October has arrived, which means pink ribbons will appear on posters, products, office walls and social media pages. Companies will encourage staff to wear pink. Walks will be organised and photographs shared. All of this can make breast cancer more visible, and visibility matters. But a pink ribbon cannot examine a lump, deliver a biopsy result or begin treatment.

That is the uncomfortable gap Breast Cancer Awareness Month must confront. We have become very good at showing that we care. The harder question is whether a woman who notices a change in her breast knows where to go, can reach that service, can afford the next step and will receive an answer quickly enough for it to matter.

The World Health Organization’s theme this year is “Every story is unique, every journey matters”. The journeys are certainly not equal. WHO reports that 87 per cent of women diagnosed with breast cancer in high-income countries are expected to survive for at least five years. In low-income countries, that figure is only 41 per cent. Around 70 per cent of breast cancer deaths occur in low- and middle-income countries.

Those figures do not mean women in poorer countries care less about their health. They reveal what happens when awareness meets delay. A woman may postpone seeking help because the clinic is far away, money is short, family responsibilities come first or she fears the diagnosis. She may reach a facility and still need another appointment, journey, payment or referral.

In Zambia, delayed presentation has long been recognised as a major problem. National breast cancer guidance introduced several years ago noted that many patients were reaching care at stage three or four. More recent research published in 2025 again described Zambia as facing rising cancer incidence alongside a disproportionate level of mortality linked to late presentation. The evidence is not new, which is exactly what should worry us.

Awareness campaigns often concentrate on the first instruction: check your breasts and seek help if something changes. That message is necessary, but it places most responsibility on the woman. It assumes that once she acts, a functioning pathway will meet her. What if the first clinic cannot investigate her concern? What if the appointment takes months or the cost of travelling becomes impossible?

This is where awareness can become performance. A company changes its logo to pink but offers no paid time for screening or medical appointments. A shop sells a pink product without explaining where the proceeds go. An organisation hosts a walk but cannot tell participants which symptoms require attention or where services are available afterwards. The campaign looks successful because it is visible, not because anybody’s route to care became shorter.

I am not arguing against ribbons, walks or public campaigns. Symbols begin conversations people might otherwise avoid. They honour survivors, remember those who died and allow families to speak about experiences carried quietly. But the symbol should be an entrance, not the entire building.

For the individual, useful awareness means knowing what is normal for your own body and seeking medical advice when something changes. It also means understanding that breast cancer does not always present as a dramatic lump. Changes in shape, skin, the nipple or underarm area can also require attention. Awareness should create informed action, not panic and not the false comfort that one self-check replaces professional care.

For families, the response matters too. Fear can make people minimise symptoms, suggest waiting or turn immediately to stories about who had cancer and died. In some communities, illness can attract whispers about punishment, fate or witchcraft before it attracts practical support. A woman does not need more fear placed on top of fear. She may need transport, childcare, money for tests or somebody willing to sit beside her at an appointment.

For employers, October offers a chance to do more than organise a pink dress day. They can allow time for appointments, share information from credible health providers, include cancer support in workplace policies and examine whether medical insurance actually covers investigation and treatment. Awareness becomes meaningful when it changes what an employee is able to do after reading the poster.

Health systems must also measure the distance between suspicion and treatment. WHO’s Global Breast Cancer Initiative proposes clear targets: at least 60 per cent of invasive breast cancers diagnosed at stage one or two, diagnosis within 60 days of the first presentation to a health facility, and 80 per cent of diagnosed patients completing recommended treatment. These targets move the conversation from good intentions to a pathway that can be measured.

The diaspora may have better access to screening, but access is not automatically equal there either. Migrant women can still face delayed diagnosis, dismissal of symptoms and poorer outcomes, while also navigating unfamiliar systems, language, work insecurity or cultural hesitation. Living in London, Johannesburg, Perth or Dubai does not remove every barrier. It simply changes its shape.

This October, going pink should be the beginning of the question, not the answer. Where can a woman go? How long will diagnosis take? What will it cost? Who helps her continue treatment? What happens if she cannot miss work? If a campaign cannot answer everything, it can at least direct people towards somebody who can.

Awareness has achieved something important when breast cancer is no longer hidden or unspeakable. The next step is making sure it is not merely visible. A ribbon can begin a conversation, but it cannot complete the journey. The real measure of October is not how much pink we see. It is whether more women are still here to see the next one.

Kaajal Vaghela is a sportswear designer and cultural wellness consultant with over three decades of lived experience managing Type 1 diabetes in Zambia and the diaspora. Having previously served as Chairperson of the Lusaka branch of the Diabetes Association of Zambia, she remains a passionate advocate for breaking down myths and building awareness about diabetes. For more personalised coaching or corporate wellness workshops, visit: www.kaajalvaghela.com and for any feedback: [email protected])