Perilous equations? Empowerment and the pedagogy of fear in breast cancer awareness campaigns

Breast cancer awareness campaigns are the major strategy used by public institutions and private organizations to empower women about breast cancer. Yet, drawing on my own research and observations as an academic and activist over the past 9 years in Spain, I argue that these mainstream campaigns are often unaware of, or oversimplify, conceptualisations of empowerment. I illustrate my argument with examples from Spain and North America. I show how the specific goal of empowerment aims to persuade women to comply with biomedical recommendations which include behaviour change and treatment-seeking. Towards this end, their main approach focuses on the use of coercive fear-mongering tactics, including misleading information and exaggeration of data on incidence, mortality, survival and treatment efficacy. A further problem is that they allude to assumptions about the reasons for women's compliance: stereotypical moral and gendered responsibilities for one's health and family as well as fear of a horrible death. Some justify this particular use of fear by appealing to the need to target women with a simplified, high-impact message. However, there is evidence that fear creates unnecessary social psychosis and further distorts the decision-making process, conflicting with empowerment intent. I argue that there is an urgent need to stimulate debate about how to improve breast cancer awareness campaigns and propose an alternative approach, grounded in a critical pedagogy paradigm- a model of critical health literacy based on a patient-centred approach that aims to develop critical consciousness and reflection of the social factors that affect breast cancer.