European School of Oncology
Pre-conference Workshop
Informing Attitudes and Beliefs
about Cancer
Introductions
Kathy Redmond, Editor, Cancer
World Magazine
Anna Wagstaff, Assistant Editor,
Cancer World Magazine
www.cancerworld.org
Workshop aims and objectives
• Look at how readers/viewers/listeners think about
cancer
• Explore the impact of myths and misconceptions on
cancer outcomes
• Discuss the role journalists play in informing
attitudes and beliefs about cancer
• Explore the factors which influence how cancer is
reported by the media
• Identify opportunities journalists have to inform
accurate and realistic attitudes and beliefs about
cancer
Cancer: key facts and figures
Cancers are uncontrolled growths of
cells which have the ability to invade
local tissue and metastasise
Cancer Kills More Globally!
8
7
Millions of victims
Millions of victims
6
5
4
3
2
1
0
TB
AIDS
Malaria All 3
Cancer
WHO (2003)
Estimated Cancer Burden in 2030
Cases
Deaths
0
5
10
15
20
25
2000
2030 (Population growth)
2030 (+1% annual increase of the risk)
2030 Annual percent change in Incidence (+1.3) and Mortality (-0.4) in France (1978-2000)*
* Remontet et al, 2002
30
35
Millions
Cancer in Low-income countries
1970 15% of global burden
2008 56% of global burden
2030 Approx. 70% of
global burden
Ratio of mortality to incidence in a specific
year by cancer type and country income
Farmer et al, Lancet, 2010 376(2) 1186-1193
Breast
cancer
survival (5year)
Low income
The Gambia
Uganda
India
Lower-middle
income
Philippines
China
Thailand
Upper-middle
income
Costa Rica
Turkey
Cervical
cancer
survival (5
year)
Life
expectancy
GNI per head Health
(2009 US$)
expenditure
per head
(2009 US$)
12%
46%
52%
22%
13%
46%
57
52
65
330
370
990
22
28
40
47%
82%
63%
37%
67%
61%
74
75
72
1460
2490
3240
63
108
136
70%
77%
53%
63%
81
74
5530
8090
488
465
79%
76%
79%
66%
83
83
21210
34640
1362
1148
High income
South Korea
Singapore
Health-care and economic data for ten countries by World Bank country income classification levels
and 5-year survival for breast and cervical cancer.
B. Anderson et al., Lancet Oncology 12:387-398; 2011
Access to Radiotherapy
, and is moving its
radiotherapy programmes to a
public health model
International Narcotics Control Board –
Global opioid consumption
90% of global opioid consumption occurs in
Australia, Canada, New Zealand, the United
States of America and several European
countries
World Cancer Declaration targets to be
achieved by 2020
•
Availability of cancer-control plans in all countries
•
Substantial improvement in measurement of global cancer burden
•
Substantial decrease in tobacco consumption, obesity, and alcohol intake
•
Universal vaccination in areas affected by human papilloma virus and hepatitis B
•
Misconception about cancer dispelled
•
Substantial improvements in early detection programmes
•
Diagnosis and access to cancer treatment, including palliative care, improved worldwide
•
Effective pain control universally available
•
Greatly improved training opportunities in oncology
•
Substantial decrease in migration of health workers
•
Major improvement in cancer survival in all countries
UN Summit on NCDs –
September 19-20 2011
Is cancer a priority in
your country?
