The saturation of the Internet into daily life in many parts of the world has characterised the early part of the 21^st century.  As a communication medium, the Internet has huge potential to increase health-related knowledge and behaviours among the general population to ultimately help prevent chronic diseases such as cancer.  However, the actual effectiveness of the Internet in improving cancer-preventive behaviours among older adults, who are among the most at risk for cancer, is unclear.  Importantly, there is unequal access to and use of the Internet in the population.  In the United Kingdom, women, older adults, and those with low income are less likely to use the Internet; this phenomenon is called the ‘digital divide’.  If using the Internet leads to participation in healthy behaviours and ultimately lower chances of cancer, then inequalities in access to online health information may increase inequalities in cancer outcomes.

Our study examined whether Internet use is associated with cancer-preventive behaviours and whether a ‘digital divide’ exists. To do this we used data from 5,943 participants in the English Longitudinal Study of Ageing: a nationally-representative study of English adults aged 50 years and older.  The study participants responded to questions about Internet and email use, self-reported colorectal and breast cancer screening, physical activity, eating habits, physical and cognitive abilities, and demographics every two years from 2002 to 2011.

We found that 41.4% of older English adults reported not using the Internet at all between 2002 and 2011, while 38.3% used the Internet intermittently and 20.3% used the Internet continuously during this time period.  Men and women who consistently used the Internet were two times more likely to participate in colorectal cancer screening than those who never used the Internet. They were also 50% more likely to take part in regular physical activity, 24% more likely to eat at least five daily servings of fruit and vegetables, and 44% less likely to be current smokers.

In short, we found that Internet plays a positive role in promoting healthy cancer-preventive behaviours.  Our research also confirmed that a ‘digital divide’ exists: Internet use in this study was higher in younger, male, white, wealthier, and more educated adults and lower in older, female, non-white, poorer, and less well-educated adults.  Age is a particularly important factor in the ‘digital divide’, as over 40% of all adults aged 50 and up reported never using the Internet.  Providing appropriate support and opportunities for Internet access among older adults may be a key first step to improving health among the ageing population. More generally, increasing Internet access among groups with low rates of Internet usage may have substantial public health benefits.  Policymakers must understand this potential for ‘digital divides’ to influence inequalities in cancer outcomes – whether for worse, or, for better if targeted efforts are made to increase Internet access and literacy among vulnerable groups.

References

Office for National Statistics. Internet access quarterly update, 2013 Q1. 2013 [cited 25 October 2013]. Available from: http://www.ons.gov.uk/ons/rel/rdit2/internet-access-quarterly-update/2013-q1/stb-ia-q1-2013.html

Viswanath K, Nagler R, Bigman-Galimore C, McCauley MP, Jung M, Ramanadhan S. The communications revolution and health inequities in the 21^st century: implications for cancer control. Cancer Epidemiol Biomarkers Prev 2012;21:1701-8.

Xavier AJ, d’Orsi E, Wardle J, Demakakos P, Smith SG, von Wagner C. Internet use and cancer-preventive behaviours in older adults: findings from a longitudinal cohort study. Cancer Epidemiol Biomarkers Prev 2013 (in press).

Cancer fatalism may be the driving mechanism linking social background with negative views on the early detection of cancer

One of the great success stories of modern medicine is that more and more people are surviving cancer these days. Whether this is due to better treatment options, improved ways of detecting it, or indeed novel ways to stop it from happening in the first place, may be a matter of debate.  However, we can say with some certainty that the triumphs in the battle against cancer are rarely due to the big ‘breakthroughs’ that are reported regularly in the press.  Instead, achievements arise from gradual improvements in all aspects of cancer research, which go hand in hand with slow, but steady increases in survival rates. Of interest to cancer communication specialists is whether public impressions of the disease move in line with these improvements? Or does the impression remain that cancer is a deadly unsurvivable monster that we are powerless to control and should not be discussed in polite conversation?

In order to investigate the issue further, behavioural scientists have begun to investigate the construct of ‘fatalism’ – the perception that an event is uncontrollable and the outcome is a foregone conclusion. Previous research has shown that people holding fatalistic beliefs about cancer are less likely to engage in behaviours that would help to ward off cancer, such as screening, self-examination and accessing health information. This is particularly true among people from deprived backgrounds, which tend to have more negative attitudes towards early detection of cancer, possibly because they are more likely to encounter negative life (and health) events than people who are less deprived. (See figure 1 for summary).

The latest publication from the HBRC aimed to combine these findings by investigating the relationship between social background, fatalism and views on early cancer detection outlined in figure 1. In the study a large sample, which accurately reflected the UK population was used. The question the researchers tried to answer was whether the relationship between social deprivation and negative views on early detection could be explained by the disadvantaged group’s tendency to hold more fatalistic beliefs towards cancer.

Cancer fatalism was measured in two ways. In one question participants had to estimate how many people with a cancer diagnosis would be alive 5 years later. Their answers were then compared with actual survival figures, with people being classified as ‘accurate’ if they answered 41-50% or 51-60%, ‘pessimistic’ if they answered 0-40% and ‘optimistic’ if they answered >60%. In the second question participants were asked their agreement with the statement ‘Many people who get cancer can be completely cured’ on a graded rating scale.

The results showed that the public’s impression of cancer survival is generally accurate; with most people correctly selecting that 51-60% of people will survive for at least 5 years following a cancer diagnosis. Individuals from the most deprived group were more likely to be classified as ‘pessimistic’, less likely to be classified as ‘optimistic’ and tended to answer towards the ‘strongly disagree’ end of the scale for the second measure of fatalism. In sum, this is evidence for fatalistic attitudes being stronger in deprived groups.

Next, Dr. Rebecca Beeken and colleagues from the HBRC showed that over 90% of their sample agreed with the statement ‘the earlier cancer is detected, the greater the chance of successful treatment.’ This is great news and shows that the message of early detection is getting through to the public. Unfortunately, individuals from socially deprived groups were more likely to disagree with this statement, suggesting more work is needed in promoting this message among this group.

However, the question is whether this relationship is explained by a greater tendency to hold fatalistic beliefs? In short, the answer is yes. After examining all of these constructs (and a couple of others that might influence the relationship) in a statistical model, it was shown that after considering fatalistic beliefs, the relationship between social deprivation and negative attitudes towards early detection disappeared. In other words, it is fatalistic beliefs which drive negative attitudes towards cancer detection and not simply being part of a socially deprived group.

The finding that the U.K public generally has an accurate impression of cancer survival rates and that the message of early detection is starting to get through is great news for health promotion and behavioural scientists in the field of cancer communication. Although deprived groups tend to have more negative attitudes towards early detection, we now know that cancer fatalism is a strong mechanism that drives these beliefs. This gives us something to target when we are delivering the early detection message.

As cancer scientists in all fields continue to develop better cures and treatments for the disease, it is important that the public keep up to date with the progress we are making. Although it appears from the current research that we are doing a good job, we must not rest on our laurels. Only when the differing attitudes towards cancer between social groups begin to converge can we be sure that everyone is equally sharing the amazing developments that are happening in the world of cancer.

Reference: Beeken RJ, Simon AE, von Wagner C, Whitaker KL, Wardle J (in press) Cancer fatalism: deterring early presentation and increasing social inequalities? Cancer Epidemiology, Biomarkers & Prevention. DOI: 10.1158/1055-9965.EPI-11-0437

Sam (Samuel.smith@ucl.ac.uk)