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.

Guest Blog: Cure

Veneta Masson is a registered nurse and poet living in Washington, DC. She has written three books of essays and poems, drawing on her experiences over twenty years as a family nurse practitioner and director of an inner-city clinic. Information about her poetry collection Clinician's Guide to the Soul is available at sagefemmepress.com. The following poem from that collection was originally published online in Pulse: Voices from the Heart of Medicine.

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CURE

In Latin it means care,
conjures priests and temples
the laying on of hands
sacred pilgrimage
sacrifice
the sickbed
invalid and
solemn attendants.

How far we have come.
Today's English
has neatly expunged
those purely human elements.
Cure is impersonal, consequential
unequivocal, sometimes violent -
the annihilation
of the thing that ails.

This nurse
approaching the patient
has discarded temple garb
for practical scrubs.
His gloved hands
unsheathe the magic bullet,
shoot it through the central line
where it locks onto the target cells.

For the not-yet-cured,
there is still sacred pilgrimage -
that dogged slog
to the high tech shrine,
the health food store,
the finish line of the annual race
where, etched on each undaunted face,
is a gritty tale of survival.

- Veneta Masson

Guest Blog: Facts and Lies

David Watts’ second book of stories, The Orange Wire Problem, along with Bedside Manners, forms a body of work which explores the complexities of the art of medicine. He has published four books of poetry and a CD of “word-jazz.” Dr. Watts is an NPR commentator, a producer of the PBS program Healing Words: Poetry and Medicine, a gastroenterologist at the University of California-San Francisco, and a classically trained musician. He has been an on-camera television host and a medical columnist for the San Francisco Chronicle. The following excerpt is from a piece originally published in the Bellevue Literary Review.

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FACTS AND LIES

Well, your pulse is great.

The emergency room nurse is bending over my foot, his tattooed deltoid rippling with fine movements of support for the hand that reaches to feel my ankle. His words, the last to come from the ER staff after a six-hour visit, are, I assume, intended to reassure, which they do, arriving like carriers of some thread of connection between us, a fellowship perhaps, a gesture both well intended and well received. And I do feel better, better able to face the tremors in my muscles, fatigued by hours of clenching a tight protection for the red-hot joint, now diminishing after the long needle's nip, the suckout of orange reticulated fluids and the push of Novocain and steroids to soothe the singe. I am in the aftermath, in the place where the body luffs in its wheelchair like sails in a dying wind. And here, in this place, his words do mean something to me, even though I know he's lying.

You see, the problem is he palpated the wrong place, not behind the inside of my ankle, where the posterior tibial artery runs like a river of renewal, but - a common mistake - behind the outside, where it does not. That he chose to tell me the pulse was great even though he didn't feel it - couldn't possibly have felt it - let me know he meant to say something grander, maybe something that sounds more like best wishes or you're going to be all right.

What puzzles me is that even though I knew his mistake as he was making it, that contrary knowledge did not prevent the good deed from happening or being well received. ... His report on the status of my pulse floated in like a gesture, only part of a larger gesture that signaled something to me - maybe only that I was being cared for. For although skill and accuracy were missing, intention was there. And somehow intention was enough.

So here I sit not minding the chill of my body so much, not minding the wait so much, sustained at least partly by the effort, though flawed, the nurse had made to try and make me feel better.

And for whatever the hell reason, I do.

- David Watts