Beliefs and attitudes about
cancer
Global survey on knowledge
and beliefs about cancer
• Survey carried out by UICC in 2007
• Findings were aggregated according to
three World Bank income categories
• The total sample size for the preliminary
report was 29,925
– 5,521in low-income countries
– 15,746 in middle-income countries
– 8,658 in high-income countries
http://old.uicc.org/index.php?option=com_content&task=view&id=16481&Itemid=544
Beliefs about a cancer cure
Be lie fs a b o u t a cu re fo r ca n ce r fo llo w in g d ia g n o sis
90
83
80
70
60
61
52
50
40
30
26
31
22
20
11
8
10
6
0
Low
Middle
High
W or ld Ba nk inc om e c a te gor y
C ure
N o C ure
Undec i ded
Important health issues
Im p o r ta n t h e a lth is s u e s
100
90
78
80
70
62
60
50
40
47
37
36
28
30
20
26
21
9
10
0
Low
Mid d le
Hig h
W o r ld Ba n k in c o m e c a t e g o r y
C anc er
A ID S
H eart dis eas e
Perceived risk of smoking
P e rce ive d ca n ce r risk o f sm o kin g cig a re tte s
100
90
80
70
94
90
69
60
50
40
30
20
10
23
8
8
Low
Middle
2
4
2
0
High
W or ld Ba nk inc om e c a te gor y
Yes , i nc reas es c anc er ri s k
N o ri s k
C an't Say
Perceived risk of chewing tobacco
P e rc e i v e d c a n c e r ri sk o f c h e w i n g to b a c c o
100
87
90
80
70
63
60
60
50
40
27
30
20
10
31
10
8
7
7
0
Low
Mid d le
Hig h
W o r ld B a n k in c o m e c a te g o r y
Yes , inc reas es c anc er ris k
N o ris k
C a n 't S a y
Perceived risk of drinking alcohol
P e rc e i v e d c a n c e r ri sk o f d ri n k i n g a l c o h o l
100
90
80
70
60
71
56
51
50
42
40
29
30
20
26
15
10
8
3
0
Low
Mid d le
Hig h
W o r ld B a n k in c o m e c a te g o r y
Yes , inc reas es c anc er ris k
N o ris k
C a n 't S a y
Perceived risk of being overweight
P e rce ive d ca n ce r risk o f b e in g o ve rw e ig h t
100
90
80
70
63
60
50
42
44
50
41
40
31
30
20
14
9
10
6
0
Low
Middle
High
W or ld Ba nk inc om e c a te gor y
Yes , i nc r eas es c anc er r i s k
N o ris k
C an't Say
Perceived risk of air pollution
P e rce ive d ca n ce r risk o f e x p o su re to a ir p o llu tio n
100
90
78
76
80
70
60
50
40
30
44
30
27
17
20
16
7
10
6
0
Low
Middle
High
W or ld Ba nk inc om e c a te gor y
Yes , i nc r eas es c anc er r i s k
N o ris k
C an't Say
Perceived risk of viruses
P e rc e iv e d c a n c e r risk fro m in fe c tio n w ith v iru se s o r
b a c te ria
100
90
80
70
70
57
60
50
40
30
40
39
22
32
23
20
11
7
10
0
Low
Mid d le
Hig h
W o r ld Ba n k in c o m e c a te g o r y
Yes , inc reas es c anc er ris k
N o ris k
C a n 't S a y
Perceived risk of stress
P e r c e i v e d c a n c e r r i sk fr o m b e i n g str e sse d
100
90
80
70
59
60
50
40
40
44
35
30
30
20
57
16
11
7
10
0
Low
Mid d le
Hig h
W o r ld B a n k in c o m e c a te g o r y
Yes , inc reas es c anc er ris k
N o ris k
C a n 't S a y
Myths and misconceptions
about cancer
Cancer Stigma
• Lance Armstrong Foundation conducted a survey on
cancer stigma in 2008
– Japan, Mexico, Russia, Argentina, Brazil, China, France, India,
Italy, South Africa
– About 500 people polled in each country
• Survey showed that
– Stigma continues to persist across countries, cultures and
communities
– Caused by misinformation, lack of awareness, deeply engrained
cultural myths and fear
– Opportunities to capitalise on shifting perceptions
– Mass media are key resources for facilitating more positive
attitudes
http://www.livestrong.org/pdfs/3-0/LSGlobalResearchReport
First thought that comes to mind about
cancer: some negative examples
•
•
•
•
•
•
•
•
•
•
•
•
•
Cancer is a death sentence
Cancer is a nightmare for the people.
There are no preventives
Long drawn-out process of hurt
Cancer is a sword that hangs over our heads.
I think about fear, death and loneliness.
Nothing you can do about it.
What comes to mind when I think of cancer is silence.
Pain is the first word that comes to my mind.
It terrifies me. It’s sly; it’s not always easy to foresee it
The cancer patient suffers a lot of isolation.
The first thing that comes to my mind is imprisonment.
I think about an ugly disease, an awful beast.
First thought that comes to mind
about cancer: changing perceptions
• If you get treatments early enough, they say you should be
ok… it could also be the end.
