It’s October again. I know this not from the calendar, or the pumpkins. I had not yet noticed the leaves beginning change, or the days ending earlier. But I know with certainty that it is October because I am a breast cancer survivor, and everywhere I look, everything, it seems, is pink.

October, as just about everyone knows, is National Breast Cancer Awareness Month, which is to say that it is the month that every retailer and manufacturer and sports franchise imaginable will put forth a pink version of themselves which is designed to sell things by making everyone more “aware” of breast cancer. And anyone who has paid even the slightest attention to the messaging of Octobers of the past, knows that awareness leads to early detection which leads to cure, for everybody diagnosed with breast cancer. Right?

Not exactly. Not always.

Some breast cancers, even if they are discovered early, will become metastatic, or stage IV, breast cancer, a disease which cannot currently be cured. The exact process that causes some cancers to do this, while others do not, is still not entirely clear. But it is a reality that is often misunderstood, or just left out, of all we’ve been made so pinkfully “aware” in Octobers.

It is still true that mammography screening is the very best tool for early detection and that, generally speaking, breast cancers detected at earlier stages are more likely to be cured. This I know first-hand: I was diagnosed, at my first mammogram at 40, when I was living with four small children I knew about and a hidden, aggressive cancer in my right breast that I did not. My tumor was not any kind of “good kind”, but still, it was small enough and contained enough to provide me with decent odds. I was given survival percentages that would not earn me an A in school, but maybe a solid B+, provided I completed included a year of treatment which including surgery and reconstruction, chemotherapy, and targeted therapy. Even then, there were no guarantees. Still, if I hadn’t followed doctor’s orders to get that first recommended mammogram at 40, things surely would have gone differently, and it is safe to say that early detection saved my life.

But, as any survivor will tell you, the pink ribbon does not tell the whole story of breast cancer survivorship; it is more complicated than the pink part of the story, or that the pinkwashing of October suggests. As a nation, we are more aware now, to be sure; the Octobers of years past have, in large part, been a success, have done their job. But there is still work to be done to eliminate the myths that still exist: the outdated belief that the surgeon “getting it all” is curative, the more recent notion that being positive is essential. The idea that breast cancer survivors somehow enjoy, rather than endure, the 31-day blitz of constant reminders of their struggle. The assumption that if you are alive, and especially if you still have your hair, you must surely have “beaten it”.

The truth is that few of us who have walked this road, our hearts broken and our ears rung by the profanity of hearing the first C word, which was Cancer, ever got to hear the C word we longed to hear our doctors say, which was Cured. Some of us, purely by the luck of the draw, got to hear some D words, like Done with treatment, and maybe even Discharged from our oncologist’s care, and when this happens, it fits the narrative of National Breast Cancer Awareness Month; it makes everyone feel good. Even then, there is no representation, on pink stand mixer displays and on pink-ballooned car lots for the losses and the fears we live with forever, the intense and post-traumatic uncertainty, the tentative and hopeful gratitude of “wait and see” and “probably-cured”.

And what of our Stage IV sisters, who find themselves, having done everything right, and gotten the mammogram, and followed doctor’s orders, and hoped in and believed in a cure, and who now do their level best to live as fully as they possibly can, despite breast cancer that has spread in their bodies, despite the fact that there will be no cure. Where are they represented in the pink merchandise, in the cure-based messaging?

It’s time to include everyone, to enter – and to include – a new stage in breast cancer awareness. The CDC estimates that there are more than 150,000 women living with Metastatic Breast Cancer (MBC), also known as Stage IV Breast Cancer, in the US today. Three out of 4 women living with MBC were initially diagnosed with an earlier stage of breast cancer.

It’s time to make National Breast Cancer Awareness Month a time to talk about MBC, increasing awareness of what it is and how and why it happens. About how we can better support all survivors, in a full color spectrum that extends beyond the pink.