E N TIERRAS AFRICANAS

By 2005, there was a tendency in Imagen to feature informational articles written by prominent doctors who were in some way professionally involved in the topic of the article. For example, a recurring column written by the then-Medical Director of the American Cancer Society PR Chapter was featured in four months of the year 2005. He wrote about different forms of cancer, such as skin, lung, or breast cancers, and their associated risk factors, screening tests, prevention strategies, and treatment options. In Imagen, this trend continued into 2010, although what was equally evident

between these years was the reliance on commercial interests to pen some of these reports. For example, several reports on the benefits of certain medical devices or techniques were written by doctors or employees of companies/clinics that had also taken out advertisements in those magazines announcing their services. An example of this is an article in the October 2010 edition of Imagen, entitled Prevención: Tu Mejor

Herramienta Contra el Cáncer de Seno (Prevention: Your Best Tool Against Breast Cancer), which was authored by Dr. Gamalier Bermudez Ruiz, a radiologist and

president of Modern Radiology, PSC and Las Vistas Imaging & Diagnostic Center. These two clinics had taken out adjacent advertisements. The article itself was not prominently identified as a commercial advertisement, and though there was a very small line at the bottom of the page marked “Advertorial,” at first glance this article had the appearance of a journalistic report. These authorship trends contrasted visibly with

Vanidades and Cosmopolitan, whose articles, without exception, were written by staff

journalists with unmentioned credentials.

Marketing and Advertisement

In Imagen, 2005 witnessed the introduction of cause-related marketing. For example, in the October 2005 issue alone, three articles on cause-related marketing were published: they discussed, respectively, a jewelry company whose pink-ribbon specially-designed necklace and bracelet line would donate 10 percent of its profits to the Breast Cancer Research Foundation; BMW’s campaign in Puerto Rico that would benefit Komen by donating a certain amount of money for every mile driven; and finally, a campaign by Ford Motor Company in Puerto Rico that would also benefit Komen. Interestingly, the advertisement of cancer-related company products was a much stronger presence in Imagen than it was in Vanidades or Cosmopolitan, perhaps because it is a strictly local, Puerto Rican magazine and not one imported or adapted

from publication abroad. By 2010, Komen was frequently advertising its Race for the

Cure fundraiser in October, running advertisements in August, September, and October.

Figure 6.5 below is a Race for the Cure advertisement from the September 2010 issue. Figure 6.5. Susan G. Komen’s Race for the Cure Advertisement, Imagen 2010 (Sept:134)

Advertisement was not limited strictly to organizational fundraisers. For example, Lilly Oncology ran an advertisement in a 2008 issue of Vanidades informing readers that as women get older, their risk for breast cancer increases (see Figure 6.6 below). The ad urges readers to consult their doctor, and it includes Lilly Oncology’s logo on the bottom right-hand corner. There is no drug explicitly advertised. Interestingly, the

prison. Whether that prison is created by lack of knowledge about breast cancer that traps women into late-stage diagnoses is not clear; however, what is evident from the picture is that screening has the power to liberate.

Overemphasis on Preventability of Cancer

In all magazines, there was a disproportionate emphasis on prevention, and this topic appeared most prominently in Cosmopolitan and Vanidades—much more so than other topics. Readers were urged to modify their lifestyle in order to “reduce risk” or “prevent cancer.” It was very common to have small blurbs, drawn from recently- released study findings, displayed on the pages of the magazines’ health sections recommending that readers eat “X” vegetable—whether it be cauliflower, carrots,

spinach, mushrooms, or another types—because it contains “X” antioxidant, enzyme, or protein that will ultimately prevent “X” cancer. A common scenario was as follows:

“A powerful way to fight breast cancer is to eat more cruciferous vegetables like turnips, watercress, cabbage, broccoli, cabbage and cauliflower. Researchers at the Vanderbilt University Cancer Center in Nashville, Tennessee, found that women with a high genetic risk for this disease can reduce that risk by 50 percent when they have a diet high in cruciferous vegetables” (Vanidades 2008, Oct:32).

