Cancer: Myths and Misconceptions

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<ul><li><p> the Promotion of Health</p><p>The Journal of the Royal Society</p><p> online version of this article can be found at:</p><p> DOI: 10.1177/146642408410400501</p><p> 1984 104: 161The Journal of the Royal Society for the Promotion of HealthVal Box</p><p>Cancer: Myths and Misconceptions </p><p>Published by:</p><p></p><p>On behalf of: </p><p> Royal Society for Public Health</p><p> can be found at:The Journal of the Royal Society for the Promotion of HealthAdditional services and information for </p><p> Alerts: </p><p> </p><p> </p><p> </p><p> </p><p> What is This? </p><p>- Oct 1, 1984Version of Record &gt;&gt; </p><p> at The University of Edinburgh on November 17, 2014rsh.sagepub.comDownloaded from at The University of Edinburgh on November 17, 2014rsh.sagepub.comDownloaded from </p><p></p></li><li><p>161</p><p>The Journal of .The Royal Society ofHealth</p><p>VOLUME 104 No 5 OCTOBER 1984</p><p>Cancer: Myths and Misconceptions*VAL BOX, M.SC., DIP.DIET, DIP.ED. FRSH., Cancer Education Adviser, S. W. Thames Regional Cancer Organisation, Royal Marsden Hospital,Sutton</p><p>INTRODUCTIONTHE FIRST paragraph of an American textbook ofCancer Nursing will be quoted, as it provides an approp-riate introduction to the psychosocial impact of cancer.</p><p>&amp;dquo;Cancer is a word that elicits an immediate emotionalresponse, a response that seems to have no relationshipto rational thinking, depth of knowledge of the indi-vidual, or the individuals role in society. The sameresponse seems to occur in physiciens, nurses, collegeprofessors, researchers, politicians, and unskilledlabourers alike. It occurs in patients, families, friends ofthose who have cancer, people who think they may have</p><p> cancer, or people who take the view that cancer is some-thing that will happen to other people. In all of thesegroups, the feelings and mental images stirred up by themention or thought of the word cancer seem to be practi-cally identical&amp;dquo;. </p><p>So far this description has only stated that attitudes tocancer are universal. However the writer would be sur-</p><p>prised if the majority of readers had not imagined this tobe a pessimistic description.</p><p>This article will attempt to document the publicsknowledge in relation to cancer.. However when asked aquestion very few people will admit to not knowing theanswer. It is the authors contention that wrong answers</p><p>may provide useful information in relation to therespondents attitude to a subject. Therefore knowledgeof and attitudes to cancer will be considered together.Health professionals attitudes will then be comparedwith those of the public. The expected effects in relationto such issues as reporting suspicious symptoms earlywhen the chance of cure would be greater and com-</p><p>* Paper presented at a meeting of The Royal Society of Health March1 st 1984.</p><p>pliance to health behaviour such as screening will also beconsidered.</p><p>Based on discussion of cancer knowledge andattitudes, the aims and objectives of cancer educationwill then be suggested and how these could beimplemented. ,</p><p>PUBLIC OPINON SURVEYSTHERE HAVE BEEN four large public opinion studies inthe U.K. carried out between 1953 and 1974, andinformation from these will be quoted together withadditional evidence from smaller studies where approp-riate.( 1 ) Manchester Study</p><p>In 1953 Paterson and Aitken-Swan conducted aninterview study in the Manchester area 2. A follow-upstudy was carried out by the same authors in 1957 on twodifferent populations within the region, one of whomhad been exposed to a cancer public education cam-paign3. Approximately 1200 women chosen systemati-cally from the electoral role were interviewed in each ofthe three groups. Women were chosen as they werebelieved to delay longer in consulting a doctor whensymptoms which could suggest cancer occurred.(2) Lancaster StudyThe second large public opinion study was carried</p><p>out by Briggs and Wakefield in Lancaster in 1966, againon women over 21 years of age. As in the previous studya follow-up was carried out by Knopf 7 years later after apublic education campaign, but this also includedwomen between 18-21 years.(3) Merseyside StudyA parallel study was conducted by Hobbs in Mersey-</p><p>side, 1966, to the one carried out in Lancaster6. How-</p><p> at The University of Edinburgh on November 17, 2014rsh.sagepub.comDownloaded from </p><p></p></li><li><p>162</p><p>ever the results are not exactly comparable as a certainamount of public education had already been carried outin Merseyside. Apart from those on Merseyside beingless positive about preventive measures, there is little toreport which is different from the other studies.(4) S.E. Wales StudyThe fourth study was carried out by Williams et al in</p><p>1972~ and is interesting as 203 men were interviewed aswell as 801 women. Differences in beliefs between thetwo sexes are noted, and in particular more men thanwomen -</p><p>(a) are optimistic in relation to cancer treatment(b) give definite answers instead of dont knows(c) provide correct answers.