• I think of death and struggle, but also perseverance and
strength.
• If I get it, it wouldn’t be the end of the world.
• It certainly cannot be prevented 100% of the time, but we can
cut the risk of cancer.
• More and more people are recognizing it is treatable.
• Just because you have cancer doesn’t mean you will be
unhappy
• People are not scared about the disease anymore, because
today, in every family, there is someone who has had cancer.
• We can beat cancer
Perceptions about cancer
Cancer Stigma and Silence Around the World: A Livestrong Report,
Impact of stigma and myths
about cancer
• Discrimination
– Loss of income
– Inability to secure loans/health insurance
• Loss of social status
– Social isolation
– Social outcasts
Impact of myths and fatalistic
attitudes about cancer
• People less likely to adopt risk reducing
behaviours
• People more likely to delay in seeking help
for suspicious signs/symptoms
– Later stage of diagnosis
– Poorer prognosis
• Reluctance to undergo certain treatment
DO THESE FINDINGS
REFLECT THE REALITY IN
YOUR COUNTY?
Back-up slides
European School of Oncology
• ESO was founded in 1983 with the aim of reducing cancer
deaths and improving the quality of care received by
cancer patients
• This is achieved by:
• Improving the knowledge and skills of all health
professionals dealing with cancer patients
• Shortening the time needed to transfer knowledge from
research to daily practice
• Promoting multidisciplinarity and humanism in cancer
care
Global variability in “successes” and
“opportunities” represented in cancer media
coverage
Informing attitudes and beliefs about cancer
WCSJ Doha
June 2011
How can journalists help limit
suffering and death from cancer
Part 1: Is cancer a priority?
Informing
attitudes
and beliefs
about
cancer
DOES MEDIA
COVERAGE OF
CANCER MATTER?
Informing
Does media coverage
of cancer matter?
attitudes
and beliefs
about
cancer
• The evidence shows it does
• Recognised effects include:
– Informing audiences (Rees and Bath,
2000; Stryker et al 2008)
– Framing and setting public and political
agendas (Passalacqua et al, 2004)
– Shaping public opinion towards
countries’ health-care systems (Benelli,
2003; Collins et al, 2006)
Informing
attitudes
and beliefs
about
cancer
For instance…
• Research has shown that public
awareness of risk and prevention correlate
with amount of newspaper coverage.
(Health Comm 23:380-390)
• In this case, high levels of coverage of the
dangers of tobacco and obesity correlated
with high levels of public awareness. Low
levels of coverage of the dangers of sun
and alcohol, and protective effect of
exercise correlated with low public
awareness
Informing
attitudes
and beliefs
about
cancer
IS CANCER A PRIORITY
IN YOUR MEDIA?
Informing
attitudes
and beliefs
about
cancer
IN SOME COUNTRIES,
CANCER STORIES
SELL WELL
Informing
attitudes
and beliefs
about
cancer
Informing
attitudes
and beliefs
about
cancer
Informing
attitudes
and beliefs
about
cancer
Informing
attitudes
and beliefs
about
cancer
HOW POPULAR ARE
CANCER STORIES WITH
EDITORS IN YOUR
COUNTRY?
Informing
attitudes
and beliefs
about
cancer
Informing
attitudes
and beliefs
about
cancer
WHY MIGHT EDITORS
LIKE CANCER
STORIES?
Informing
attitudes
and beliefs
about
cancer
Reasons editors like
cancer stories
• Universal: most of us have known (of) someone with
cancer
• Topical: constant stream of new stories: new drug, new
treatments, new cancer gene found, new cancer scare, new
celebrity diagnosis
• Impact: people are interested in cancer because they
fear it. They want to hear good news
• Controversial: agri-business is poisoning us, nuclear
plants, depleted uranium from US tanks
• Human interest: Stories of ordinary people fighting
against the odds
• Novelty interest: Familiar things turn out to save
you from cancer – turmeric, green tea -- or give you cancer –
talcum powder, candles
Informing
attitudes
and beliefs
about
cancer
WHY MIGHT EDITORS
NOT LIKE CANCER
STORIES?
Informing
attitudes
and beliefs
about
cancer
Taboo
• People don’t like to
talk/read/hear about cancer
because of a culture of fear and
superstition
Informing
Words and images
attitudes
and beliefs
about
cancer
• How do you talk about body parts?
unlike infectious diseases, cancer
happens in the breast, or the rectum,
or the neck of the uterus.
