How overly aggressive cancer awareness can backfire

The American Cancer Society has designated this weekend “Suits and Sneakers Awareness Weekend,” as part of the annual Coaches vs. Cancer program that will feature well-dressed basketball coaches wearing “sneakers instead of dress shoes with their usual game attire during weekend games to demonstrate their support for the Society and the fight against cancer.” The idea is to encourage people to exercise and eat a healthy diet to reduce their risk of cancer. Of all of the ACS’s cancer prevention initiatives, this is probably one of the best.

I’m suspicious of other “cancer awareness” efforts, though – in particular, the increasing fad of designating particular months or weeks of the year as times for heightened awareness of individual cancer types. According to the 2009 ACS calendar, the fall months are particularly crowded: September was for ovarian cancer, childhood cancer, leukemia and lymphoma, and prostate cancer Month; October was for breast cancer (with a “National Mammography Day” on the 16th); and November was for lung and pancreatic cancer.

And this month saw Facebook virtually consumed for a few days by a “breast cancer awareness campaign” with female users posting the colors of their bras in status updates. While advocacy groups such as Susan G. Komen for the Cure denied any involvement, they also professed to be pleased with the attention that breast cancer was getting.

Yet I wonder if breast cancer really needs any more attention in a country where the recent release of painstakingly crafted recommendations to individualize mammography decisions for women in their 40s caused weeks of public furor and threatened to derail health reform legislation over the make-believe issue of “rationing.”

And from a public health standpoint, focusing on this single cancer to the exclusion of all other threats to women’s health makes little sense. Among the causes of death in women, breast cancer doesn’t even make the top five. It ranks 7th overall, and according to statistics from the Centers for Disease Control and Prevention, it isn’t even the number one cancer cause of death. (That would be lung cancer, by a nearly two to one margin.) Even if breast cancer is detected and appropriately treated, there is scientific consensus that up to 1 in 3 women receiving treatment gain nothing from it, because the cancer was either slow growing or the patient was destined to die of some other cause (such as a heart attack or stroke) before the cancer would have caused any symptoms.

Finally, well-intentioned cancer awareness efforts can backfire by encouraging unnecessary or unproven screening for cancers. During the Facebook campaign, I was dismayed to see some of my former high school classmates discussing how a similar strategy might be used to persuade men to get testicular and prostate screenings (brief or boxer color?) or women to get checked for ovarian cancer (you’ve got me on that one). Unfortunately, there is no evidence that detecting any of these cancers with existing tests saves lives, and doing so could lead to cause emotional or physical harm from false positive testing.

I’m all for cancer awareness when the goal is to reduce the risk of developing cancer, or to deploy proven screening tests for early-stage cancers in age and risk groups that are supported by good scientific evidence. But naive “awareness” – that is, high doses of enthusiasm combined with misinformation – may actually harm as many people as it helps.

Kenneth Lin is a family physician who blogs at Common Sense Family Doctor.

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  • Finn

    Even as a woman with a BRCA2 mutation and therefore extraordinarily high risk of breast cancer, I’m sick to death of breast cancer “awareness,” which appears to have become an industry in this country. Unfortunately, all this “awareness” leads women to be far more frightened of breast cancer than necessary, believing they are at higher risk of developing and dying from it than they actually are. These incessant “awareness” campaigns do little or nothing to promote activities and behavior that can reduce cancer risk, like losing excess weight. In the end, they’re about as helpful as screaming “Look out! A monster!”

  • http://www.diabetesdaily.com/blogs/fadingtogray Christine

    I’d like to see more awareness for conditions people are much more likely to get, and can do much more to prevent- type 2 diabetes, HTN, dyslipidemia, etc, etc, etc.

  • AnnR

    I have decided to do my fund/awareness raising for women’s health in support of heart disease.

  • Primary Care Internist

    Very well put. I second Christine, especially regarding diabetes – a much much more relevant health threat, especially to our young overweight population with a positive family history of DM.

    Living in NY, the incessant pink ribbons on walk-a-thon jerseys and as car magnets are just becoming trite. Sometimes I wonder what people think they’re actually contributing by buying a $2 ribbon & wearing it on their shirt. If they really wanted to do something constructive, how about investigating & educating others on REAL evidence-based cancer screening guidelines, and the rationale for such.

  • Anonymous

    Even more troubling is the blatant abuse of x-rays that could potentially cause more deaths than they prevent. We still have no statistical means of determining what the cancer risk of x-rays is. All quantitative statements compare exposures to ‘what a person gets from flying cross-country in a jet’ without even taking into account the difference between full-body vs. concentrated exposure let alone the fact that all ionizing radiation is potentially carcinogenic regardless of its source or intensity, and should therefore be avoided unless there is some known benefit. But still no one even attempts to rate the potential cancer risk of a given exposure, just compares it to some other exposure as if that makes it safe.

