Everywhere there are women wearing white shirts bearing personal messages: “I’m running for my mother,” “I’m running for my sister.” The women here are among the 96,000 people across the country who have come to act out their fear of a deeply distressing and potentially fatal illness that annually kills 5,500 Canadian women.

It’s hard not to be aware of breast cancer: the amount of press coverage it receives in the mainstream media is phenomenal. In the last six months, for example, The Toronto Star carried 57 articles about the illness. Such saturation coverage peaks each October, officially Breast Cancer Awareness Month since 1993: this year the National Post printed 12 articles about the subject in October, one fewer than The Toronto Star. The high level of reporting is not confined to the Toronto dailies: the Halifax Chronicle-Herald and The Edmonton Sun ran 10 and six respectively. Weeks after the fund-raising run, columns and articles about the breast cancer event were still appearing in major papers.

Given this volume of coverage, it would be easy to get the impression that breast cancer is the number-one killer of women. In fact, while it certainly is the number-one health fear, about seven times as many women die annually of heart- and stroke-related illnesses than of breast cancer. And yet these and other major health problems for women-such as lung cancer and thyroid disease-receive far less coverage. For example, theStar, with the biggest circulation of any paper in the country, ran just 30 pieces on heart disease last year, slightly under a third of the space it devoted to breast cancer.

This underreporting can have deadly consequences. Many women are still ignorant of the onset symptoms of a heart attack because women’s symptoms are completely different from men’s. Thyroid disease afflicts about eight percent of women; if undetected, this manageable condition can be fatal. So why are these problems that affect so many women getting so little coverage?

André Picard, who’s been covering health issues since 1981, most recently at The Globe and Mail, thinks underreporting of other women’s health issues is due in part to the relative success of breast cancer activists in getting their message across. “There’s an infrastructure there [in breast cancer] that makes it easy to get out information,” he says. “We tend to listen to people who crow the loudest.”

And in the case of breast cancer issues, there are a lot of people to crow. Although the Canadian Cancer Society and the Heart and Stroke Foundation of Canada each have roughly 450 full-time employees, it’s much easier to find support groups for breast cancer victims. These include such countrywide bodies as Look Good…Feel Better, which teaches women how to camouflage the effects of radiation and chemotherapy treatment, the Canadian Breast Cancer Network and Breast Cancer Action. There are also a number of regional and provincial groups, such as the New Brunswick Breast Cancer Network, the Burlington Breast Cancer Support Services and Toronto’s Willow Breast Cancer Support and Resource Services. Newfoundland even has an audio teleconferencing network for women living in rural areas. And as Sharon Bell-Wilson, until last January the executive director of the Ontario chapter of the Canadian Breast Cancer Foundation, points out, “This list only scratches the surface. These are some of the ones I can name off the top of my head. If I took out a book I would find hundreds.” By contrast, groups for women with heart and stroke concerns are much harder to find. Heart to Heart and Living with Stroke exist, but serve both sexes.

The number of breast cancer groups has grown substantially since 1993, the year a national forum on breast cancer was held in Montreal. Organized by the Medical Research Council, other medical organizations and several breast cancer advocacy groups, the conference was the impetus for breast cancer awareness through a grassroots movement. “It was when the silence about this disease was broken,” says Bell-Wilson. “Years ago breast cancer was a taboo subject. Now we have survivors wanting to tell their stories.”

By comparison, other organizations haven’t been as successful in promoting their causes. Part of the problem is human resources. “I have a hard enough time organizing files, let alone advocating for thyroid,” says Barbara Cobbe, president of the London chapter of the Thyroid Foundation of Canada. “If you have a way we could get more coverage, I’d love to hear it.” Occasionally, her cause gets a boost when some high-profile person develops the disease. For instance, last year when Marilyn Lastman, wife of Toronto mayor Mel Lastman, underwent thyroid surgery, the disease hit the newspapers for a time. But Cobbe remarks in frustration that this kind of ink is an anomaly. “We got lots of coverage after that incident, but there was no consistent coverage afterward.” Part of the reason is that Cobbe and her colleagues don’t have time to stay in touch with reporters. Mary-Jane Egan, the only health reporter for The London Free Press, was unaware of an upcoming thyroid seminar. No one had told her about it.