• Is it hard to find words that are in
common use but also suitable to
publish/broadcast?
• What about the use of images?
Informing
attitudes
and beliefs
about
cancer
Sources and stats
• Is there a problem getting
accurate local information?
• Statistics on new cases and
deaths?
• Expert sources willing and able
to talk to the media using
everyday language?
• Patients and families willing to
talk about their experiences?
Informing
News value vs
importance
attitudes
and beliefs
about
cancer
• What sort of stories get
covered? And why?
Informing
attitudes
and beliefs
about
cancer
• British Journal of Cancer study (99:569
– 576) on BBC coverage showed breast
cancer got more than one-third of the
coverage, but accounted for only 13% of
all cancers
• Attributed to:
– Strength of advocacy
– Advances in treatment (new drugs
accounted for a very high proportion of
stories)
– Cancers where progress in treatment have
been slow and where there is less advocacy
get less coverage
Informing
Not just quantity of
coverage that matters
attitudes
and beliefs
about
cancer
• Quality also matters
Coffee break
Informing attitudes and beliefs about cancer
WCSJ Doha
June 2011
How can journalists help limit
suffering and death from cancer?
Part 2: How well is cancer covered
by the media?
Informing
attitudes
and beliefs
about
cancer
WHAT ARE JOURNALISTS
AIMING TO ACHIEVE
WHEN COVERING CANCER
STORIES?
Informing
Inform and empower
attitudes
and beliefs
about
cancer
• Help people understand what
raises and what lowers their risk
of cancer and what steps they
can take to protect themselves
and their family
Informing
Promote informed
debate
attitudes
and beliefs
about
cancer
• Help increase awareness of the
urgent need for tackling cancer,
and push debate about how to
do this up the political agenda
Informing
Provide a voice for
patients and families
attitudes
and beliefs
about
cancer
• Cancer patients, their nephews,
nieces, grandchildren, aunts and
uncles are among your
readers/viewers/listeners
• You can help give them a voice
to end their isolation and
challenge discrimination
Informing
In reality, however…
attitudes
and beliefs
about
cancer
• Research has shown that all too
often media coverage of cancer
sows confusion and reinforces
myths
Informing
attitudes
and beliefs
about
cancer
HOW DO YOU GET
YOUR FACTS RIGHT?
HOW DO YOU
PRESENT THEM
WELL?
•
Informing
attitudes
and beliefs
about
The Scotsman said: the “WHO's
International Agency for Research on
Cancer (IARC) said a "causal link"
had been established between
radiomagnetic fields and an
aggressive form of malignant brain
tumour called glioma”
cancer
Behind the headlines, (www.nhs.uk/news) a health news
evaluation website said,
“…the classification means that the link is far from certain,
with the IARC saying there is only ‘limited evidence’ of a
link to brain tumours in humans, and that the results
supporting a link may be due to other factors distorting
study data.
Overall, this classification should not be taken to mean that
there is a definite link between mobile phone use and
cancer, only that some initial (possibly anomalous) study
results have highlighted a relationship that needs further
robust scientific investigation.
… and an insignificant story even
if the Scotsman got it right
Informing
attitudes
and beliefs
about
cancer
Informing
attitudes
and beliefs
about
cancer
The Telegraph reported:
“Researchers have found that
the fumes from paraffin wax–
the most common and
cheapest form of candlewax –
can be poisonous
and even cause cancer.”
“Behind the headlines” said: the candle risk reports stemmed
from brief press releases and a presentation abstract at the
American Chemical Society (ACS) and the data were
impossible to evaluate. “It is
possible that the study may never be published,
as a great deal of research presented at
Conferences does not make it into peer-reviewed journals.”
IN OTHER WORDS THERE IS NO PROPER EVIDENCE!
Informing
How strong is the
evidence?
attitudes
and beliefs
about
cancer
• Where did the story originate?
• Who is quoted in the press
release?
