Checking up on ourselves
Should we really be scrutinising our balls, breasts and bowels for signs of cancer?
Cancer Research UK recently launched a five-year national campaign ‘Reduce the Risk’, with the aim to ‘alert everyone to the fact that each one of us can reduce our risk of getting cancer’, and ‘to raise public awareness of the avoidable risks for cancer and the importance of early detection’.
Cancer awareness seems to be everywhere nowadays, from Colon Cancer Concern’s ‘Don’t blush, look before you flush’ campaign, and the Orchid Cancer Appeal’s ‘Know your balls – check them out’ videos, to thousands of women running in the Race for Life to raise funds for breast cancer charities. All varieties of cancers now have their own charities, dedicated to making people aware of the cancer and its symptoms, however rare. Millions of women undergo screening tests for breast and cervical cancer every year, and we are soon to be offered the chance to be screened for colon cancer.
Advocates of cancer awareness would say this is all to the good. Gone are the days when a cancer diagnosis was shameful, and when people would hide their symptoms, or fail to recognise them, until death was inevitable. The more idea people have of what to look out for, the earlier they will visit their doctor.
But cancer awareness has a downside too – by increasing anxiety among the vast majority of healthy people. Ironically, mortality rates from cancer in all age groups have been falling, slowly but consistently, over the past 20 years.
Do we really have a problem with patients presenting too late? Sadly patients often do present with cancers that are too advanced to be cured, but this is not necessarily because the patient has ignored their symptoms. It may be they are suffering from a particularly aggressive cancer, or a form of cancer that did not have early symptoms. In general, patients are much more comfortable nowadays to turn up to their doctor for investigation of unusual symptoms.
The days of women hiding their breast lumps for years are long gone. In several years of hospital medicine, I can only think of one young patient who ignored his symptoms for a long time. In his case, I think he was well aware of the gravity of his diagnosis, but was in denial, despite family members trying to persuade him to seek medical help. Whether jolly public awareness campaigns help this sort of troubled patient is questionable.
Many doctors (myself included) are thinly disguised hypochondriacs. Our training tends to have that impact. As students, we become aware of just how many things can go wrong with the human body. Then in hospital practice, we meet people just like us for whom these things have gone wrong. Until recently the majority of the population has been spared such anxiety-inducing experiences. But now, publicity around the stories of young cancer victims means that it is hard to avoid the (false) conclusion that cancer in young people is fairly common. Cancer sufferers such as Colin Osborne, founder of the Orchid Cancer Appeal, take part in this publicity, hoping to save other people from going through the experience they went through. But for the majority of young people what results is anxiety, not an early diagnosis of cancer.
The Cancer Research Campaign’s website advises us there are easy things to do to combat the risks of cancer. But if we follow these tips it becomes clear that no part of our lives will be untouched by trying to avoid cancer: our diets (fresh fruit and vegetables, olive oil), our holidays (minimal sun exposure), our weight (slim), our nights out (limited alcohol, and of course no smoking). Not to forget regular inspections of our stools and our scrotums. Considerable energy is required to sustain this level of vigilance over our behaviour and our bodies.
The bright, cheerful Cancer Research leaflet informs us that ‘research shows that around half of cancers can be avoided by lifestyle changes’. I wonder what is meant by this. Will we never get cancer if we change our lifestyle, or will we just put it off until we are older? Or will we die of heart disease instead? In the end, probably a third of us will suffer from cancer at some stage, although it’s unlikely to be diagnosed before the age of 65. But the question is, should we spend our time worrying about it now, or enjoy disease-free life while we have it?
Dr Liz Frayn is a surgical trainee in southwest England, and is speaking at the Institute of Ideas conference Health: an unhealthy obsession? in London on Saturday 12 February 2005.
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