This month, the magazine racks are lined with covers advertising stories about breast cancer. The stories have become almost a seasonal reminder: It must be October, Breast Cancer Awareness Month.
The most recent figures from the National Center for Health Statistics clearly list heart disease as the leading cause of death in women overall. All cancers combined are the second leading cause of death. A closer look at cancer-related deaths among women reveals that lung and bronchus cancer top the list; breast cancer is second. For some women, breast cancernot lung cancer or heart diseaseis the disease that they fear most, and stories about breast cancer abound in consumer magazines for all ages.
"I think that one reason that breast cancer gets more than its fair share of coverage is due to the great efforts of breast cancer activists," said Barron Lerner, M.D., Ph.D., associate professor of medicine and public health at Columbia University, New York, and author of the book The Breast Cancer Wars.
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Age as a Risk Factor
A major concern about the increased media attention is that age is not always adequately reported as a risk factor for breast cancer. A study published this year found that in popular and general-interest publications only 14% of articles about breast cancer presented factual information about age as a risk factor.
Wylie Burke, M.D., Ph.D., and colleagues from the Department of Medical History and Ethics at the University of Washington, Seattle, also found that in articles that included patient vignettes, 84% of those women were diagnosed with breast cancer before 50 years of age, when in fact the expected percentage of women diagnosed would be 16%. In 47% of the vignettes, women were diagnosed with breast cancer before 40 years of age; the expected percentage of diagnoses in that age range is 3.6%.
The researchers concluded that, "Stories about breast cancer in popular U.S. magazines misrepresent the age distribution of the disease, emphasizing atypical cases of early-onset breast cancer and their social consequences."
Such articles may do a disservice, Lerner suggested, "if articles are not written carefully and youve got 24 year-old women marching into doctors offices and demanding mammograms because they read in a young womens magazine that breast cancer is a problem."
But Barbara Rimer, Dr.P.H., director of the Division of Cancer Control and Population Sciences at the National Cancer Institute, noted that if such articles accurately convey information about breast cancer at a young age and "allay womens concerns about breast cancer and let them know that they dont need to be getting mammograms in their 20s and 30s, I think that kind of information could in fact be helpful."
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There is some debate regarding the effect of heightened awareness and fear on appropriate breast-screening behaviors. Rimer coauthored a study with Isaac M. Lipkus, Ph.D., and others at Duke University, Durham, N.C., that discussed screening behaviors and delved into the connection between risk and worry. "Its important that people have awareness of risks and of what they need to do," said Rimer, "and even a moderate level of fear can be very helpful because people will take action. But if people become extremely fearful, they may become paralyzed and unable to act."
Kevin D. McCaul, Ph.D., and colleagues at North Dakota State University in Fargo, wrote in a recent review article that the majority of data suggest that breast cancer worries do not lead to screening avoidance but, instead, worry leads people to try to protect themselves by taking advantage of screening opportunities.
But regardless of whether a high level of worry about breast cancer leads people to act or to shun breast screening behaviors, researchers have another concern associated with breast cancer worries: inattention to other diseases.
Numerous studies conclude that women overestimate their risk of breast cancer. "And when women overestimate the risk, they pay less attention to other issues," asserts Neil Weinstein, Ph.D., a professor at Rutgers University in New Brunswick, N.J., and a visiting scientist at NCI.
Adverse Impact?
Indeed, many other researchers have found exactly that effect. In a recent article, Joel Erblich, Ph.D., and colleagues at the Derald H. Ruttenberg Cancer Center at the Mount Sinai School of Medicine, New York, concluded: "The present study contributes to an emerging appreciation that well-intended efforts to promote awareness of breast cancer risk in the population by both the health care community and the mass media may have had an adverse impact on perceptions of risk for heart disease, a much more likely source of morbidity and mortality." This misperception of risk was found to be a particular problem among women with family histories of breast cancer.
Surveys have shown that not only do women tend to fear breast cancer, overestimate their risk of developing it, and have less concern about developing heart disease, but they are also not aware that lung cancer is the major cause of cancer death for women overall.
"I have read over the years a number of articles discussing how certain womens magazines really ignore lung cancer risks," said Weinstein. "The suggestion has been that theyre so reliant on tobacco advertising that they just dont treat it honestly. So women, I think, get a skewed perception of which hazards they should be paying the most attention to."
Rimer concurred. "We see smokers who are very very worried about breast cancer, and yet theyre continuing to smoke. They have a much better chance of getting and dying of lung cancer than breast cancer, but many women underestimate their chances of getting lung cancer."
Womens misperceptions of breast cancer risk may be based partly on the fact that for women younger than age 55, specifically, breast cancer does cause more deaths than heart disease or other cancer sites, including lung cancer. For that specific age group, only accidents cause more deaths than breast cancer, according to a study by Phyllis Wingo, Ph.D., and colleagues at the American Cancer Society, Atlanta, and at the Fred Hutchinson Cancer Research Center in Seattle. They point out, however, that women probably dont recognize that absolute death rates are very low, in general, at young ages, and how dramatically heart disease death rates increase with age when compared to breast cancer death rates. These age-specific findings underscore the importance of judicious reporting.
Lerner suggested that the provocative nature of some of the stories may cause unnecessary alarm. "As long as we have editors who want to get people to read their newspapers and we have marketing people who want to get advertisements into magazines, newspapers, and television, youre going to have provocative material that is designed to raise eyebrows. . . . And there will be a segment of the population who gets unnecessarily alarmed."
Lerner said he hopes women will see such articles or advertisements, go to their doctor and say, "Look, I saw this. What do you think? Lets talk about it."
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