Monday, October 1, 2012

Cancer awareness can also be a negative thing

The incongruous spectacle of Cowboys and Bears players on ESPN's Monday Night Football sporting pink jersey patches and pink shoes in honor of National Breast Cancer Awareness Month prompted me to revisit (and slightly revise and update) the following piece, originally posted in January 2010.


The American Cancer Society designated this 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.