Why Shanghai turned pink

October this year turned pink. In the US and Hong Kong women raced each other in high heels, many wearing pink stilettos. In the UK, Buckingham Palace and other landmarks in London turned pink on October 1. In Shanghai dozens of women ran along Suzhou Creek throwing their bras into the air at the finish line. Elsewhere in the city, hundreds of women got together, all of them wearing pink.

It was not a problem with color blindness. October is the annual breast cancer awareness month and every year major charities hold events to increase public awareness about the disease and raise funds for research.

For more than 20 years in a row, breast cancer has been the most lethal cancer for women in Shanghai. According to the city's disease control and prevention authorities, women between the age of 40 and 60 are the most prone to the disease. Every year around 170,000 women across China contract breast cancer. The disease is the leading killer of women not just in Shanghai, but also in Beijing, Tianjin and Guangzhou.

With overseas influences and a growing expat community in Shanghai, more city charities have become involved and have created a range of events to increase public awareness and raise money. Sometimes in headline-grabbing ways and with a great deal of fun but always with the serious purpose to help fight this deadly disease.

Lessons on the run

On October 20, around 200 people, mostly women, raced 7.8 kilometers along Shanghai's Suzhou Creek. At the finish line some of the women took off their bras and threw them into the air.

Yu Xiaoyan organized the run and told the Global Times that the event was intended to raise awareness about breast cancer. "We chose running because we're trying to get more people to take up exercising on a daily basis," he said.

The 200 participants were mostly inspired to join the move through a call by the organizer - the non-profit organization Tian Tian Yi Dong - on Weibo, microblogging. "Most of the participants were female office workers," Yu said. As they ran they distributed breast cancer information leaflets.

"It was the first time that we've had such an event. We researched many events from abroad. There's not a lot of experience in this area in Shanghai," said Yu, who has been involved in planning and organizing other events promoting disease awareness. "In July our event centered on World Hepatitis Day. We've also had promotions for AIDS and diabetes."

While the big event was the race downtown, Yu said other people participated in other ways by hiking in Pudong New Area or in one residential community, scores of women migrant workers had their own run. "This event directly touched 1,000 people. But it's far from enough to really change the local community's awareness of breast cancer," he said.

A personal touch

While this race was inspired by overseas events, the promoter of another event had a personal story behind her inspiration. Suzanne Calton believes in "sisterhood in action" and is the founder of More Than Aware - a non-profit organization. Last year More Than Aware held its first event, attracting over 200 women and raising 50,000 yuan ($8,014) at a silent auction.

That event happened just a little over a month after Calton's mother died of breast cancer. "My mom passed away in September 2011. I was devastated and heartbroken. I saw her go through all of the process. She had been diagnosed with breast cancer in the late 1990s. And she was told that she would only live for three years. She started to eat healthily. She started to do a lot of things to help her body recover. So she lived for 10 years longer than expected. It was a miracle that she could beat the odds," she told the Global Times.

But Calton believed that her mom lacked one thing which could have helped her live even longer - sisterly support. "When I went home to visit her, people would come to her house and say: 'Why don't you relax. Don't bother with your diet.' And she was always having to explain to people: 'This is my goal. I want to be healthier.' But people would say: 'The doctor told you just go back to bed.' I believe if she had more support, she would still be alive."

With the strong message gleaned from her mother's experiences, Calton said she believed she should do something. "I watched my mom suffer until she died. And I later learnt that one in eight women will have breast cancer. That's huge. So we actually fear it. By establishing More Than Aware, we hope that by teaching women to become more than aware, we can overcome that fear and replace it with empowerment and action."

At the second annual event on October 30, more than 1,000 women dressed in hot pink gathered, mostly expat women, and some current and former breast cancer patients. They sat together exchanging personal stories and giving each other support. Doctors and celebrity Yue-Sai Kan were also there, sharing their perspectives of breast cancer and ways of staying healthy.

A persuasive example

Unlike the run along Suzhou Creek, the More Than Aware annual event also raised funds through a silent auction to assist cancer patients. This year they chose the Shanghai Cancer Recovery Club as the beneficiary. "We wanted to find one that empowers women to heal. We don't tell women how to treat their cancer. We don't say chemo or no chemo. That's an individual decision. The only thing we want to promote is empowerment so our women can take care of their lives on a daily basis and use self-care and meditation - all those things that make women healthy from within. The Shanghai Cancer Recovery Club focuses on healing the inside of a woman," Calton said.

Founded 23 years ago, the Shanghai Cancer Recovery Club is a self-help and mutual-aid group founded by cancer patients. The club boasts a 90 percent recovery rate for breast cancer, which has made it a research base for the World Health Organization and Harvard University. The club's motto is: "Don't ask the club what the club can do for you, you do what you can do for the club." Tami Dyer is a member of the beneficiary committee and serves as a liaison between More Than Aware and the Shanghai Cancer Recovery Club. She said that the 90 percent breast cancer recovery rate at the club was not a coincidence. The secret of this success was women loving and supporting other women.