Prevention was also a recurrent theme in articles that addressed skin cancer, which predominated in Cosmopolitan. These articles uniformly urged readers to avoid the sun or to “practice safe sun,” because the etiology of skin cancer is clear—exposure to UV rays. Cosmopolitan had made this its pet project, termed “Practice Safe Sun,” with the goal of raising awareness about the dangers of indoor tanning. For example:

"Tanning beds were recently declared carcinogenic, meaning they cause skin cancer […] Going indoor tanning before you hit 30 raises your risk of melanoma (the deadliest form of the disease and the most prevalent type of cancer among women in their 20s) by a shocking 75 percent" (Cosmopolitan 2010, Oct:NP).

"Don't buy into the hype that you must bake in the sun sans sunscreen or schedule time at a tanning salon to get your RDA of D—it is totally not true and will backfire by

damaging your skin and possibly leading to skin cancer" (Cosmopolitan 2010, Dec:214).

Reporting Style

Overall reporting and presentational style differed dramatically between the three magazines. Cosmopolitan overall tended to feature quite superficial reporting of cancer- related topics and the fewest numbers of articles or news blurbs related to this theme.

Vanidades, on the other hand, often featured the results of published research studies,

translating them into layman’s terms, for publication in their Health or Medicine sections. Importantly, a strong tendency in Vanidades was the presentation of studies in ways that created false expectations. For example, articles would feature a captivating title, such as Vacuna…Contra el Cáncer de Seno (Vaccine… Against Breast Cancer), that

promised a huge advance in a screening, diagnosis, treatment, or vaccination method, generating the impression that the development would impact people’s lives immediately and positively. Then, several sentences later, the reader would find out that this “huge advance” was only in the mouse-model stage of research and had not even reached the level of human subjects research. For example, in the above-named article, the first sentence read as follows:

“A new vaccine developed at Wayne State University in Detroit is capable of delivering a gene into cells to fight cancer, which then allows the generation of immune system proteins and cells that destroy the tumors…”

It is not until one gets to the very last sentence of the article that it mentions the fact that the study has been done in mice, not humans:

“According to the information presented in the journal Cancer Research, the vaccine eliminated tumors in mice with a type of cancer called HER2 positive, which represents between 20% and 30% of breast tumors” (Vanidades 2008[48:22]:99, emphasis added).

Similarly, an article entitled Combatir…Los Tumores del Cerebro (Combating…Tumors

of the Brain), had one brief, easy-to-miss mention of the fact that the study was

conducted in mice, not people. Interestingly, it referenced a mouse in the singular sense, rendering the finding even less immediately applicable to humans than the title suggests.

“A study published in the journal Molecular Therapy provides a new way to fight brain tumors with gene therapy. Researchers at Massachusetts General Hospital introduced genes that fight cancer into healthy tissue adjacent to the malignant brain tumor of a

mouse and this prevented its spread" (Vanidades 2008[48:23]:99, emphasis added).

Use of Celebrities

Vanidades, and two in the 2010 issues of Imagen. This was a lower number than

expected, but it is significant that the only celebrity references occurred in the most recent issue. Perhaps this reflects a growing trend for celebrities to either be public about their own disease or to be involved in fundraising efforts. For example, Vanidades featured an interview with Lorena Rojas, a Mexican soap opera star diagnosed with breast cancer. In another issue, it listed recent celebrities diagnosed with cancer as a way to call attention to increased cancer incidence in young adults:

“The Mexican actress and songwriter Lorena Rojas, star of the soap opera ‘The Body of Desire,’ talks about the process of dealing with breast cancer and her determination to maintain a positive spirit” (Vanidades 2008[48:21]:72).

“The [fact that] show business figures such as Adamari Lopez, Sheryl Crow and the late singer Soraya have or have had breast cancer certainly pressed the alert button in many young women. What's going on?” (Vanidades 2008[48:13]:34-35).

Imagen featured reports on celebrities becoming more involved in fundraising, such as

Amaury Nolasco, a well-known Puerto Rican actor who runs an annual golf classic to raise funds for the pediatric oncology department at the Hospital Pediátrico in San Juan.

