What's your cancer color?

(Editor's note Oct. 3, 2024: Updates have been made to this story since original publication, including the addition of some cancer colors.)

It’s anything but black and white.

Amid a kaleidoscope of colors meant to stoke cancer awareness, one hue rules. Think pink. Out of all the ribbons for awareness, pink is so effectively tied to breast cancer attention, there can be a veritable sea of it during runs and walks.

In recent years, though, there has been criticism from some pointing to the proliferation of pink and how this “over awareness” means other cancer types can’t get the attention they deserve. Of note, after promoting breast cancer awareness exclusively from 2009-2016, the NFL announced that beginning in 2017, teams would be able to choose their own cancer types to support. This announcement was a catalyst for change, allowing other cancer colors to come to the forefront.

Today, more than 30 cancer types have inspired bracelets, clothing and gear spanning at least 20 pigments and five patterns – including zebra stripe. There are also colors that cancer awareness advocates wear to represent issues related to cancer, or specifically for people who are caregivers or survivors. Childhood cancers and “all cancers” have colors, too. Some wear their color proudly to represent their own cancer or support a loved one. But others fear this collage of colors creates an unnecessary division.

“I’m going to die of my breast cancer and I feel like I have a lot in common with people who have lung cancer, who have stage 4 pancreatic cancer. Our experience of life is much more similar than it is different,” said Beth Caldwell, a 38-year-old metastatic breast cancer patient, and blogger who was treated at Seattle Cancer Care Alliance, now known as Fred Hutch Cancer Center.

“I’m hopeful that as we progress with science and see that tumor biology is sometimes more important than the organ that it came from, we’ll start to work together as patients, as a community.”    

After Schneider died from the disease months later, her daughter learned there were no pancreatic cancer support organizations. All she found, Marquardt said, was a “pancreas cancer” chat board on the Johns Hopkins Medicine website. Marquardt asked users there about using purple to signify the disease. They agreed.

In 1999, Marquardt founded the Pancreatic Cancer Action Network. Its website is drenched in purple. Today, purple (or orchid or violet or periwinkle) has been adopted in several places within the cancer-support landscape.

But other advocates who are seeking to ignite recognition and funding for carcinoid cancer picked a far more unusual pattern: zebra stripe.

It’s based on philosophical advice doctors get in medical school: “If you hear hoof beats think horses, not zebras.” That means: If you’re presented with symptoms of common diseases, think of common diseases, not infrequent ailments like carcinoid cancer, a type of neuroendocrine tumor.

“We want doctors to think that, in addition to one of the more common illnesses, those symptoms might be caused by something rare [like carcinoid cancer]. And that’s the zebra,” said Grace Goldstein chief operating officer of the Carcinoid Cancer Foundation. On the nonprofit’s Facebook page, a filter was posted allowing users to place zebra stripes over their profiles.

“It is a community. That’s also important,” Goldstein said. “But without enough awareness of the disease, there won’t be research.”

In addition to ribbon-wearing, activities and events related to cancer colors exist, too, such as fundraisers where participants show solidarity by wearing the same color or illuminating tall buildings at nighttime in a cancer color. Dress in Blue Day is one color-focused event, founded by stage 4 colon cancer survivor, Anita Mitchell. She started it in 2006 to honor the memory of her father and a friend, as well as recognize her own personal battle with the disease. The Colorectal Cancer Alliance) adopted Dress in Blue Day in 2009 and it’s recognized every year on the first Friday in March.

How peach became pink

The most famous tone, pink, has more than a splash of controversy in its colorful history. In a California dining room in 1991, Charlotte Haley, then 68, started making peach ribbons to bring attention to breast cancer. On every pack of five, she tacked a postcard asking people to lobby the National Cancer Institute to boost its cancer-prevention budget. Haley distributed thousands of peach ribbons.

In 1992, the editor of Self Magazine and the vice president of Estee Lauder asked Haley to partner. She refused, saying their planned use was too commercial. The executives instead decided to use pink for their own awareness campaign, according to the Breast Cancer Consortium. 

The real surge of cancer shades began about 10 years later. In 1999, when Linda Nielsen and two partners launched ChooseHope.com, a for-profit, merchandise site for cancer patients and supporters, there were “maybe six” colors, including teal for ovarian cancer and white for lung cancer, Nielsen recalled.

“We went to each organization and said: ‘Do you have a cancer awareness color?’” said Nielsen, a breast cancer survivor whose company she helped found has since donated more than $970,000 to cancer charities.

Today, ChooseHope is under new ownership, but the original mission remains. They sell wristbands, clothes and other colored awareness products covering 30 cancer types or cancer groups. 

“I worry about the proliferation," said Caldwell, the metastatic breast cancer patient and blogger from Seattle. “It’s not because I don’t think that the camaraderie and awareness it brings is bad. Obviously, that’s good. But as someone who lives in Breast Cancer Land and sees Pinktober, pink cans of mace or pink handguns – things obviously not good for your health – I worry that for organizations for other cancer types, their message will get co-opted the way it has with breast cancer." 

But for Marquardt, whose mother inspired purple to represent pancreatic cancer, the hue remains a way for her to honor her mom and battle the disease that took her life. Marquardt still wears the color today. 

“Purple was my mother’s favorite color. When I was a little girl, my bedroom was white and lavender. The color was always in our lives,” Marquardt said. “It’s funny, because my mom came from nothing. She grew up in the Twin Cities without much. She never really thought her life mattered, but look where we, and the color purple, are today.”