And what reporters don’t know about they can’t write about. As Michele Landsberg, a Toronto Star columnist who specializes in women’s issues, says, “If you don’t have the time, you go on what the lobby groups give you and what the government hands out.” Asked whether she thinks breast cancer receives a disproportionate amount of attention, Landsberg identifies another reason other illnesses rate so little attention. “For years the heart disease organizations simply ignored women,” she snaps. “Now they are angered that breast cancer gets so much more attention. Instead of doing constructive outreach to women, by women, they spend a lot of misdirected energy attacking breast cancer coverage.” (Still, the breast cancer community has engaged in its own sniping: in March 2000, members of the breast cancer community asked the Heart and Stroke Foundation to abandon an ad it thought belittled the seriousness of breast cancer. The image showed a woman with her hands crossed over her breasts and the caption read: “Quick, what’s the number one killer of women? Here’s a hint. It’s not what you think.” The ad was pulled.)

Elinor Wilson, chief science officer for the Heart and Stroke Foundation, thinks Landsberg’s comment is unfair: “This isn’t a competition with which disease is the worst. Both diseases are devastating and we share a lot of common risk factors, so the objective is to work together for improvements in women’s health overall, not just women’s cancer problems or heart problems.” But she also inadvertently seconds Landsberg’s point about women themselves being the biggest advocates for breast cancer: “The grassroots movement, in my understanding, was not started by the Cancer Society, it was started by women connecting with women, and you haven’t seen that in heart disease. There are many questions about why that is the case.” She suggests one explanation: “We know from some of the literature that there is a stigma associated with heart disease. People with heart disease have sometimes been concerned that if, for example, employers know about a heart attack or heart disease, there might be implications for their employment. Women aren’t willing to come forward and say, ‘I’ve had a heart attack.’ It doesn’t seem to be that way in terms of breast cancer.”

Timing may be another factor. In late September, one week before the breast cancer run, the Heart and Stroke Foundation held its own fund-raising event. But in comparison to the 20,000 who participated in the Run for the Cure in Toronto, just 3,000 people turned out for the Heart and Stroke Mother Daughter Walk, raising $200,000, a little over a tenth of the $1.8 million that the breast cancer run netted in Toronto. While most major papers carried pieces about the walk before the event, there were no follow-up stories. Asked if timing was considered when planning the heart and stroke event, Barbara Steele, manager of communications for the Heart and Stroke Foundation, says no. “We’re not that strategic. If we avoided doing something because it belongs to another disease, we’d never do anything. If you look at the government calendar of organizations, you’d find every month has some disease.”

And while organizations are competing for attention, inside newsrooms, reporter cutbacks make getting news that is not from a wire service or from a press release harder. These days, many papers lack a dedicated health reporter or health editor. At the Ottawa Citizen, for example, there is no one full-time on the health beat. Last fall, former health editor Wendy Warburton noted that coverage had suffered since the two full-time health reporters who used to cover the consumer angle were moved to other positions during the summer of 2000. “We still have someone who covers national health issues and one reporter now covers the science angle,” she said, “but no one is writing about the consumer issues.” (Typical consumer stories are those on genetically modified foods or how boys who wear diapers may experience sterility when they’re older.) The other health positions were never posted and the paper resorted to using freelancers. Warburton noted, “There are certain stories that we can do a better job on than a freelancer. We just don’t have anyone whose job it is anymore to pay attention to that angle.” However, in the last few months, Warburton says things have improved: “One new woman we have on the desk is more interested in these topics, and a reporter who used to write a lot more science is doing more consumer-related health stories.”

According to managing editor Richard Hoffman at The London Free Press, “Health coverage is sacrosanct. London is one of the country’s top medical centres.” Still, the one dedicated health reporter at the Free Press, Mary-Jane Egan, is regularly assigned elsewhere. “We’re very tight, staffwise,” she explains. “Everybody doubles for everything. I do copy editing and I’m pretty well there all summer and over Christmas. And when an election comes we all get pulled off our beat to help with the newspaper.”