Negative Emotions and Stress as Cause of Cancer

An interesting theme was a focus on negative emotions and stress as a potential cause of cancer—either directly or indirectly by fostering unhealthy lifestyle practices2. In one article entitled Relájate…Para Evitar el Cáncer de Seno (Relax…to Avoid Breast

Cancer), Vanidades (2008[48:13]:32) reported on the results of a study investigating the

role that stress plays in the development of breast cancer. The study found that women in high-stress jobs had a 30 percent higher risk of developing the disease, which

researchers speculated could be the result of stress encouraging the adoption of an unhealthy lifestyle—elevating estrogen levels and in turn increasing risk. Magazines recommended that readers practice muscle relaxation, describing some techniques.

2 _{This was also a prevalent theme in the survivor interviews. See Chapter Seven for these} findings, and Chapter Ten for a discussion of this theme in the context of the existing literature.

Another article reported on the link between anxiety, depression, and cancer:

“Anxiety and depression have an adverse impact on the development of cancer. Researcher Ronit Peled explained that a negative event—the loss of a loved one or a marital breakup—can be the mechanism that drives breast cancer in a young woman. Various sources show that, in the same way, maintaining a positive attitude helps the healing process of the disease. There are countless programs that promote optimism during the process” (Vanidades 2008[48:21]:72-75).

Meanings of Cancer and Recovery in Survivor Profiles

Imagen featured survivor or advocate interviews and profiles at a greater

frequency than the other magazines. For example, for three of the four years sampled (2000, 2005, 2010), the magazine advertised the American Cancer Society’s fundraising gala by publishing in-depth profiles of five couples or families in which one of the

members had gone through cancer. These profiles offered a rich source of ethnographic information about conceptions of cancer or survivorship. Valuable themes surfaced in the survivors’ and family members’ accounts, varying little between years. These same themes also emerged throughout the interviews with survivors and advocates in this study, ratifying the prevalence of the ideas in Puerto Rico. Most notably, the survivors profiled in these articles talk about how cancer was a life-changing event that affected them positively in many ways, whether it be learning how to live in the moment, or being able to reprioritize and value more the “important things in life,” such as their family and children. One of the survivors profiled, a doctor, reported this tendency:

“For Dr. José Arroyo Gau and his wife, Carmen Padilla, the experience of having beaten cancer twice has meant learning to enjoy the present more and thinking a little less about the future. ‘We have changed our scale of values in the sense that before we were accustomed to making long-term plans. We learned to enjoy the day and to only think about tomorrow a little bit, and that change has been good’” (Imagen 2000, Feb: 189-99).

A survivor profiled in another issue, Mili, reiterated the same theme:

“[Mili, a cancer survivor] reaffirms that the whole experience has been a learning for her. She learned to value and appreciate the really important things in life, such as family and good friends. ‘The mind becomes clear in many ways’” (Imagen 2000, Oct:238-242).

recovery from the disease and in being able to withstand the trials of treatment—or perhaps more accurately, the detriment of negative thinking. In an Imagen article profiling cancer survivors, one survivor noted:

“The medical treatments are not going to have the same effect on a pessimistic person’” (Imagen 2005, Feb:95-105).

A husband and wife, who been diagnosed and treated for cancer at the same time, spoke of the importance of a positive attitude in their own recovery after the disease:

“‘The most important thing in this process is the attitude. There are people that without being ill, have such a negative attitude that they feel things they don’t have’ said Gilberto, while [his wife] added that they never stopped working and changed as little as possible in their lives’” (2005, Feb:95-105).

Profiled survivors spoke about the importance of family in a few ways: first, the important role of family support in their experience, and second, how informing family was the hardest part of the experience. For example:

When Raymond was diagnosed, “the hardest thing was to inform their children—Ricardo, Cristian and Richie—what had happened since ‘they’ve always seen me as a strong person and I didn’t want them to feel sadness or pity for me’” (Imagen 2005, Feb:95-105).

