How cancer awareness efforts can backfire

The American Cancer Society designated an October weekend weekend “Suits and Sneakers Awareness Weekend” as part of its annual Coaches vs. Cancer program that featured 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 2012 ACS calendar, the fall months are particularly crowded: September was for ovarian cancer, childhood cancer, leukemia and lymphoma, thyroid cancer, and prostate cancer Month; October is for breast cancer (with “National Mammography Day” coming up on the 19th); and November is for lung and pancreatic cancer. January 2010 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 denied any involvement in this apparently spontaneous campaign, they also professed to be pleased with the attention that breast cancer was getting.

Yet I wonder if breast cancer really needs any extra attention when a few years ago the 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 friends 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 consistent evidence that detecting any of these cancers with existing tests saves lives (ovarian cancer screening, in fact, has been proven to cause net harm), and doing so can and does lead to emotional or physical damage from false positive tests.

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 hurt as many people as it helps.

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

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  • Vikas Desai

    I feel that the susan komen foundation has a lot of stake in the game in regards to maintaining its importance for various reasons and because of this it directly correlates the explosion of breast cancer awareness. In my own opinion the same level of enthusiasm needs to be given to obesity and for depression/anxiety/insomnia awareness. These two conditions cause a disturbingly high percentage of morbidity, diagnostic testing and specialist referrals as well as mortality.

  • meyati

    Wow. I’m in a Presbyterian hospital insurance program. Nobody has asked me about cancer family history; I never filled out a form that included cancer. I live in an area that has a high-skin cancer rate-and I’m Irish. My father died of small intestine cancer, his sister died of small intestine cancer, 2 great-aunts (maternal died the same). My maternal grandfather had colon cancer-he died hunting (I think it was suicide). I asked for a fecal blood test once a year. Yet on TV they advertise their cancer clinic on the same property as my primary clinic. Now they told me that Medicare and pres won’t let me have Armour thyroid. The synthetic thyroids don’t work at all. At least the pharmacies still carry it, 2 morrow I’ll see if my doctor will write a script for it. I’ve tried to talk my disabled vet son to move to mexico.. And this is one of the better programs-another major one lost all of their doctors and thousands of patients don’t have doctors. What is good to have awareness if there’s nothing to back it up.

  • Andrew Griffith

    Good piece. Part of this reflects our belief that we can control things and our sometimes shallow culture and wish to join causes.

  • Danielle Reszenski

    Yes! I work in Pediatrics and I always find myself upset in October. NFL players now have touches of pink in their uniforms for October, and breast cancer is one of the most funded cancers to research! Especially when it’s not even the #1 killer of women.

    In regards to Vikas’s comment, YES – and with obesity comes endocrine problems. I had Cushing’s Disease, which cause my 160lb athletic body to balloon into an obsese 285lb body in no time, and had to fight for 6 years to even get a diagnosis. Two brain surgeries and a bilateral adrenalectomy later, I am back to my original weight. Maybe something like this is underdiagnosed and underfunded and could use some attention, as well as screening efforts and programs like weight watchers for everyone else that has a high BMI.

  • Wy Woods Harris

    I appreciate the November awareness of Lung and Pancreatic Cancer because I believe the Cancer Community really needs to get on the same page and even share some survival secrets to make a difference in Palliative care and Quality of life issues and that all of us need to communicate to each other! I am an ACSCAN Advocate Volunteer just wanting to make a difference!

  • Robert Bowman

    There are entire movements of individuals and associations focused on making non-communicable diseases as the top focus of any and all health efforts.

    As noted, these are a distraction from tried and true public health measures and work to reduce important emphasis on basic health access. Searching on basic health access and disease focus will bring up works in this area.

    Make no mistake, the NCD focused have penetrated the CDC and the World Health Organization. Given their hundreds of billions in health care spending in the US, they have the time and resources to keep up their efforts until they break the bank of the US economy with non-primary care health spending – while not impacting the lives of over half of Americans left behind

    That do not benefit from their designs, plans, screenings, or disease care.

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