Saturday, January 30, 2010

The dark side of "cancer awareness"

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.