Informing
Reporting risk
attitudes
and beliefs
about
cancer
• Cancer is all about risk. It can
be very difficult to translate
statistical findings into
something meaningful for
readers/viewers/listeners
Absolute v relative
Informing
attitudes
and beliefs
about
cancer
• Absolute risk is what matters
to readers (relative risk
makes the better headline)
Relative:
X doubles your risk
of brain cancer
Absolute:
X increases your risk
of brain cancer from
1 in 50,000 to 2 in
50,000
HYPOTHETICAL
EXAMPLE!
Informing
attitudes
and beliefs
Put it in perspective 1
How much of the cause for how much effect?
about
cancer
• If 50,000 people used
their mobile phones for
4 hours a day for 20
years we would expect
two additional cases of
brain cancer
(hypothetical example)
Put it in perspective 2
Informing
attitudes
and beliefs
about
cancer
How important is this finding for your overall
risk of cancer?
The graph says it all!
Informing
attitudes
and beliefs
about
cancer
POPULATION RISK V
INDIVIDUAL LIFETIME
RISK V INDIVIDUAL
RISK
Population risk
Informing
attitudes
and beliefs
about
Population risk tends to be given as x number of new
cases in every 100,000 people every year. eg the
Ghana graph
cancer
Readers/viewers will find this easier to understand
Individual lifetime risk
Informing
attitudes
and beliefs
about
cancer
“What is my risk of getting breast cancer ever?”
Related to population risk, but also individual risk factors. In this
case…
• individual genetic factors – eg the BRCA gene
• reproductive factors – age of starting your period, first childbirth,
menopause
• lifestyle: weight, smoke exposure, alcohol, exercise, diet… and
• how long you live. Age is the biggest risk factor
Informing
Individual risk
attitudes
and beliefs
about
cancer
• Stats for the UK show women
have roughly 1 in 10 chance of
getting breast cancer ever
• But…
Under 30 years old the
risk is
1 in 1,900
Informing
attitudes
and beliefs
about
cancer
Under 50 years old the
risk is 1 in 50
By 85 years old it is
1 in 10
Informing
And yet…
attitudes
and beliefs
about
cancer
• Research done in Australia has
shown that:
• 44% of articles about breast
screening portray women under
40 years of age
• 50% of images show women
under 40 years of age
•
J Health Comm 9:309-325
Informing and empowering
Informing
attitudes
and beliefs
about
cancer
• Be clear about strength of
evidence
• Be clear to your leaders/viewers/
listeners about what this story
really means for their cancer risk
• Spell out the evidence on how to
protect yourself against known
risk factors
Informing
attitudes
and beliefs
about
cancer
Provide evidencebased advice
• Good information gives your
readers/viewers/listeners the chance to
make informed decisions on their lifestyles
• Muddled information gives the impression
everything could be a risk and we are not
sure what is bad and what is not.
• Research shows that a the most effective
risk communication uses a combination of
absolute risk, relative risk and prevention
advice
(Preventing Chronic Disease vol6, no 1)
Informing
attitudes
and beliefs
about
cancer
Helpful tips to protect
against cancer – the
global perspective
• A global report from the World
Cancer Research Fund presents
evidence on lifestyle
• Some of these lifestyle factors
pose the greatest threat to lowand middle-income countries as
sections of society become more
well off and adopt unhealthy
western lifestyles.
•
http://www.dietandcancerreport.org/
Informing
attitudes
and beliefs
about
cancer
• Obesity is second biggest risk factor
after smoking
• No evidence that any superfoods
protect on their own
• But… diet is important. A healthy diet
is low in meat (particularly red meat),
low in alcohol, high in fruit, veg,
legumes, unrefined cereals
• Exercise can help protect against
cancer but weight is more important
•
(from the summary report of the World Cancer Research Fund
http://www.dietandcancerreport.org/)
Informing
To recap…
attitudes
and beliefs
about
cancer
• Journalists should seek to
inform and empower
• Promote informed debate
• Provide a voice for patients and
families
Informing
Promoting informed
debate
attitudes
and beliefs
about
cancer
• Most cancers cannot be prevented by
healthy lifestyles
• National action
is needed
to prevent
many
Journalists
can help
by promoting
informed
cancers
those
stemming
debate
on(eg
how
countries
canfrom
achieve the
infections)
best results from limited resources
• To detect early and treat well where
possible
• To care for cancer patients
The debates we need…
Informing
attitudes
and beliefs
about
cancer
• Focus on the main problems –
which cancers are most common?
