What's your cancer color?

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. But beyond that pervasive shade, the palette gets busier than a microwaved box of Crayolas.

Nearly 30 cancer types have inspired bracelets, clothing or gear spanning at least 20 pigments and five patterns – including zebra stripe. 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 is treated at Seattle Cancer Care Alliance, treatment arm of Fred Hutchinson Cancer Research 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 Rose 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 recently 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.”

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 has since donated more than $900,000 to cancer charities.

Today, ChooseHope sells bracelets and other awareness products covering 29 cancer types or cancer groups. Their online stock includes $6 black tumblers for melanoma and $1 amber rings for appendix cancer.

“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 Pamela Acosta 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. She 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.”