NEWS

Surveys Find Adults Willing To Pay To Reduce Their Cancer Fears

Christine Theisen

While several ongoing clinical trials search for definitive answers to which cancer screening tests are in the best interests of patients, two recent national surveys indicate that Americans are willing to spend money to reduce their worries about cancer, and they highlight some concerns about how well people understand the risks and benefits of screening.

In one survey, conducted by researchers Lisa Schwartz, M.D., and Steven Woloshin, M.D., of Dartmouth Medical School and the VA Outcomes Group of White River Junction, Vt., 87% of respondents reported they believe that routine cancer screening is a good idea and that finding cancer early means saving lives. Seventy-three percent of respondents said they would rather receive a total-body computed tomographic (CT) scan than receive $1,000 in cash.

A second survey found that respondents were more worried about getting cancer than they were of suffering from heart disease, Alzheimer’s disease, or HIV/AIDS, and 80% of respondents said they favor increasing federal funding for cancer research.

"The American public fears cancer far more than they fear other potential tragedies, including an automobile accident or even a terrorist attack," said Warren Froelich, director of communications for the American Association for Cancer Research, which, along with the Lance Armstrong Foundation, sponsored the second survey of 1,000 adults in late 2003.

Schwartz and Woloshin found that people are worried enough about getting cancer that many feel those who are not screened are irresponsible. This may be because 53% of respondents believed that screening usually reduces the amount of treatment that would be necessary if cancer is found. Two-thirds of respondents said they would want to know they had cancer even if nothing could be done about it. The results of their survey, a random telephone survey of 1,000 adults without a history of cancer, were published in the Journal of the American Medical Association in January of this year.

Can We Talk About It?

Schwartz and Woloshin are concerned that the current level of enthusiasm for cancer screening does not allow for public discussion about the risks and benefits of screening for the disease. The importance of screening also extended strongly to people’s beliefs about their own health. In the focus groups they used to develop their survey, Schwartz and Woloshin asked women how they would react if their doctor recommended that they have Pap smears (screening for cervical cancer) less often. "It was amazing," Woloshin said. "People would say things like ‘My doctor wouldn’t do that. My doctor’s a good doctor,’ and ‘I would go to a different doctor.’"

"We were surprised that people would try to keep having [Pap smears] over their doctor’s advice," Schwartz added. The U.S. Preventive Services Task Force recommends that women be screened for cervical cancer at least once every 3 years, not necessarily every year.

Woloshin noted that another consequence of the public’s strong belief in the benefit of screening is that people may question the motivation of a person or organization that tries to point out the risks of screening as well as the benefits. "If I say that screening may not be worthwhile or there may be a downside to screening, is it because I’m a greedy HMO and I’m trying to save money?" asked Woloshin.

Screening Today: Total-Body CT

A popular form of screening being used today is the total-body CT, which is actively marketed to the public by some hospitals and radiologists as a disease-screening tool for cancer, heart disease, and other illnesses. CT scans are traditionally used as a diagnostic tool at times when doctors are concerned about the functioning of a specific part of a person’s body.

In their survey, Schwartz and Woloshin asked respondents whether they would prefer a total-body CT or $1,000 in cash. They described the total-body CT as a "3-D look inside your body using a CT scanner. A CT scan gives a very detailed picture of your lungs, liver, heart, and other internal organs, as well as bones and arteries. A total-body scan can find many diseases like cancer before they can be found by routine checkups. The body scan is quick and painless."

The question is not whether total-body CT scans can identify cancer but whether there is a health benefit to identifying the disease early that outweighs some of the possible costs. "It’s just intuitively appealing, the idea that [identifying cancer] earlier is better," said Schwartz. Although the idea is appealing, "what we know about screening is that ... there’s a small proportion of cancers where screening will make a difference [and reduce mortality]," she added.

The costs of screening, especially of screening tests such as the total-body CT, which have not been proven by randomized trials to reduce cancer mortality, range from the physical effects of the scan itself—"the amount of radiation exposure is pretty substantial," said Woloshin—to the stress of experiencing the follow-up tests, such as biopsies, that follow a false alarm.

Results and Next Steps

Schwartz and Woloshin hope that the results of their survey can be used as a starting point for organizations that promote screening messages. "We’re hoping to promote a more balanced discussion about screening rather than a one-sided message that says screening can only be beneficial," said Schwartz, "because screening healthy people is a two-edged sword. While testing will help a few people, it will create problems for others. It seems like most of the messages out there about testing exaggerate its potential benefits and fail to mention harms."

The Centers for Disease Control and Prevention are taking steps in this direction. "One encouraging thing is that the CDC, in their new initiative for prostate cancer screening ... [is] trying to develop a public health campaign that helps to present both the benefits and the harm [of screening] and provide a more realistic sense of the risk of prostate cancer," Schwartz said. "I think we’re hopeful if we can have more balanced public discourse, people will have the permission to make a decision about screening as opposed to feeling like it’s an obligation."



             
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