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Cancer awareness months: Are we missing an opportunity or missing the point?
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Coincidentally, I had e-mails from two research charities with an interest in hematologic malignancies, reminding me that September was Blood Cancer Awareness Month. I feel embarrassed that I need to be reminded every year about Blood Cancer Awareness Month, although I’m not quite sure why. Because the best opportunity for awareness campaigns seems to me to be in changing attitudes and behaviors toward cancer prevention, screening and early detection, it’s not too surprising that this wouldn’t be a high priority for those of us taking care of patients with hematologic malignancies. These strategies have no major role in leukemia, lymphoma and multiple myeloma, so it’s difficult to believe that an awareness campaign could have much direct impact.
Of course, I understand that a major driver of cancer awareness months is to help fundraising for research and patient support organizations, which in turn has patient impact. I was interested to see if there is an evidence base for cancer awareness campaigns as a method for directly affecting cancer-related behaviors and whether our on-the-whole hands-off approach to cancer awareness months — with the exception of breast cancer — is a missed opportunity to influence our local community’s attitudes toward screening and prevention.
Impact of awareness
As I started to investigate this issue, I discovered that blood cancers are not the only malignancies “assigned” to September. It turns out that September is also recognized by the American Cancer Society as the awareness month for childhood, gynecologic, ovarian, prostate and thyroid cancers. Maybe the most surprising aspect of this is that even as a cancer specialist — albeit a relatively siloed one — I was completely unaware of these awareness efforts and wonder how many of my professional colleagues, even working within these specialty areas, know about their respective awareness months. On the other hand, if these awareness months function primarily as fundraising boosters, then maybe direct engagement of oncology providers isn’t important.
Not surprisingly, a Google search of cancer awareness months is dominated by breast cancer and by articles published in the popular press rather than the biomedical literature. A PubMed search identifies a more limited yield of publications, again dominated by breast cancer, but with some interesting data.
A study from University of Oregon investigated the relationship between Breast Cancer Awareness Month and the number of breast cancer diagnoses in November for the years before and after the introduction of Breast Cancer Awareness Month using SEER data. Jacobsen and colleagues showed that between 1973 and 2005 there were some clear “spikes” in November breast cancer diagnoses. Two of these spikes were attributed to increased awareness related to breast cancer diagnoses in first ladies. In the mid-1990s, there was a clear spike in November diagnoses, associated with the introduction of Breast Cancer Awareness Month, which lasted for 3 years but was not seen in subsequent years. Of note, however, screening rates overall have increased, and the distribution of breast cancer diagnoses throughout the year has become more uniform — the fact that there is no longer a November spike is probably because women have got the message about the importance of mammography and, as a result, we are no longer seeing the effect of a short-term awareness campaign. The results show that in the early years, the awareness month was highly effective.
These data suggest that awareness months may have clinically relevant impact. Further evidence comes from a United Kingdom-based study in which a large-scale public awareness campaign was launched (not strictly speaking, an awareness month) for early detection of lung cancer. A relatively brief national campaign was piloted in 2011 and then expanded nationally in 2012, encouraging citizens with a cough of longer than 3 weeks’ duration to visit their primary care physician for evaluation. The campaign resulted in significant increases in public awareness of persistent cough as a possible symptom of lung cancer, urgent referral for suspected lung cancer, increased lung cancer diagnosis and increases in the proportion of early-stage, resectable tumors. At the time of the study, this had not converted into survival changes, but the potential to modify clinically meaningful endpoints is clear.
Other objective data are difficult to find. No doubt breast cancer issues will be prominent in the lay press during October — many studies have shown this to be the disease women fear most. Concerns have been raised about the possible adverse effect of this coverage — the National Center for Health Statistics shows heart disease to be the most common cause of death in women, followed by lung cancer. Breast cancer is the third most common cause of death. Whether breast cancer awareness month really distracts women from other health care issues is not clear, but merits further study. If this is so, then the media coverage of awareness month is missing the point.
Returning to blood cancers, I was excited to see a headline in the lay press which spoke to proof of impact of Blood Cancer Awareness Month, although on a closer read of the article, it’s apparent that the impact really refers to the long-term impact that increased funding for research can have on these diseases. I am not able to find any data to suggest a short-term impact on patient behaviors, referral patterns or outcome.
Missed opportunity
The benefits of cancer awareness are clear and proven. Increased uptake rates for many prevention, screening and early detection strategies have saved millions of lives. Data to support the additional impact of short-term awareness campaigns are more elusive. There is no doubt that these campaigns are of major importance as fundraising opportunities and that the events surrounding awareness months enable increased support and advocacy for those affected by cancer. An outstanding question is whether, as cancer health care professionals, we can harness some of the energy generated by awareness months to change cancer outcomes. At least one study has explored the use of social media, specifically Twitter, during Breast Cancer Awareness Month, demonstrating that despite a huge peak of activity, particularly at the beginning and end of the month, there is virtually no exchange of information or education or prevention — tweets constituted mostly one-way communication. This would seem to be one opportunity to investigate interventions that could influence screening behaviors.
Amid the buzz that is always created around Breast Cancer Awareness Month, I am starting to think about whether we can make interventions synchronized with these events that can have direct patient impact. Some early data suggest that we can and that we are missing opportunities.
References:
Gottlieb N. J Natl Cancer Inst. 2001;93:1520-1522.
Ironmonger L, et al. Br J Cancer. 2015;doi:10.1038/bjc.2014.596.
Jacobsen GD and Jacobsen KH. J Health Econ. 2011;doi:10.1016/j.jhealeco.2010.11.005.
Thackeray R, et al. BMC Cancer. 2013;doi:10.1186/1471-2407-13-508.
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John Sweetenham, MD, is HemOnc Today’s Chief Medical Editor for Hematology. He also is senior director of clinical affairs and executive medical director at Huntsman Cancer Institute at the University of Utah. He can be reached at john.sweetenham@hci.utah.edu.