PITTSBURGH, Pennsylvania (AP) ― The country is awash in pink for breast cancer awareness month, and some women are sick of it.

While no one is questioning the need to fight the deadly disease, some breast cancer activists are starting to ask whether one of the most successful charity campaigns in recent history has lost its focus.

“The pink drives me nuts,” said Cynthia Ryan, an 18-year survivor of breast cancer who also volunteers to help other women with the disease. “It’s the cheeriness I can’t stand.”

Activists have even coined a new word: Pinkwashing.

They say that’s when a company or organization does a pink breast cancer promotion, but at the same time sells and profits from pink-theme products.

Some of the pink products have generated plenty of discussion among breast cancer advocates.

A Smith & Wesson 9mm handgun with pink pistol grip? The manufacturer says a “Portion of the Proceeds Will Be Donated to a Breast Cancer Awareness Charity.”

You can get the “Pink Ribbon Combo” at Jersey Mike’s Subs, a sandwich store, and the Sephora Collection Pink Eyelash Curler. One year, there was a pink bucket of Kentucky Fried Chicken.

The San Francisco group Breast Cancer Action has led the campaign to question pink products, but executive director Karuna Jaggar said they are not saying all such products are bad.

She said there is no doubt that when the pink ribbon campaigns started about 20 years ago there remained a great need to raise awareness.

“At one time, pink was the means,” Jaggar said. “Now, it’s almost become the end in itself. In its most simplistic forms, pink has become a distraction. You put a pink ribbon on it, people stop asking questions.”

Breast cancer activists agree that the use of a ribbon to promote awareness evolved in stages. They note that in 1979 there were yellow ribbons for the American hostages in Iran; in 1990 AIDS activists used red ribbons to call attention to victims of that disease; and 1991 saw the first major use of the pink ribbon, when the Susan G. Komen Foundation gave them out at a New York City Race for cancer survivors.

The ribbon symbol may tie into a far older tradition, according to the American Folk Life Center at the Library of Congress. It notes that various versions of the song “Round Her Neck She Wore A Yellow Ribbon” have been popular for 400 years, all with the theme of displaying the ribbon for an absent loved one.

Still, it is clear that too many loved ones are lost to the disease, despite many advances in diagnosis and treatment. The National Cancer Institute estimates that in the United States alone about 40,000 women will die of breast cancer this year, and 230,000 new cases will be diagnosed.

Jaggar, of Breast Cancer Action, wonders whether more awareness is what is needed to reduce those numbers.

Additionally, Breast Cancer Action takes exception to products it considers potentially harmful ― like a perfume the Komen Foundation introduced this year, “Promise Me.” Jaggar said the perfume contains some possibly toxic or hazardous ingredients, and Breast Cancer Action asked that Komen discontinue its sale.

Federal regulatory agencies do not consider small amounts of those ingredients to be a threat, and Komen’s scientific and medical advisers did not believe there was a problem. Komen said that to allay any concerns the next batch of “Promise Me” will be reformulated without the ingredients that were criticized.

Leslie Aun, a spokeswoman for Susan G. Komen for the Cure, based in Dallas, Texas, said the advocacy group is not apologizing for all the pink.

“Research doesn’t come cheap. We need to raise money, and we’re not apologetic about it,” Aun said.

Komen, founded in 1982, has contributed $685 million to breast cancer research and $1.3 billion to community programs that help with mammograms, transportation and other needs, Aun said.

Komen would love not to have to do marketing, but that simply is not realistic, she said.

“We don’t think there’s enough pink. We’re able to make those investments in research because of programs like that,” Aun said.

Samantha King, a professor at Queens University in Ontario, Canada, and author of the book Pink Ribbons, Inc., said that at first people warned that she would get hate mail for writing critically about the pink campaigns.

“And in fact the opposite was true,” King said. “I had underestimated the level of alienation that many women felt.”

King said she felt the Komen Foundation crossed the line a few years ago, when they partnered with Kentucky Fried Chicken on the pink bucket of fast food.

“What’s next, pink cigarettes for the cure?” King asked. “I think this really speaks to the fact that they’ve lost sight of their mission. Their primary purpose appears to be to sell products.”

Perhaps not, said Ryan.

Over the past two years she has worked with homeless women who have breast cancer, in her hometown of Birmingham, Alabama. Some of the women are at an advanced stage of the disease, no health insurance, and no place to call home. Yet when Ryan recently asked two of them what they wanted to help promote awareness among other homeless women, the response came quickly.

Pink handbags.

That answer promoted Ryan to take a hard look at her aversion to pink.

Now, she is not sure whether it is her place, or anyone else’s, to proclaim that a particular pink-themed product is acceptable, or not.

“I’m conflicted,” Ryan said, adding that she still worries that many people buy the pink products without really knowing where the money is going.

Jaggar said that different women will make a variety of choices. The point is to have them consider what the best choice is, instead to buying a pink product blindly.

For example, the lingerie company Aerie, based in Pittsburgh, draped thousands of bras on one of the many steel bridges in the city, to heighten awareness. Aerie said $1 from every sale during October will be donated to a breast cancer charity, up to $50,000.

Jaggar said that is the type of detail that shoppers should pay attention to, and decide whether $1 out of a $20 or $30 sale is enough.

Jani Strand, a spokeswoman for Aerie’s parent company, American Eagle Outfitters, said they feel strongly that it is a good thing to get young women talking about breast cancer.

Aerie’s target audience is 20-year-old women, and Strand said the things that get that age group excited about a cause are different from what attracts older women.