For 30 years, the Susan G. Komen Breast Cancer Foundation has set the pace and won the race - not for the cure of the disease, but for trademarks, sponsors, alliances, and clout.
While Komen's power has long inspired mixed emotions among other breast cancer groups, the grassroots remained loyal - at least until this week, when Komen announced it would stop funding Planned Parenthood's breast-cancer-screening efforts.
Komen reversed itself Friday, but only after blistering outrage from legions of people who Race for the Cure or buy pink-ribbon products.
And its problems may not be over. Komen is facing ire on a new front: antiabortion activists who feel the group caved to pressure from the left.
Komen is "clearly in trouble, but they have a loyal fan base, and they have been extremely successful at promoting their approach to breast cancer for a long time," said Samantha King, a health sociology professor at Queen's University in Ontario and author of Pink Ribbons Inc., a scathing look at breast-cancer-cause marketing. "I think it's too soon to tell what will happen."
In trying to smooth things over, Komen announced that it would continue to give grants to Planned Parenthood's breast-health programs and that it would amend its new grant process to disqualify only those applicants who are under an investigation that was "criminal and conclusive in nature and not political." Planned Parenthood is under investigation by an antiabortion congressman, Cliff Stearns (R., Fla.).
Komen officials also said they were "distressed" that anyone thought the original funding criteria changes "were done for political reasons or to specifically penalize Planned Parenthood."
Planned Parenthood Federation of America - which has received about $3 million in pledges since Tuesday, more than four times last year's Komen grants - promptly accepted the olive branch. "We are heartened," it said, "that we can continue to work in partnership" to provide breast screening to poor women.
But if retired nurse Muriel Siegel, 85, of Audubon, Montgomery County, is any indication, a lot of women are not so forgiving.
"Today I got a letter from Komen about donating to the 2012 Race for the Cure," Siegel said Friday. "I called them and told them to take my name off the list."
Komen was founded 30 years ago in Dallas by Nancy Brinker, a breast cancer survivor whose sister, Susan Komen, did not survive the disease.
As Brinker wrote in her memoir, Promise Me, her sister said: "Breast cancer ... it has to change, so women don't die. Promise me, Nanny. Promise me you'll make it change."
Since then, the foundation has raised more than $1 billion for breast cancer education, detection, care, and research.
But Komen has also been faulted by some breast cancer activists for turning the movement into a cuddly, commercialized, cash-laden crusade that is nowhere near curing the disease that annually strikes more than 230,000 American women and kills 40,000.
"If we were to see a shift in Komen's agenda and priorities, that would be a good thing," said King, whose book has been made into a documentary. (Coincidentally, Pink Ribbons Inc. premiered Friday in Canada and reaches the United States this spring.)
San Francisco-based Breast Cancer Action faults Komen for accepting money from companies whose products may be environmentally linked to breast cancer. It has skewered Komen in campaigns, including "Think Before You Pink" and "Raise a Stink."
The latter denounces Promise Me, a perfume Komen commissioned and began selling in April. Action had a sample chemically analyzed (the label doesn't list ingredients) and found galaxolide, a synthetic musk common in fragrance products, which has been found to disrupt estrogen and accumulate in human tissues.
"At the end of the day, we want the same thing: We want to end this breast-cancer epidemic," said Breast Cancer Action president Karuna Jaggar. "We just have fundamentally different views of how to do this.
"The model of cancer that Komen promotes is outmoded and oversimplified: that all breast cancer is the same and grows in the same way, and that if we just catch it early enough, it can be cured," Jaggar said. "In fact, we now know breast cancer is many diseases."
Views and values are at the heart of the brouhaha, said Steven Balzac, a Stowe, Mass., management consultant and psychology professor who has blogged about the brouhaha.
"Donors thought they had values that matched Komen's values - women's health, eradicating breast cancer, things that transcend petty politics. We're talking about people's lives. What donors suddenly realize is: It's not all about people's lives."