"Breast cancer is their common enemy. The recovered women form a very tight circle to embrace, listen, share, accept, protect, nurture, teach, support, connect, love, and value the new members. It's about women sharing their own emotional and physical experiences and expertise, and their love for life. To know you are not alone in your fight against breast cancer and to know you have an army of women standing by your side is very powerful. This is the significance of this sisterhood's group fight against cancer," she told the Global Times.

The club now has 12,000 members with 25 to 30 percent of the members breast cancer patients. Its entire staff of 500 are unpaid volunteers and all are cancer survivors.

Liu, a lady in her 60s, is one of the volunteers with the club. She was diagnosed with breast cancer in her early 50s but completely recovered 11 years ago and is living healthily today. She attended the gathering on October 30 and told the Global Times that she was ready anytime she was needed.

"I was there so I know exactly how devastated people feel," Liu said. She recalled the moment when she was told the crushing news. "I still remember that day very clearly. I had been given a local anesthetic and was lying on the operating table. My brain was very clear. The tissues were taken out for an instant test. When the doctors came back and said the result was positive, I felt my world had just collapsed. I couldn't help but cry. And that day was the anniversary of the death of my father."

Fortunately Liu had the support of women in the club who had suffered similar experiences and could give her a lot of emotional back-up. After she recovered completely she became a volunteer with the club. "In the past 10 or so years, I never hesitated when the club called for help. I would talk to patients in the club or in hospitals, doing whatever I could. I hope that I can positively influence others. And I am accepted by patients because I have experienced the same pains and troubles," she said. Liu is optimistic. She doesn't restrict herself too much in her diet but she stressed that exercise was important as well as support and encouragement.

Although she was unable to communicate with many of the expat participants at the gathering, Liu said she was very touched that the foreign community in the city was doing this for local cancer patients.

Helping their own way

Not all volunteers can have the influence on patients that Liu has. Ling Xiaofen is a volunteer for More Than Aware and is in charge of media coordination and contacting potential donators. "Without any government support, it was hard for us to market this event. But we tried out best to reach into our friends' networks, hoping to affect as many people as possible," she told the Global Times.

And for Cindy Hsu, a participant at the Suzhou Creek run, it was a small step forward for herself. "I watched two of my former colleagues suffer from the disease. But I've never done anything like this before. I don't think it will have major impact on people immediately but the picture will change for the better for sure in the near future," she said.

According to Yu Xiaoyan who organized the run, domestic media coverage of breast cancer campaigns was comparatively limited and so was the public's knowledge of the issue. Yu said the country was still at a very early stage in this campaigning. "I'm hoping to see a breakthrough in five years. But what we can do at this moment is to mobilize businesses who have corporate social responsibility commitments to do as much as possible, like financially supporting female migrant workers to have regular breast checks," he said.

Different approaches

Doctors have their different approaches when it comes to breast cancer prevention. Doctor Doris Rathgeber, from Germany, has been studying traditional Chinese medicine and lives in Shanghai. She suggests women learn to deal with their emotions better.

"We experience 450 emotions every day. But of these there are three emotions that are crucial to women - anger which is associated with the liver, worry which is associated with the spleen and fear which is associated with the kidneys," she told the audience in the Kerry Hotel, where the More Than Aware event was held. "On top of this, anger can cause the stagnation of qi (energy) and blood. And this can result in lumps in the breast, pain in the breasts before periods and premenstrual syndrome. My suggestion is to deal with your emotions before they overwhelm you."

Doctor David Zeoli from the American Medical Center in Shanghai, however, believed this was a lifestyle problem. "It's better for women to eat foods that are rich in iodine. And it's also crucial that people cut down any contact with poisonous heavy metals and be tested regularly for heavy metals," he said.

Gynecologists in China suggest women regularly check themselves, looking into a mirror while holding their arms in the air to see if there are any visible lumps in the breasts or if there is any change in the size of the breasts.

The things to look out for

The first symptom of breast cancer most women would notice is a lump or an area of thickened tissue in their breast. Most lumps are not cancerous. According to Chinese health organizations, 70 percent of these lumps are benign tumors. According to foreign health organizations, 90 percent of these lumps will be benign. Still it's recommended that women should be examined by a doctor if they notice:

A lump or area of thickened tissue in either breast

A change in the size or shape of one or both breasts

Discharge from the nipples

A lump or swelling in the armpits

Dimpling on the skin of the breasts

A rash on or around the nipple

A change in the appearance of a nipple, like it sinking into the breast

Pain in either of the breasts or armpits not related to a period