Religious belief was a prominent theme in these accounts as an underlying force for dealing with the cancer experience and a motivating factor in getting well. For example:

“‘In our faith, we knew that God would work through medical science’ [...] Both express that their faith sustains them in every situation of life and that God gave them the necessary peace at the moment Judith was diagnosed” (Imagen 2000, Feb:189-199). “‘Cancer gave me the opportunity to see life from a totally different perspective, to see it more spiritually than before’” (Imagen 2005, Feb:95-105).

Very few survivors’ accounts touched upon the possibility of infertility. More often they discussed how their children were their biggest concern upon diagnosis. For example, a married survivor remarked that when she was diagnosed with cervical cancer at age 32:

“‘Those words hit us like a bucket of ice water. I'll never forget how I felt at that moment, that day and the others that followed. But at that moment I decided to make an

appointment fast for the operation [...] I have two children (a five-year old boy and a three-year old girl), and what went through my mind was their faces, and I could not leave the matter long so I took fast action [to have a hysterectomy]’” (Imagen 2010, Jan:130-2).

Despite the fact that the survivor quoted above needed to undergo a sterilizing

procedure as a treatment for the cancer, the article never touched upon her reaction or thoughts about this aspect. Rather, it focused on the constant stress and worry of recurrence. Her cancer was depicted as difficult to detect, requiring persistence and multiple visits to the doctor in order to secure an accurate diagnosis in the first place, and constant vigilance thereafter. Initially she regarded it as a death sentence, but that perception faded with time, despite the constant recurrence worries.

Several survivors related how their hair loss (or the threat of it) was one of the most traumatizing aspects of the experience for them. Others remarked that physical changes or mastectomies were the most difficult aspect, but one that can be overcome:

“‘When I saw that [my mother’s] hair was falling out, I realized what was happening. To stop the torture, my dad and I shaved her head, full of emotion, pain and sadness for the drastic physical change” (Imagen 2010, Feb:111-116).

“‘For a woman, the physical change is the most difficult, the one that you feel the most because cancer does not hurt. With treatment, I felt bad the first day, but then I was perfectly fine. The worst thing is to see your body maimed, such a feminine part as the breast; it’s to see yourself without hair, but I learned to handle all this positively’ says Annette [...] ‘If you are a person who tries to have inner beauty, that comes out. In that process, I think that it was the time in my life when I was more beautiful inside because I started to enjoy and appreciate the little things everyday’” (Imagen 2005, Feb:95-105).

There were references in three years—2000, 2005, and 2010—to the need for survivors to reach out, to help someone with cancer, or a responsibility to raise awareness. This speaks to a need to make sense of the experience through serving and helping others. One couple who had both survived cancer related how they are now involved in many volunteer activities for other patients, which is part of their learning to value life:

“‘We enjoy and celebrate life. We are involved in the American Cancer Society […] We belong to the organizing committee for Relay for Life, in Manatí. We value life and learned to love our neighbor more than we already did. We are part of the American Cancer Society’s Yo Puedo [educational and support] program. We have so many people to thank’” (Imagen 2010, Feb:115).

A long article in Imagen’s December 2010 issue profiled a survivor who had started her own organization to aid others. It explained her motivation:

“‘El Comité Niños que Quieren Sonreír (The Children Who Want to Smile Committee) was born because I was a cancer patient at 23 years old. I was diagnosed with

Hodgkin’s disease [a lymphoma] in an advanced stage, but thanks to God, although the prognosis was somewhat daunting, I was able to recover completely and in spite of being treated with chemotherapy and radiation I was able to have a daughter who is now 15 years old,’ relates Aidiliza Levis de Buenaga, founder and president of the Comité Niños

que Quieren Sonreír, whose life lesson and gratitude motivated her to reciprocate the

blessings she received” (Imagen 2010, Dec:174-177).

Cervical Cancer Prevention

Cervical cancer was a large presence in the 2010 issues of Imagen. This was after the Gardasil HPV vaccine had been approved. Several Gardasil advertisements appeared in Imagen that year, as well as two related articles. One of these articles reported on the FDA approval of the vaccine in men/boys, and the other was entitled