herself survived a bout of the same genetically based cancer (BRCA1) and decided to raise money for cancer research and stimulate awareness of the disease at a time when the words "breast cancer" rarely made it into the papers.
TWENTY-FIVE years later, the foundation, says Brinker, has raised $750 million, much of that money thanks to events like the Komen Race for the Cure, which is held in a large number of communities. With some 100,000 volunteers, about 200 staff members and 125 affiliate groups in the US and half a dozen around the world, the foundation has become the largest source of non-profit funds dedicated to the war against breast cancer.
Her father, 91, was healthy until diagnosed at 87 with cancer; her mother, now 88, fortunately did not contract the disease. Her parents' families fled from Germany and Russia. Brinker's mother's family were prosperous merchants and art collectors, but those who stayed in Europe perished in the Holocaust, leaving a very small family. Her father made a considerable fortune in real estate and banking, and her second husband Norman Brinker made his own fortune as a restaurant magnate. Thus Nancy was free to pursue her cause without concern about paying the bills.
Brinker had an hour-long interview with The Jerusalem Post at Jerusalem's King David Hotel, where she stayed during her first-ever visit to Israel, which lasted only 36 hours. Brinker arrived here from Amman, where she had been a participant in a signing ceremony of the US-Middle East Partnership for Breast Cancer Awareness and Research. The Partnership has just been joined by the University of Texas M.D. Anderson Cancer Center.
"We are honored to be a part of this groundbreaking effort to effect positive change in breast cancer in Jordan and the Middle East," said Prof. John Mendelsohn, the president of the cancer center who visited Israel last year to accept the $1 million Dan David Foundation Prize for the Future Dimension. "By uniting the expertise and dedication of our partners, we can more quickly advance our shared mission of eradicating cancer throughout the world." he said.
But although it is called a Middle East Partnership, Israel has not (yet) been invited to join the project, which is designed to increase early breast cancer detection and reduce related deaths in the region through improved awareness, increased clinical resources and world-class research. The partnership was created by the US State Department Office of Public Diplomacy and Public Affairs, and launched by First Lady Laura Bush last June.
The effort is meant to be a "community driven, culturally sensitive approach through local champions, and enhances the vital role women play in their families and communities," according to the M.D. Anderson Center. Not only the Susan G. Komen Foundation and the Texas cancer center is involved, but also Amman's King Hussein Cancer Foundation and King Hussein Cancer Center, founded after the death from cancer of the late king of Jordan. Asked why Israel, which boasts numerous leading breast cancer researchers and clinicians, has not been included, Komen said it was only her first fact-finding visit to the country.
"We'll try to get Israel involved," she declared, adding that she hopes to promote more research in cooperation with Israeli scientists and physicians.
Her whirlwind visit took her to the Weizmann Institute in Rehovot, where she met world-class breast cancer researcher Prof. Hadassa Degani. She also visited Sheba Medical Center at Tel Hashomer, where leading breast cancer researcher Dr. Bella Kaufman has applied for a $250,000 grant from the Komen Foundation for her detailed research proposal of a mobile breast cancer mammography, 3-D ultrasound and MRI unit that could travel to outlying Palestinian and other areas, with the results to be transmitted by teleradiology to Sheba for evaluation; the foundation has already funded Sheba research by Prof. Moshe Papa and Dr. Sigal Sadetzky on the influence of religious beliefs on breast cancer survival rates.
BRINKER ALSO made a quick visit to Jerusalem's Shaare Zedek Medical Center to meet experts on the genetic background of breast cancer; and Beit Nathan in Jerusalem, that promotes breast cancer awareness among haredi women. She met with Israeli Arab and Palestinian women who are reluctant to go for mammography screening and whose tumors are thus detected at a later and less-treatable stage. Her schedule here reflected the Komen foundation's stress on increasing breast cancer awareness among groups who avoid early detection. "We fund not only research but also delivery of care. There is excellent treatment for breast cancer in Israel; many places in the US would pale by comparison to Israeli cancer centers," she added.
"We don't pursue things unless we know they'll work. We have active grants in 47 countries, and in Israel we started with one in 2000 to Hadassa Degani, We start slowly." she said, adding: "I wanted the organization to 'look' like my sister, because she cared, even when she was so sick. She always looked after me. She was beautiful and popular in school, went to the University of Missouri and did part-time modeling, but never had a real career because she became a wife and mother. I left for Texas and became a student activist and then got into public relations and marketing after meeting Stanley Marcus of the giant Neiman Marcus department store."
It was then that she learned her only sister had breast cancer.
"I knew enough about cancer to realize it was serious. There were no cancer centers then and no Internet or toll-free cancer information numbers. There were only about eight or nine cancer drugs. The only alternative was a mastectomy. Suzy remembered seeing the body of our aunt after a mastectomy; she was all purple, and Suzy was horrified. I think Suzy had metastatic disease from day one, as it spread to her lungs. I had a feeling she wouldn't do well. She had three massive rounds of chemotherapy and lots of surgery. It was torture, but she never admitted she was dying. Suzy made me promise that when she 'got better' I would find a way to cure the disease. She was incensed about the lack of access to care. Even during her last few weeks of life, she went to a children's cancer ward to talk to them. After another round of treatment at M.D. Anderson, Suzy asked me to "do something to help the sick women in the hospital. This practically tore my heart out because here she was, hardly able to manage a whisper, and she was worrying about other people."
