It's the No. 1 health-related killer of women. There's a month devoted to its awareness. A colorful icon as its symbol. Races, walks, products and promotions raise funds for it, and community organizations and corporate partnerships contribute millions of dollars for research. Think it's breast cancer? Think again. So why do so many breast cancer organizations have women thinking pink, when the more prevalent threat of heart disease should have them seeing red?

Though heart disease kills roughly 12 times more women than breast cancer each year, breast cancer programs continually overshadow the promotion of and dissemination of information about heart disease. There are pink ribbons, pink products, pink ribbons on other products and pink promotions for everything from toothbrushes to automobile test drives. Many cities go so far as to light their buildings with a pink glow during October, National Breast Cancer Awareness Month. There's even a Stamp Out Breast Cancer postal stamp, which has raised roughly $ 50 million for breast cancer research. But even though many of those exact same promotions exist for women's heart health, the awareness, sponsorship and exposure levels aren't even close.

One of the main reasons that breast cancer has eclipsed heart disease as a women's issue is the fact that only recently has heart disease been considered more than just a man's disease, so heart advocates are playing catch-up with the breast cancer movement. But it's not just a matter of sluggish marketing on the part of women's heart health: From the length of time breast cancer has been an issue to the emotionally charged nature of the disease, experts say the disparity is a result of several factors that simply make breast cancer issues easier to promote and keep in the public eye.

According to the American Heart Association (AHA), cardiovascular disease claims the lives of about 500,000 women a year, more than the next six causes of death combined, including all cancers. Meanwhile, the American Cancer Society estimates that nearly 41,000 women will die from breast cancer this year. It's not even the leading cancer killer in women; lung cancer is.

But those numbers are not reflected in public awareness or perception. According to a 2005 study by the Society for Women's Health Research in Washington, D.C., of more than 1,000 adult U.S. women surveyed, only 9.7% said heart disease was the disease they feared most, while more than twice that number, 22.1%, said breast cancer was their biggest fear.

Insiders say the biggest reason for that disparity is the fact that breast cancer has been openly discussed as a critical issue for women for much longer than heart disease.

"For so long the mythology was that heart disease is a man's disease," says Nancy Loving, executive director of WomenHeart: The National Coalition for Women with Heart Disease in Washington, D.C. "Through the '80s, women were taught that they were not at risk for heart disease. That belief system has been slow to crumble."

Politics have also played a part in getting the breast cancer movement into the public eye, adds Loving, who herself had a heart attack 10 years ago and was shocked at the lack of resources for women with heart problems.

"When the women's health movement was being organized in the early '90s, they needed a political rallying cry around which to organize and they chose the lack of funding for breast cancer research. On Capitol Hill that became a real political issue, so it was an excellent (choice). And with high-profile supporters like Betty Ford and Nancy Reagan, the momentum just took off," Loving says.

Inspired by the red ribbon of AIDs activists, Dallas-based Susan G. Komen Breast Cancer Foundation began handing out pink ribbons to promote awareness at its national Race for the Cure in New York City in 1991. It took off like wildfire across the rest of the nation.

Caroline Wall, cause-related marketing manager for Komen, says the pink ribbons struck a chord with people, and when Self magazine put one on the cover of its annual breast cancer issue the following year, it cemented the ribbon's place as a national icon. "From there, the symbol and the movement just began exploding," Wall says. "Today we have volunteers and partners who have been with us for more than 10 years."

By contrast, it wasn't until September 2002 that the National Heart, Lung and Blood Institute (NHLBI), together with WomenHeart, launched The Heart Truth campaign, the first of its kind to increase women's awareness of heart disease and how it can affect them. The campaign introduced the Red Dress as its icon geared toward raising awareness during American Heart Month at New York's Fashion Week in February 2003. One year later, Dallas-based American Heart Association introduced a separate, parallel campaign called Go Red for Women, which also uses the red dress as its icon.

Jo Parrish, vice-president of Institutional Advancement at the Society for Women's Health Research, says the heart movement's slow start is a symptom of the way research and information has been categorized.

"The American Heart Association has been quite late in their publicity about heart disease and women," she says. "But typically when a disease affects men and women, the information about who's being affected, and how, has all been lumped together regardless of gender. It's only now that they are making a real effort to break out their information in terms of the differences between men and women."

Another factor that makes heart disease especially hard to market is that while there's no blame or guilt associated with breast cancer, several risk factors for heart disease are stigmatizing.

"It's difficult to communicate a positive message about heart disease because there's so much shame and blame associated with it," Loving says. "Some people tend to blame the victim for lifestyle choices such as smoking or a sedentary lifestyle, when family history is actually the bigger risk factor," she says.

Much of breast cancer's marketing success also comes from the fact that it is primarily a women's disease, and as such has more emotional ties among the general population than heart disease.

Jeffrey Wolf, partner and director of account planning at Deutsche Inc. in New York, says breast cancer resonates more in the public eye because it is more emotionally charged than cardiovascular disease.

"The breast is such an important part of identity in our society," he says. "Breasts are worshipped, they're life-giving and they're sexually arousing. Men love them and women envy them. Anything that attacks that is going to get an extremely emotional response, and when you look at that relative to heart disease, it doesn't have the same level of emotion," he says.

That emotional response also stems from the fact that breast cancer strikes more women at a younger age, Wolf says.

"Cardiovascular disease is the big killer when you look at total life span, but because breast cancer kills more women in their prime it becomes more tragic and gets more attention," he says.

