NEWS

Why Don’t People Heed Risk Warnings From Science?

Barbara Boughton

Years of research have produced several specific recommendations to reduce the risk of cancer, such as eating a balanced diet and avoiding excessive sun exposure in the summertime. But many people still fail to take steps that could prevent cancer or catch it early, and researchers are now beginning to understand why.

Some of the most prevalent barriers are low income and lack of education about cancer prevention. Many people are also embarrassed about taking screening tests. Whether health providers advise their patients about preventive health behaviors or recommend cancer screenings also has a great impact, according to recent studies. And it helps if advice about preventing cancer is understandable to the patient and easily achieved.

"There is [a lot] of evidence that tells us that if a doctor suggests a concrete behavior to a patient, and it’s not too difficult, it does make a big difference," said Neil Weinstein, Ph.D., a researcher in risk perceptions, professor at Rutgers University, and visiting scholar at the National Cancer Institute. "But sometimes the advice that consumers get, especially about diet, is frustrating for them because it’s hard to follow," he said. Many consumers, especially smokers, may also deny that their behavior is dangerous, unless they receive risk information that’s personalized to their individual lifestyle.

Though recent articles on whether smokers underestimate or overestimate their risk of cancer and respiratory disease are somewhat contradictory, they do clearly show that smokers underestimate the hazards when comparing themselves to other smokers. Smokers voice a wide variety of reasons why the risks of smoking does not apply to them. "Often they’ll say ‘I don’t smoke as much, I don’t inhale as much, or the rest of my lifestyle is healthy,’" Weinstein said.

Screening Barriers

A recent study highlighted a few misperceptions about cancer screening. When Carolyn Beeker and fellow researchers at the Centers for Disease Control and Prevention put together 14 focus groups of white and African-American men and women over age 50, they found there was a great deal of misinformation about the benefits of colorectal cancer screenings.

"Many people believed that since they didn’t know about colorectal screening, it must not be important or the prognosis must be hopeless," said Beeker, director of the Urban Research Center and chief of evaluative behavioral science methods in the Epidemiology Program Office at CDC. Her study was published in June in the Journal of Community Health.

People in the groups, which numbered from 10 to 11 people, also expressed embarrassment about going through colorectal screenings and fear of finding cancer as reasons why they had not had the tests. The participants also said that their doctors had not recommended the tests for them, or even talked about them in more than a superficial way, Beeker said.

The Doctor’s Role

Research in other areas of cancer prevention indicates that physicians and other health professionals may not be getting the word out about preventive screenings to all their patients. Mammography rates among all women in the United States have risen since 1996, but they still remain low for minority women, especially African-American women, said Sherry Crump, M.D., a researcher who studies mammography, and assistant professor in the department of community health and preventive medicine at the Morehouse School of Medicine in Atlanta.

In a review of studies between 1989 and 1996 on barriers to breast cancer screening, researcher Sharon George, Ph.D., found that many physicians failed to recommend mammograms or perform clinical breast exams, especially for minority and low-income women. Women who were less educated and lived in rural areas were also less likely to get mammograms or clinical breast exams. Barriers to breast self-examination included lack of information about breast cancer risks and embarrassment.

"The data reveal that we need to increase our efforts to reach women who are underserved and give them the right kind of thorough information," George said. The review was published in Health Care Women International in January 2000.

Although increased recommendations from providers may help change many consumer health behaviors, public education is also needed to make preventing cancer easier. One example is the Hawaii SunSmart Program, in which researchers supplied educational materials and staff training for interactive workshops on sunscreen and skin cancer, and even provided sunscreen and shaded areas for children to play at 14 outdoor recreations sites in Hawaii.

In a study on the program, researchers revealed that these activities increased sun-protective behavior from 8% to 20% among the 285 participants—a statistically significant amount. "Three months after the study, the behaviors were also partly maintained, though there was a little bit of backsliding," said lead researcher Karen Glanz, Ph.D., professor of cancer prevention and control at the Cancer Research Center of Hawaii at the University of Hawaii.

"We felt that these improvements were a good sign that creative, engaging public education efforts can work. There’s also a great deal of promise in creating public policies, such as having shaded areas in playgrounds, that can easily have an impact on skin cancer prevention," Glanz said.



             
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