Samantha King’s 2006 book Pink Ribbons Inc. was one of the first that examined why breast cancer, more so than any other illness, became a ubiquitous marketing movement. Answer: The most significant risk factors for breast cancer (such as genetics and age) can’t be altered by women, which is why it’s often regarded as a “blameless” disease. It attacks mostly women, who account for the bulk of America’s purchasing power. It attacks the very symbol of femininity, the breast. And a pink ribbon is cute and soothing. “I’ve talked to survivors who’ve contacted me and were so enraged that their struggle with the disease was being commodified in this way,” says King, who is based in Kingston, Ontario. “The response I’ve heard from corporations when I challenge them about this is ‘Who cares, as long as the money is going to a good cause?’ ”

“It’s such a double-edged sword,” says LaShaune Johnson, 33, another breast cancer survivor and a postdoctoral fellow, who recently relocated to Hartford from Hyde Park. She did her dissertation on breast cancer organizations and black women. “On the one hand, buying that pink stuff makes you feel connected to the people who survived and made it to the other side.

Since she was diagnosed 2½ years ago, Anna Schleelein, a 26-year-old attorney in Newton, spends Octobers in a self-imposed pop-culture blackout. She tries to avoid TV, magazines, and, especially, shopping, to steer clear of all those pink-ribbon products. “October is just a reminder of my cancer,” Schleelein says. She is screened for recurrences with MRIs and mammograms every six months, and October is particularly difficult if she is awaiting the results of a test. “I want to buy my English muffins and not be reminded of it while I’m waiting for results to come in.”

Many breast cancer survivors like Zielinski find themselves conflicted over this little powerful ribbon. Some survivors feel companies are exploiting breast cancer, marketing themselves as philanthropic outfits that care about women when what they mostly care about is the pink ribbon’s enormous ability to boost profits. Some just feel overwhelmed by the constant pink reminder, especially in October, Breast Cancer Awareness Month, of a disease that has forever altered their lives.

“I think that the pink ribbon, as a symbol, tends to pretty up what is a pretty crappy disease. But a pink ribbon is easier to look at than the disease itself.”

But it wasn’t long before she got a little sick of the pink. “I felt kind of hateful,” says the insurance company sales manager who lives in Charlestown. “I was like, ‘What makes you think I like pink now?’

When Kim Zielinski was diagnosed with breast cancer in 2007 at the age of 33, well-meaning friends inundated her with products bearing a little pink ribbon. Each product’s maker promised a cut of the sales price to a breast cancer charity, and these friends felt they were supporting the cause and, by association, Zielinski. A petite brunette who’s now 35, she was enormously grateful for the millions of dollars that these pink-ribbon products direct each year to charities that fund breast cancer research and education.

But most consumers don’t read reports from Midwestern business schools. Many people believe that a firm that puts a pink ribbon on a product is donating money out of its own pocket, at a loss, because it is committed to the fight against breast cancer. That’s not to say the employees and executives aren’t committed to the cause, but that is not why they do it.

A recent study of the effects of cause marketing by two professors at the Ross School of Business at the University of Michigan at Ann Arbor found that not only can companies raise prices and make higher profits on the sale of products that benefit a cause, these companies’ entire brand portfolios can experience a “spillover” increase in sales and profits, which more than compensates for the money given to charity. The report concluded, “Our results suggest that actions of [cause marketing] firms should be looked on with some skepticism by consumers and government officials -- while the firms may be helping with charitable causes, they are also using [cause marketing] to increase their own prices and profits.”

It is also a powerful technique for raising profits. Research from Cone Communications, a Boston consultancy that helped pioneer the widespread use of cause marketing, has shown that 79 percent of consumers would likely switch to a brand that supports a cause, all other things being equal. People want to buy from companies that appear to do good deeds. In one test conducted by Cone and Duke University’s Fuqua School of Business, shampoo aligned with a cause saw a 74 percent sales increase over the same brand without a cause.

When a company sells a product and promises a portion of the proceeds to a cause or charity, it’s called cause-related marketing. (This is unlike the charitable foundations that some companies set up to give away money unconnected to product sales.) Avon and Estee Lauder were two of the first to use the pink ribbon as a marketing tool by slapping it on cosmetics in 1993. Other companies rapidly followed suit. Susan G. Komen for the Cure, the Texas-based 900-pound gorilla of breast cancer fund-raising, has turned cause marketing into a money-printing machine. Last year, the charity raised almost $50 million from more than 250 corporations, which gave Komen some of their proceeds from product sales. Komen is just one of dozens of charities that partner with companies to raise funds. The technique has been a tremendously powerful way of generating money for breast cancer research and education by redirecting consumer dollars.

