04 December 2009

Paper tigers

A government-backed report into cancer this week revealed some interesting statistics, and a treeful of newspaper stories. Most preferred to focus on the negative aspects of Professor Mike Richards' findings in Cancer Reform Strategy, and there was certainly enough material in there for indignation by those papers for whom it is the stock-in-trade: "postcode lottery" for survival rates, lower one-year survival rates than our European neighbours and the call for improvement in early diagnosis.

For me the most interesting aspect of the report was the positive macro findings which gave reasons to give at least two cheers: "There has been a further fall in cancer mortality, with the latest data (the average for 2006–08) showing that, among people under 75, cancer mortality has fallen by 19.3% since 1995–97. We are well on track to achieve the target of a 20% reduction by 2010....For breast cancer, five-year survival rose from 80.6% in 2000 to a predicted level of 86.0% in women diagnosed in 2007. The equivalent figures for colon cancer in men are 47.6% rising to 53.4% and in women 47.6% rising to 52.7%."

Whether you live in Paris or Peterborough, across the board, cancer survival rates are improving across the western world - in short, fewer people are dying of cancer at ages that we would consider 'young'. Terrific news if you are a human being but bad news if, instead, you write for the Daily Mail. For example, the Mail has warned us that the following things are likely to give us cancer: mouthwash, obesity, wine, shampoo, mozzarella cheese, chips, underarm deodorants, your height, vitamin C and candles. With all those threats lurking in every corner, it's a wonder we can even leave the house, never mind attend a screening appointment.

Even more disappointing for the Daily Mail is the apparent cause behind these reductions: evidence-based medicine. Those really boring things like better dietary advice, national screening programmes, vaccination, scientific research and improved surgical techniques. Because they are often difficult, slow and take a long time. They require some patience, rational thought and careful observation. All the things the Daily Mail is against.

The Mail likes its cancer solved quickly - preferably through a cheap, easily available, everyday commodity that can tackle a terrifically complex and various condition, such as cancer, in a simple way. So, again, according the Daily Mail, the following things will probably cure cancer - a balance, if you will, for all that shampoo and mouthwash: mushrooms, kangaroos, raspberries, a special gene, aspirin, tea and uncut carrots.

It is often said that fear of crime is much more prevalent that crime itself - no matter how much crime rates decline, people still put it high on a list of worries when polled in the street. In the same way what the Daily Mail writes about is fear of cancer rather than cancer itself, at least in terms of writing about its risks in a meaningful or sensible way. We see Jade Goody dead at 27 from cervical cancer, we listen to horrific statistics from cancer charities that 1 in 3 of us will die from it (or 1 in 2, depending on the type of cancer or who you ask). We conflate the two points, and imagine middle aged cancer as disturbingly common, smack bang in the middle of the Mail's demographic. But leaving aside unusual cases like lung cancer, which correlate strongly to a single cause, there is one overwhelming factor that determines the risk of you dying of cancer of whatever type and ferocity: age.

Cancer is a disease of the elderly, or at least the over 60s. Over 75 and the rates skyrocket. We all have to die of something, and for the elderly, cancer is a high risk. Of course some young people die of cancer, and when they do it seems cruel, baffling and capricious - the sort of thing that might make you throw up your hands and buy another punnet of raspberries or rub a kangaroo.

The relentless coverage of what is, to the majority of the population, actually quite a low risk, and the giddying array of PR campaigns to promote cures, products, drugs and quackery through the media has the effect of making cancer seem inexplicable, random as though a punishment from the Almighty. Certainly if every day you are told of a different test in a lab that produced a surrogate outcome on a mouse, and that is filtered through the Daily Mail to a simplistic cause and effect: today drink more tea to prevent cancer, tomorrow don't cut up your carrots. It is latter-day shamanism, and rather than empowering readers, or making them better informed, it stops them seeing the wood for the trees - from concentrating on what we know from long-term studies has a meaningful impact on risk insofar as you can control it: better diet, healthy exercise, moderate alcohol intake, no smoking and reduced stress. Evidence-based medicine saves lives, but where's the angle on that?

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