• Focus on where the greatest
Back to the problem of what makes a
impact can be made for the most
good news story vs what is important
people at the most sustainable
cost – which cancers are most
preventable, detectable,
treatable? What can we do for
cancer patients?
Informing
attitudes
and beliefs
about
cancer
The most common
cancers?
How good are our statistics? Most countries
do not have national cancer registries, or
even local or hospital registries.
Informing
attitudes
and beliefs
about
cancer
Greatest impact?
• Breast cancer. Detecting it early can
save your life.
Region
% diagnosed
late
Nile delta Egypt
70%
Syria
73%
Sudan
78%
Jordan
69%
Tunis, Tunisia
49%
Iraq
47%
Bahrain
33%
Source: Cancer in EMRO powerpoint presentation, WHO Syria
Should this country do more of this?
Informing
attitudes
and beliefs
about
cancer
Or more of this?
and this…
Women learn
about breast
self
examination at
a Cairo clinic
Informing
attitudes
and beliefs
about
cancer
Liver cancer
• Most liver cancers in low- and
middle-income countries are caused
by Hepatitis B infection
• Vaccination is cheap, but tricky to
organise (1st shot within 24hrs)
• How can this country do more of
this?
Informing
attitudes
and beliefs
about
cancer
Cervical cancer
• Cervical cancer is caused by the
HPV virus
• Effective vaccines are available but
not can
cheap
How
your country best protect women
• Cervicalagainst
cancercervical
can becancer?
detected
before it is a cancer, using fairly lowtech methods, or even very low-tech
methods
• It takes organisation and there are
cultural obstacles
Informing
attitudes
and beliefs
about
cancer
Lung cancer
• Lung, mouth and other tobaccorelated cancer remain the most
common cause of cancer death
in men and this is rising among
women
Should we be doing more of this…
Informing
attitudes
and beliefs
about
cancer
Or this….
And less of this….
Informing
attitudes
and beliefs
about
cancer
• What are the most effective ways to stop
young people starting to smoke and to help
those who do smoke to stop?
• Is your country a signatory to the WHO
framework convention on tobacco control?
• Is your government implementing what it has
signed up to?
Improving treatment
Informing
How can we do more of this?
attitudes
and beliefs
about
cancer
Specialist urological cancer
team at the Hopital Grand-Yoff,
Dakar
National Cancer
Institute, Cairo
Informing
While not denying treatment to people living far
away from specialist cancer centres?
attitudes
and beliefs
about
cancer
Cancer hostel in Tunis where patients can stay during their treatment
Why are people dying in agony when cheap
and effective pain killers are available?
Informing
attitudes
and beliefs
about
cancer
Should we be doing more of this?
Informing
attitudes
and beliefs
about
cancer
Picture from the African Palliative Care Association
Informing
To recap…
attitudes
and beliefs
about
cancer
• Journalists should seek to
inform and empower
• Promote informed debate
• Provide a voice for patients and
families
Informing
attitudes
and beliefs
about
cancer
JOURNALISTS CAN
HELP PATIENTS FIGHT
THE PREJUDICE AND
DISCRIMINATION
THEY OFTEN FACE
Could these be among your readers and
viewers and listeners?
Informing
attitudes
and beliefs
about
cancer
Cancer Patients and
families in Malaysia
get their message
across at a press
conference held by
the Max Foundation
Informing
attitudes
and beliefs
about
cancer
THREE FINAL POINTS
Informing
World Cancer
Declaration
attitudes
and beliefs
about
cancer
• A global
blueprint for
controlling
cancer
• A tool for
journalists
Informing
attitudes
and beliefs
about
cancer
Tackling cancer and
spirit of the Arab Spring
• We don’t follow a western agenda. We
have our own priorities, our own solutions
(but we welcome collaboration as equals!)
• We look for solutions for all citizens, not
just an elite
• We can make things better through
education, awareness, debate and
advocacy
Informing
attitudes
and beliefs
about
cancer
Best
Cancer
Reporter
Award
• The Best Cancer Reporter Award winner will
receive a cash prize of €10,000 ($14,000). There is
also a runner-up prize of €5000 ($7000) and a small
number of Special Merit Awards.
An article written by winning journalists will be
published in ESO’s Cancer World magazine.