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Public Health Rep. 2011 Sep-Oct;126(5):733-40.

Methods of generating state revenue for breast cancer prevention and early detection: an analysis of pink dollars.

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Washington University in St. Louis, George Warren Brown School of Social Work, Prevention Research Center in St. Louis, St. Louis, MO 63110, USA.



We assessed income tax check-offs, specialty license plates, and lottery tickets as ways states raise funds for the early detection and prevention of breast cancer.


We conducted an inventory of state legislation allowing these revenue-generating methods, and collected and compared information on each initiative. We conducted logistic regression analyses to compare these methods with state breast cancer mortality rates.


Eighteen states had programs for contributions through an income tax check-off. Revenue for tax check-offs and plates is influenced by state population. The median annual revenue for the income tax check-off was $115,000. Twenty-six states had breast cancer license plates generating more than $4.1 million in revenue. The extra cost of the plates ranged from $20 to 75 (mean = $37). Only Illinois offered a state breast cancer lottery ticket, which raised $4 million from 2005 to 2009. States with medium or high breast cancer mortality rates were 2.5 times more likely to offer breast cancer specialty license plates than states with low breast cancer mortality rates; however, we found no statistically significant difference in breast cancer mortality tertiles by income tax check-off.


Revenue-generating breast cancer initiatives can be successful strategies for states to raise funds for breast cancer prevention and early detection programs. Although these initiatives can generate revenue, amounts are variable due to population differences, the number of other plates/check-offs/lotteries offered, and the choice to decrease donations during difficult economic times. State breast cancer mortality rates may influence the availability of these initiatives.

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