Because breast cancer survivor rates are on the rise, more of these younger women are also getting involved with the cause, leading to a bigger grassroots movement and awareness behind the disease, says Jack Calfee, resident scholar at the American Enterprise Institute in Washington D.C.

"Heart disease is still seen mainly as happening relatively near the end of your life, so the grassroots and private organizations haven't been as strong. But the women who get breast cancer relatively young usually do survive, so they often go on to work vigorously to help someone else avoid going through what they've been through," he says.

The Komen Foundation is a shining example of that movement. It is the world's largest private funding organization of breast cancer research and community outreach programs. It counts more than 75,000 volunteers – many of them breast cancer survivors – among its ranks and has invested more than $ 500 million to help combat the disease. Meanwhile, the NHLBI, one of the largest groups behind women's heart awareness, is part of the National Institutes of Health, a government agency.

Ironically, this government affiliation, coupled with the marketing that is being done on behalf of the drugs used to prevent heart disease, may be impeding fundraising efforts for heart disease, according to Calfee.

"When asked to give money or support, people ask themselves whether it's really going to make any difference. When they see all these commercials for heart drugs such as Lipitor or Zocor, they assume that a lot of people &ndash including the federal government and pharmaceutical companies &ndash are spending a lot of money on heart disease research," he says. "Since they don't see ads for breast cancer drugs or treatment, most people think of it as something we don't have a cure for, so anything they can contribute might actually help."

All of these factors have helped breast cancer become a health issue that businesses have been more willing to align themselves with, leading to big bucks for research and promotion in the form of corporate marketing partnerships and cross-promotions.

The obvious reason for breast cancer's success with corporate partnerships is that it is a natural fit for businesses that sell primarily to women. Some of the biggest companies with ties to the breast cancer movement include Avon Products Inc., Revlon Consumer Products Corp., Lee Jeans, Hallmark Gold Crown Stores and Yoplait USA Inc.

"They see that a large percentage of their consumers might be women and that this is a concern for them," says Wall, who says that Komen's cause-related marketing programs raised about $ 31 million for the foundation in 2005.

But while heart disease is a women's issue as well, Parrish, with the Society of Women's Health Research, says many companies aren't willing to risk aligning themselves with a cause that's not already firmly established.

"The bottom line is that companies want their products to sell, so they want to tie themselves to the issue that's going to resonate the most with the person making the purchase," Parrish says. "Breast cancer is an easy one for a company to align itself with because it's primarily a women's issue that everybody already understands. The information is already out there. But heart disease in women isn't understood that well yet. So much would have to be explained, so until it becomes really well known, those partnerships and sponsorships probably aren't going to be as widespread," she says.

That foundation of knowledge also allows the breast cancer groups to expand upon their message in their promotions.

"We're always looking not only for the fundraising side of a corporate partner program but for the educational benefits of it as well," Wall says. "Each one of our cause-marketing programs has some type of educational message in it, whether it's putting risk factors on packaging, dedicating a page of their Web site or getting information out about our toll-free help line or Web site for information," she says.

Dee Baker Amos, senior communications manager for the AHA in Dallas, says her cause simply doesn't have the luxury of that multipronged approach just yet.

"The first two years we've really had to focus on awareness, and we've been able to move that needle," she says. "Now that we've got that base, this year we're going to continue our efforts on awareness, but now we're going to work on education, too."

Indeed, the women's heart health is seeing some marketing success. A 2004 survey by the AHA shows that 57% of American women know that heart disease is the leading killer of women, up from 34% who knew it in 2000. And a January 2005 study by WomenHeart found that 25% of women recalled the Red Dress as the national symbol for women and heart disease awareness.

"Last year alone the Go Red campaign did more than a billion media impressions; That's unheard-of for a campaign in its infancy like this one is," Amos says. "We're excited because it really tells us we're moving in the right direction."

The movement is starting to pick up steam, according to Jennifer Wayman, senior vice president and group director at Ogilvy Public Relations Worldwide in Washington, D.C., who works on The Heart Truth campaign.

"The partnerships the campaign has developed with the fashion industry and a lot of community and media organizations have helped propel it into the mainstream and it's starting to take off," she says. "We do have a ways to go to catch up to how successful the breast cancer movement has been, but I think it will happen with time."

For now, Amos says Go Red for Women has rebranded many of its fundraising promotions and affairs as Red Dress events, and corporate sponsorships, including ties with Macy's department stores, Pfizer Inc. and Bayer Corp., are on the rise. First Lady Laura Bush has signed on as The Heart Truth campaign ambassador. And in February, American Heart Month, national and local landmarks including the Seattle Space Needle and the Empire State Building will be bathed in a red glow to further raise awareness of women and heart disease.

There may even be a Red Dress postal stamp in the works. Fundraising stamps of this nature must be approved by Congress, and according to Amos, the AHA is awaiting the passage of a bill this year that would be the first-ever federal installation around women and heart disease. "We're hoping the stamp will come along soon after," she says.

If it all sounds familiar, well, it is. But both sides emphasize that while they may be competing for marketing dollars from outside partners and promotions, this isn't a war of the diseases, and there are plenty of alliances to go around. Those working for women's heart health say their imitation is the highest form of compliment.

"The breast cancer folks clearly have their act together and have done a fabulous job," Loving says. "Anything we do tends to be imitative, and that's difficult because the last thing you want to do is imitate someone else. But it is a little daunting because they already have every corner covered."

Adds Wayman: "We don't want to do anything that takes away from the breast cancer movement; we're just trying to make some noise about heart disease in much the same way that they've done, so women can hear about all the risks they're facing. They've really paved the way, not just for heart disease but all diseases."


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