  • Liz

    Couldn’t agree more…
    I’m a screening skeptic…I would never consider cancer screening until I heard the WHOLE story and sadly, that never comes from doctors. I want to hear about the benefits (the actual benefits, not the manufactured ones) and the RISKS.
    I also hate the aggressive climate that surrounds cancer screening for women.
    Even though informed consent is a legal requirement for cancer screening, women are treated like lepers if they dare question the need or choose not to screen for whatever reason. In fact, we need to produce an “excuse” and then others are permitted to pick it apart.
    I really disapprove of medical control in our lives.
    If screening was handled differently, I’d have no issue.
    Tell us the whole story, don’t “fashion” statistics to mislead, give us risk information, time to make an informed decision and then RESPECT our decision.
    I don’t have cancer screening – I’m fit and healthy and see no need to test for a rare cancer (especially when I’m also low risk) or have a test that carries significant risks to my health. (false positives, radiation exposure, unnecessary and harmful biopsies and other treatments…even surgery)
    Also, I have no wish to focus on cancer my whole life…
    Of course, doctors don’t accept that women can choose not to screen…we’re almost ordered into testing and coercion is common. (holding birth control until women submit)
    I’m so tired of the intrusiveness of cancer awareness and testing….why not adopt a balanced and sensible lifestyle and get on with life?
    My grandmother did that…and died peacefully in her sleep at 92.
    I hope to do the same thing!

  • Susanne

    Dr. Lin,

    Thank you for your post about overly aggressive cancer awareness and screening activities. It seems everywhere I go these days, there is some sort of pink-ribbon promotion going on and not just in the designated “awareness month” of October. My mother died in November 2007 after a nearly 18-month battle against glioblastoma multiforme (brain cancer). I can’t tell you the last time I walked into my local supermarket and saw a gray ribbon slapped on a yogurt carton or a box of tissues to promote brain cancer awareness or raise money for brain cancer research.

    From the viewpoint of someone who lost her mother to a something other than breast cancer, it seems things are heavily and unfairly skewed in favor of one disease and that no one gives a damn about any other illness.

    Interestingly, I have learned that cardiovascular disease kills around 5 times as many women as breast cancer, yet we never hear anything about that. Why?

    When the Facebook post-your-bra-color campaign took hold a few weeks ago, I felt compelled to remind my fellow Facebookers that breast cancer was not the only disease out there killing women. I suggested that instead of playing some Facebook game that half of the people on the site couldn’t figure out, we should actually TALK about it and do something to raise money for research for ALL cancer. The response I got from some folks was, how shall I say, less than pleasant. It seems many have been caught up in this pink frenzy without really knowing why they are in it, and they respond negatively to anyone who does not follow the herd, so to speak.

  • http://fertilityfile.com IVF-MD

    Great post, Dr. Lin.

    Things will start to improve as we learn to think critically and look at things in a complete fashion as opposed to narrow-mindedly focusing on things in isolation and reacting wildly without regard to the repercussions of how certain policies can have far-reaching effects on other important aspects of life.

  • JT

    Liz:

    >>why not adopt a balanced and sensible lifestyle and get on with life?>>

    I agree with you, absolutely!

    Unfortunately, eating right and exercising are long-term lifestyle choices. We live in a society that values instant gratification. Screening tests = instant gratification, for both patient and physician.

    We’re a nation of lazy, unhealthy people who consistently make poor choices then rely upon medicine to rescue us. Sad but true.

  • Aestivate99

    I enjoyed the article and hope you won’t mind that it reminded me of a funny incident at my former workplace, a large state health agency. When we used to receive paper pay stubs, a blurb about health was printed on them each month. One month we had quite a laugh when it said, “October is breast awareness month” someone having mistakenly forgotten the word cancer between breast and awareness. Needless to say, breast cancer awareness month got the most attention it ever had among all of us and the Fiscal director received quite a bit of kidding.

  • http://twitter.com/ddwebster Dana

    So, I am the one who is going to both agree and disagree here.

    Too much focus and money are going to certain causes. When the NFL chose to wear pink in support of breast cancer, wouldn’t that money have better been spent being donated to fund research?

    However, as a recent cancer survivor, I think too many people are not acutely aware of their own bodies. In my case, my only real “symptom” was a small, palpable, non-fixed node I found after nursing my 7 week old daughter one night. I went to Google, did a search of the lymphatic system, found it was supraclavicular, and my heart sank. T

    Because I was postpartum, I went to by OB/GYN the following day who was “not overly concerned” but wanted to reassess in a week. I went to my Family Practitioner the following day who was more concerned and ordered an ultrasound and referred me to an ENT. When he asked if I was fatigued? Of course, I have a 2 year old and a 7 week old. Had I been losing weight? Yes, I am postpartum. Was I nauseated? No.

    My CBC was normal except for a minor elevation in CRP. My ultrasound results: benign adenopathy. It took 3 pathologists to confirm Nodular Sclerosing Hodgkins Lymphoma.

    No one thought I had cancer except for me until the pathology confirmed it. I was Stage IIA at diagnosis and so far have successfully been treated.

    While I do think some attention is over the top, I think patients need to be more accountable for themselves (including dyslipidemia, Diabetes, etc) and be better advocates.

    All you need to do is going on to one of the many Mommy sites to see how ignorant people are about their health and why to seek medical advice.