Uwe Reinhardt, Ph.D., remembered how he was swept up by the news of U.S. Sen. John McCains (R-Ariz.) melanoma last August. Around that time, Reinhardt noticed that his toe had turned black. He usually walks around his house without shoes on and wondered if he simply stubbed his toe. Much to his surprise, when he discussed it with his wife, who had kept up with news of McCains melanoma, she told him that it could be a subungual melanoma, a very rare type of melanoma.
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They told him that his odds of having melanoma were slim, but Reinhardt chose to pay $800 out of pocket for the procedure. Luckily, doctors did not detect melanoma, he recalled. Reinhardt stressed that in such a case, insurers should not have to pick up the tab because the odds of finding disease are so low and it would bankrupt the nation. "You cannot charge the collective for every neurosis," he said.
Reinhardt said that his story illustrates how public figures experience with cancer can prompt screening, intervention, and costssometimes inappropriately. It is a cascade the public rarely sees. Instead, when a public figure gets cancer, the news becomes saturated with days, sometimes weeks, of infinite detail about the cancer, with anatomic diagrams, diagnostic technology information, and statistics on how many Americans die from the disease. Then, calls to cancer organizations, office visits for screening tests, and often, funding for the disease, spike, at least temporarily.
The effect is far more than anecdotal. NCIs Martin Brown, Ph.D., and Arnold Potosky, Ph.D., found in a 1990 study that public interest in colorectal cancer and the screening tests associated with it spiked in 1985 following President Reagans colon cancer scare. According to a 1998 Journal of the American Medical Association study, there was a prominent shift in surgery preferencce from breast-conserving surgery to mastectomy in the months following Nancy Reagans mastectomy. The effect was seen mostly in white women ages 50 to 79.
These blips also followed news of Betty Fords breast cancer, Katie Courics campaign for colon cancer screening, and New York City Mayor Rudolph Giulianis prostate cancer. A recent panel discussion took up the thorny issue of whether news coverage of celebrities cancers necessarily improves the publics health.
George D. Lundberg, M.D., panel moderator and editor in chief of Medscape, read four vignettes describing what followed after celebrities revealed that they had cancer. In 1974, Betty Ford became one of the first women to discuss breast cancer publicly, he pointed out. She underwent a radical mastectomy and subsequently became a strong advocate for the procedure. Next, her daughter Susan Ford Bales began a campaign urging women to get annual mammograms.
"In 1974, there was a crying need for information on breast cancer," said panelist Barron H. Lerner, M.D., Ph.D. "Women appreciated that the topic came out at all and Betty Fords stance was considered a courageous, heroic move." Lerner, associate professor of medicine and public health at Columbia University, and author of The Breast Cancer Wars, added: "In 1974, screening guidelines were not yet in play."
Robert Smith, Ph.D., director of cancer screening for the American Cancer Society, distanced ACS from Bales campaign for early mammograms. "We never had a guideline urging women to have annual mammograms beginning at age 35."
But Karla Kerlikowske, M.D., assistant professor of medicine, epidemiology, and biostatistics at the University of California at San Francisco, noted that the ACS used to recommend baseline mammograms beginning at age 35, a guideline that quietly disappeared some years later.
Kerlikowske said that the celebrity angle seems to play on peoples emotions and emphasize anecdotal information rather than evidence-based information.
"I remember when Gilda Radners husband was encouraging everyone to get ovarian cancer screening," she said. "After Gilda died, her husband pushed screeningeven though there is not a good screening testand advised performing prophylactic oophorectomies in women with a family history [of ovarian cancer]."
Eric (Rocky) Feuer, Ph.D., of NCIs Surveillance Research Program in the Division of Cancer Control and Population Sciences, acknowledged that "it can be positive for celebrities to come forward," adding "if they try to understand the science and the controversy." However, "when your emotions are caught up in it, it is hard to think that early detection is not always a good thing."
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"We are a hysterical nation that does not like to face things. We can never discuss the price of a human life. Human life is priceless . . . . As a policy analyst, this is the worst possible way to allocate dollars."
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