After Komen's death, Brinker founded the foundation in Dallas in her name. "With a small group of volunteers, we raised high dollars for cancer in Texas during the oil boom in the early Eighties. We had a real cultural problem, though. A woman journalist came to one event and said she couldn't write the words 'breast cancer' in the newspaper. I despaired about getting public attention."
During the Vietnam war, 59,000 men died, she said, but during the same period, over 300,000 American women and some men died of breast cancer. "We thought we could introduce a non-threatening message that would make people want to turn out for fundraising events.
IN 1982, Brinker and colleagues thought up the idea of using a pink ribbon to symbolize breast cancer, and initiated the Susan G. Komen Race for the Cure. Some 800 women came to the first one, In those days, only about $20 million a year went to breast cancer research in the US, and the survival rate was very low.
"Treatment was accessible only to a few. Our foundation could not be ignored anymore, and we targeted corporations that had money. It was hard to find donors for research, as philanthropists like their names on buildings," Brinker recalled.
As a wealthy woman with strong Republican sympathies, she provided financial backing to George W. Bush for the Texas governor's race, which he won. When he ran for president in 2000, she made large contributions to his campaign. He didn't forget her, and named her US ambassador to Budapest in gratitude; she remained in the post for two years. Even in Hungary, she organized a walk over the bridge in Budapest to raise money for the foundation, of which she remains an unpaid volunteer.
BUT BRINKER and the foundation she set up are not without controversy. One article called The Marketing of Breast Cancer - written in 2002 by New Jersey journalist Mary Ann Swissler and made possible by the Fund for Investigative Journalism in Washington, DC - was very critical of both of them. Swissler's main complaint was that the Komen foundation receives much of its funding from vested-interest industrial corporations that have a (Republican) political agenda, which includes opposition to the environmental quality movement. The Race for the Cure, claimed the 10-page article, "merely focus women on finding a medical cure for breast cancer and away from environmental conditions causing it, the problems of the uninsured and political influence of corporations over the average patient... Brinker relies on the blockbuster PR value of the Race for the Cure. The year-round calendar of cancer walks that draw grief-stricken yet hopeful patients and their loved ones, along with a fawning media, preserve Brinker and her group's image as being on the side of the average American woman tragically afflicted with breast cancer. So most people would be shocked to find that the Komen Foundation helped block a meaningful Patients Bill of Rights for the women [which was opposed by the Bush Administration that] it has purported to serve since the group began in 1982."
Swissler continued that "through the years, the Brinkers helped deliver the state of Texas to George W. Bush, for the governor's seat and then the presidency. Their phenomenal fund-raising skills earned them the moniker of 'Bush Pioneers,' followed up with committee positions for the Bush Inaugural Ball, which requires a minimum $25,000 donation. On her own steam, Nancy Brinker lists nearly $256,000 in Bush and Republican Party donations."
The foundation, she continued, has received financial support from AstroZeneca, the maker of Tamoxifen, which is one of the most widely used and successful breast cancer treatments today, but has been linked by some researchers to uterine cancer. According to the article, Brinker's investment portfolio includes $500,000 worth of stick in US Oncology, a chain of for-profit treatment centers whose lobbying firm represents the Philip Morris tobacco company.
Unlike the Komen foundation, San Francisco-based Breast Cancer Action - which campaigns to increase women's awareness of the disease but does not fund cancer research - "refuses all donations from corporations that make money off breast cancer such as pharmaceutical companies, tobacco and pesticide manufacturers, and cancer treatment facilities."
BCA's executive director Barbara Brenner explained that "with the growing effort by corporations to look like 'good guys' by supporting cancer organizations, it is difficult, if not impossible, to know whether an advocacy organization's positions are based on well-thought-out policies or on who's paying the bills."
When I raise these issues and the Swissler article, Brinker looks stung and her jaw stiffens. A State Department official who sat with us during the tail end of the interview freezes, then closes up her things and says: "There is no more time. Nancy has to go."
Brinker does not specifically address Swissler's criticism, but declares: "Ours is an apolitical cause. I am very connected to the GOP, but my organization is not. We are a non-governmental organization, and 98% of our activists and volunteers are Democrats. Where were these [critical] folks in 1977, when I started? They raise no points I would be afraid to debate in front of millions."
Furthermore, commenting on complaints about its alleged lack of concern for the causes of breast cancer, including pollution, the foundation has said that it recently collaborated with the Silent Spring Institute to study the links between the environment and breast cancer. The study results, the foundation added, helped it to decide on grants it has awarded for the design of better, more definitive environmental research methods. The results of the study will soon be published by the prestigious journal Cancer.
The Israelis who receive - or would like to get - Komen foundation grants said they were unaware of the criticism. "The foundation has had enormous impact on a global scale for awareness of screening, and facilitates programs for the poor and underinsured," commented Dr. Nathan Cherny, a Shaare Zedek palliative medicine expert who met her. "Nancy Brinker wants to develop mobile mammography in the Palestinian Authority, and is interested in what our researchers are doing on community screening. She deserves credit."
And Brinker is constantly honored for her contribution to the cause. She was a signatory and witness to the Treaty of Paris Against Cancer presented at the Palace of Versailles, receiving a prize for her "exceptional contribution to oncology" from French president Jacques Chirac.
She was also installed into the Cancer Research and Treatment Funds Cancer Survivors Hall of Fame.
When a cure for breast cancer is finally achieved, - after today's situation, in which breast cancer is for many women a chronic disease that can be lived with - Nancy Brinker and the Susan G. Komen Breast Cancer Foundation can certainly claim some of the credit.