Not every paper is feeling the crunch. The Globe has an unprecedented five health reporters, and health editor Paul Taylor is proud of the investigative work his team has accomplished: “I report to David Ellis [Globebeats editor at the time] and his approach is that if there is something really important, we’ll clear the books and do it. In the spring of 1998, we put Sean Fine and Carolyn Abraham on the issue of Canadians going south for cancer treatment and they wrote a series of stories on whether people were getting better treatment. We devoted a considerable amount of space to it.” He also notes that his paper has given women’s heart disease prominence. Last year, the Globe carried 31 heart-and-stroke-related stories, of which five directly related to women. “We recognized the women and heart disease trend years ago and wrote about it,” says Taylor. However, he also points out: “Newspapers are about news events. Newspapers aren’t encyclopedias.”

Egan is a little envious of papers like the Globe that have better resources: “We’ve had a number of staff recently go to The Globe and Mail and they do talk about the difference in having the time and those extra people.” Calgary Herald health reporter Robert Walker, the only medical reporter at his paper, says that his coverage is generally limited to breaking news. “I come in and find Ralph Klein said something or other, there’s a crisis or there’s more money, and that kind of dictates where I go, but a paper like the Globe is probably different because if it has more reporters, it has the luxury of people making choices. It’s not as easy for a smaller paper to make those choices.”

Even at larger papers like the National Post, which has four health reporters, time is tight. Brad Evenson, one of the four, says that to cover something such as the relationship between poverty and health would take a couple of days, time he is seldom granted: “The data is not hard to find but the topic is abstract and a lengthy feature is the only way to explain it.” Nevertheless, Marilyn Linton, The Toronto Sun‘s health editor for the past five years, believes that journalists are not tenacious enough in finding their own stories, as opposed to those handed to them by advocacy groups. “Reporters aren’t good at chasing after the stories and the researchers,” she says.

The biggest issue, though, may be that heart disease, depression, lung cancer and other ailments just don’t generate the same emotions that breast cancer does. This was brought home during a phone interview with Valerie Hepburn, a public health consultant for Toronto. Hepburn began talking about the women she knew who had died of breast cancer. Soon I could hear her sobbing on the other end of the line.

“We prefer not to cover [an issue] unless there’s something new or something more sexy,” is how theCitizen‘s Warburton explains this factor. As she points out, health issues like clinical depression are not so “interesting.” Neither is heart disease, which can be prevented by a few simple measures: eat well, exercise and reduce stress. Brad Evenson agrees. “Healthy living is not newsworthy, it seems,” he says matter-of-factly. “Media are not in the business of reporting what is important. They are interested in what is new.”

The interconnection of poverty and health is an even harder sell. “That’s one of my largest problems with the press,” says Hepburn. “There are issues with no sexiness to them whatsoever and one of them is that women are living in poverty. Poverty is the greatest indicator of disease. That’s not interesting, but that is the issue we need to look at.” Dennis Raphael, an associate professor in the department of public health sciences at the University of Toronto, makes a similar point: “If you bring up the issue of income and point out that there had been a feminization of poverty, health reporters don’t feel prepared to understand it. For them, health is lifestyle and medical treatment. They’ll never make the link.” However, the Star’s Judy Gerstel says there is a reason for this: “Poverty, as a health issue, is covered as health policy, most of which goes into the A section rather than our lifestyle section. I think that they are two different subjects; they are certainly linked, but in terms of how beats are broken down, that rarely happens. It’s just politics of a newspaper.”

If poverty is unsexy, so are aging and the health problems associated with it, such as heart troubles, particularly since many health reporters are between the ages of 30 and 40. On the other hand, that is the same age group that is likely to have firsthand experience with breast cancer. “The baby boomers and their issues do get the disproportionate share of stories,” says Gerstel. She admits there’s a tendency among reporters to write what most directly affects them: “I tend to give short shrift to pregnancy issues just because that’s in the past of my life.” Dr. Jean Marmoreo, midlife health columnist for the National Post, echoes this point: “Breast cancer is touching our friends and our families. With heart disease, you’re getting frail, you have a little angina, you function less well and you need more drugs and a nitro patch. Where is the story in that?” she asks ironically. “We undervalue age so much that it is difficult to get the same kind of attention that breast cancer does and it’s very difficult to advocate for a bunch of 70-plus women. It’s much easier to advocate for a group of 50-plus women.”

As her comments hint, ultimately, the aging of the baby boomer reporters and their younger colleagues may solve the problem of older women’s diseases being poorly covered. As André Picard from the Globe says, “Elderly women’s issues will get covered in 10 years when we reporters are walking to work in the winter and it’s a hard chore, when it was easy many years ago.”