The Big C…Shhh
By Samuel Smith, on 7 October 2011
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