As al­ways, Oc­to­ber looks love­ly. There are pink rib­bons to look at in the bank while wait­ing in an aw­ful­ly long line with two tellers, pink la­bels in the su­per­mar­ket and pink bal­loons at the en­trance to a com­pa­ny whose staff have been asked to wear pink on Fri­day.

There will prob­a­bly be a pic­ture of them on Face­book eat­ing dou­bles (hope­ful­ly the chan­na is not pink) af­ter a 5k.

The term “pinkwash­ing” de­scribes the use of breast can­cer con­cern to pol­ish a rep­u­ta­tion or sell a prod­uct with­out a mean­ing­ful com­mit­ment.

You do not need to be cyn­i­cal to ask how much mon­ey reach­es pa­tients. A pink la­bel may promise that “a por­tion of pro­ceeds” will be do­nat­ed. I would love to know what por­tion and to whom af­ter I run the road race.

I have noth­ing against “Pink­to­ber”. Since Es­tee Laud­er’s 1992 cam­paign with 1.5 mil­lion pink rib­bons, breast can­cer aware­ness has helped women seek care and sup­port­ed fam­i­lies.

Many fundrais­ers are or­gan­ised by peo­ple who have lost some­one and are try­ing, through the most painful kind of ex­pe­ri­ence, to help some­body else.

The trou­ble­some de­tails of breast can­cer are less wel­come. Who paid for the biop­sy of the lump? How long did the re­sult take? Who mind­ed the chil­dren while she re­ceived treat­ment?

Why did scans take months to get a re­port? Why were med­ica­tions not al­ways avail­able? Did she lose her job?

Ear­ly de­tec­tion re­quires some­where to go. A sus­pi­cious find­ing re­quires in­ves­ti­ga­tion. A di­ag­no­sis re­quires a treat­ment plan that the pa­tient can ac­tu­al­ly com­plete.

An aware­ness cam­paign ought to fol­low the woman be­yond the mo­ment she agrees to get checked.

Friends of­ten say, “Let me know if you need any­thing.” They mean it kind­ly but ought to be more spe­cif­ic. Take her to the clin­ic or col­lect the pre­scrip­tion. Bring din­ner but check be­fore vis­it­ing or bom­bard­ing with mes­sages af­ter chemother­a­py.

Pa­tients don’t have to be “in­spi­ra­tional” ei­ther. A woman can be fright­ened, fu­ri­ous or thor­ough­ly fed up and still de­serve ex­cel­lent care. She should not have to per­form op­ti­mism to keep the peo­ple around her com­fort­able. And a woman who dies has not “lost her bat­tle” be­cause she lacked courage or faith.

A new breast or armpit lump, nip­ple changes or dis­charge, skin dim­pling, or a change in breast shape de­serves as­sess­ment.

Most lumps are not can­cer, but re­as­sur­ance should fol­low an ap­pro­pri­ate ex­am­i­na­tion. Men can de­vel­op breast can­cer too and any changes de­serve the same at­ten­tion.

Most women di­ag­nosed have no known fam­i­ly his­to­ry. Con­verse­ly, a sig­nif­i­cant fam­i­ly his­to­ry should prompt a dis­cus­sion about in­di­vid­ual risk and whether ge­net­ic ad­vice is ap­pro­pri­ate.

Oth­er risk fac­tors in­clude ear­ly pe­ri­ods, late menopause, hor­mon­al re­place­ment ther­a­py, obe­si­ty and ex­ces­sive al­co­hol con­sump­tion.

Screen­ing means check­ing be­fore symp­toms ap­pear. Guide­lines dif­fer: US rec­om­men­da­tions in­clude mam­mo­grams every two years from 40 to 74 for women at av­er­age risk.

Dis­cuss tim­ing with your clin­i­cian. Ul­tra­sound may help in­ves­ti­gate a find­ing but does not sim­ply re­place screen­ing mam­mog­ra­phy.

Treat­ment has moved well be­yond a sin­gle pre­scrip­tion for chemother­a­py. De­pend­ing on the can­cer, it may in­volve surgery, ra­dio­ther­a­py, hor­mone tablets or med­i­cines that tar­get par­tic­u­lar fea­tures of the tu­mour.

Test­ing the tis­sue for hor­mone re­cep­tors and HER2 helps de­ter­mine which treat­ment of­fers the best chance.

There are dirty se­crets that few dis­cuss. A woman may strug­gle with al­tered sen­sa­tion, pain, fa­tigue or the way she feels when she un­dress­es.

She may want to talk about sex and be wait­ing for some­one to give her per­mis­sion. She may mourn a part of her body while feel­ing grate­ful to be alive. Keep call­ing af­ter the last chemother­a­py ses­sion.

Good pal­lia­tive care is lack­ing for those whose can­cer can­not be cured. Pain re­lief, hon­est con­ver­sa­tions, com­fort and help for the fam­i­ly are worth fund­ing. Many have “buck­et lists” to com­plete.

When a biop­sy re­sult is de­layed, a med­i­cine is un­avail­able or ra­dio­ther­a­py is in­ter­rupt­ed, the bur­den lands in some­body’s home. Peo­ple start beg­ging for mon­ey. A moth­er won­ders whether to pay pri­vate­ly or wait. We should pub­lish treat­ment wait­ing times and med­i­cine avail­abil­i­ty along­side our Oc­to­ber pho­tographs.

Feel free to wear the rib­bon but let it be an open­ing for a con­ver­sa­tion, a re­minder to arrange care, or a way of rais­ing mon­ey whose des­ti­na­tion is clear.