Many breast cancer survivors and women battling the disease care, that’s who. And they’re increasingly willing to speak out about it. “I would hope that companies aren’t looking to profit off the use of the pink ribbon,” says Zielinski. “There are other ways that they can market things.” But few causes have proven to be as incredibly profitable -- or as exploited -- as breast cancer.

Of the complaints, Karen White, director of corporate relations for Komen, says: “It’s not something that we hear on a regular basis. Responsible cause marketing is good cause marketing and serves a wonderful cause. We’re excellent stewards of the funds that come in through this.” Still, nonprofit executives realize that some companies are misusing the pink ribbon, and they recognize that if corporate partners appear greedy instead of philanthropic, it tarnishes the charities’ own reputations -- and fundraising efforts. White says Komen approves the products on which its partners are slapping Komen’s trademarked version of the pink ribbon, and the charity says it monitors partners to ensure they are following accepted charitable giving guidelines and state laws that govern corporations involved in cause marketing.

With one in eight women being diagnosed with breast cancer, more research is needed into cause, treatment, and prevention. Every donated dollar helps, so most charities refuse to bad-mouth pink-ribbon cause marketing, no matter how much it upsets some breast cancer patients and survivors.

“For those of us with breast cancer, it’s like getting hit in the face,” says Sather. “The companies are making money off my disease -- even if they’re giving an amount to charity, they’re making so much more in profit.”

Such misuse and hoop-jumping infuriates Jeanne Sather, a Seattle woman battling metastatic breast cancer and known throughout the cancer community for her fight against the pink ribbon and Breast Cancer Awareness Month. She will send a “Boycott October” button to anyone who asks. Her blog,

The profit power of cause marketing is why, come October, everything turns pink. The pink ribbon’s use is unregulated, and it has no consistent meaning. Some companies simply attach a ribbon and say they’re “raising awareness.” Many pink-ribbon campaigns require the purchaser to register the sale online or through the mail.

“Often, I hear the argument that we would be better off if companies would just donate the dollars that they spend on marketing these products or creating these products,” says Chris Mann, associate manager of brand marketing for Brighton-based New Balance, which for the past eight years has given a percentage of the sales of its “Lace Up for the Cure” shoe, apparel, and accessory collection to Komen. “And I don’t disagree that a donation of that amount would be very impactful. At the same time, that point of view doesn’t understand the realities of how for-profit corporations have to work. In most of the cases, that money was never earmarked as purely a donation or a philanthropic initiative. In most cases, it’s funds that are coming out of a marketing budget. And by definition, a marketing budget is meant to drive return for the business.” (The New Balance Foundation, a separate entity set up to make charitable donations, has given more than $100,000 over the past four years to local breast cancer initiatives and gave $100,000 in 2007 to Komen.)

Nonetheless, Breast Cancer Action (BCA), a San Francisco-based advocacy and fund-raising nonprofit, has for years called Komen out for joining with companies that it accuses of raising money for breast cancer while manufacturing products that contain ingredients that have been proven to or are likely to cause cancer. BCA recently declared victory when Yoplait, one of Komen’s biggest partners through its “Save Lids to Save Lives” campaign, agreed to stop using milk from cows treated with recombinant bovine growth hormone, or rBGH. The byproduct of the hormone that remains in milk has been linked by many studies to the development of breast cancer. Shortly after Yoplait’s statement that it would stop using milk from treated cows, Dannon made a similar announcement about its yogurt.

In 2002, BCA created the “Think Before You Pink” campaign, encouraging consumers to ask questions before buying pink, among them: Is the product bad for my health, where is the money going, and how much is going there?

It’s difficult or impossible to answer these questions while confronting a sea of pink products in aisle five at Walgreens. Which is why Komen, for one, insists that its corporate partners clearly say on products how the sale will benefit Komen and if there is a donation minimum or maximum. One of Komen’s partners with a maximum is New Balance, which caps its contribution at $1 million per year. The shoe maker has hit that target during each of the past two years and expects to do so again this year, according to Mann. “We would love to [raise the cap],” he says, “but the unfortunate realities of the business world at this point are that [we], like many other companies, are not having the flexibility given the current economic times to increase marketing spends.” So what happens each year to the money that the company earns after the cap is reached that would normally go to Komen? “We would hold on to that.”

White says that Komen monitors its partners’ sales and requires that when they hit their maximum they tell consumers that purchases are no longer benefiting Komen. New Balance, however, said in a statement that it does not inform consumers once the company reaches its cap; its product labels state that a maximum donation exists, so the firm believes it’s in compliance with Komen’s rules.