</p><p>THE PUBLICS KNOWLEDGE IN RELATION TOCANCERGeneral Cancer Knowledge:Some of the answers supplied by the public when</p><p>interviewed in the studies previously described aredocumented in Table 1. It is interesting to note commonmisconceptions, but also pleasing to see evidence thatknowledge has improved over time.</p><p>a) Which disease kills most peopleIn 1980 there were 130,566 deaths from cancer in the</p><p>U.K., which accounted for 22% of all deathsg. Howeverdeaths from I.H.D. diease were 154,371, accounting for27% of deaths, and if figures are taken for circulatorydisease deaths these were 290,395, approximately halfof all deaths. The incidence of cancer is high, and it isnow quoted that 1 in 3 people develop cancer duringtheir life-time9. However, cure seems to be overlookedand to many a diagnosis of cancer implies impendingdeath. Data in Table 1 suggests that a large proportion ofthe population believe cancer to be the chief cause ofdeath and if anything the belief was increasing.</p><p>b) Early treatment increases the chance of cureSeveral studies have shown that with increasing delay</p><p>in reporting symptoms and receiving treatment, thepatients prognosis has become poorer. It is thereforereassuring to find that belief in early treatment hasimproved and by 1973 was 88%. However when lookingat the same studies there seems an overlap of views aswhen for example in 1973, 88% believed in curabilitywith early treatment there were also 22% who suggestedthat cancer is never completely curable. One feels thatalthough some people have correct information, whichthey can quote, their attitude may deny this knowledge.</p><p>c) Do you know someone who has been cured of cancer ?If approximately 33% of the population have cancer</p><p>at some time and yet only 20% of the population diefrom it, it could be suggested as a crude figure that 1 in 3are cured of their cancer or it is successfully controlledso that they do not die from it.Hoever in 1953 only 30% of the population knew</p><p>someone who had been cured and 45 % by 1966. It couldbe suggested that those with cured cancer may neverhave been told their diagnosis and therefore could nottell of their cure. Cancer has often been described as ataboo subject, one which we do not talk of and thereforecures are not advertised. Journalists appear happier topublicise The death of another cancer victim than thestory of an individual who is cured or coping successfullywith their disease.Early Warning Signs: </p><p>.</p><p>Questions and answers in relation to the early warningsigns of cancer are to be found in Table 2 and Figure 1.</p><p>It would appear that there has always been a highawareness of a lump in the breast being possibly cancer.Indeed one would be surprised if any woman did notknow of the possibility and one wonders if those who donot mention it are engaging in some type of denial.The knowledge that bleeding ten years after the</p><p>menopause is likely to be cancer still does not appear to(be realised by even the majority of women. Also it couldibe said that bleeding after the menopause is more likelythan a lump in the breast, of being cancer. One in ninebreast lumps are benign although in older women thechance of malignancy is higher. Cancer of both the cervixand uterus increase in the lower social classes, but unfor-tunately knowledge of their symptoms decreases as doescompliance with the cervical smear test.Other reasons given in 1973 for bleeding after the</p><p>menopause are listed in Figure 1. One finds that asusual the pill is blamed. There is some suggestion thatnot looking after oneself or perhaps being run down as acause. It has also beeen suggested that there is a beliefparticularly in social classes IV and V that it is normal toexpect poorer health as one gets older and this symptomin that case would probably not be reported.The last two suggestions are unfortunate, as although</p><p>it is now generally accepted that the incidence of cervicalcancer increases with the number of sexual partners, amoral judgement appears to have been made againstthose developing this type of cancer. This can produceseveral problems ranging from the belief that only prom-iscuous women need cervical smears, to being unwilling (to go for confirmation of the diagnosis of this type ofcancer for the fear of societal rejection.</p><p>Table 1.</p><p>Public Opinion in Relation to Cancer(% indicating a particular answer or attitude)</p><p> at The University of Edinburgh on November 17, 2014rsh.sagepub.comDownloaded from </p><p></p></li><li><p>163</p><p>Table 2.</p><p>Figure 1.</p><p>Other reasons given for bleeding 10 years after menopause</p><p>What Causes Cancer?:The most common spontaneous answers to interviewersquestions in relation to cancer causative factors aresmoking; and knocks, bumps and falls. Smoking wasmentioned by 18% of those interviewed in Lancaster in1966 rising to 20% in Lancaster in 1974, but this still isvery low. There was more agreement in the wrong belifin knocks, bumps and falls, 25% in 1953, 38% in 1969and 32% in 1974. This is often in relation to breastcancer. However it is also mentioned in relation to sportsinjuries and cancer of a limb bone. Other answers in1973 included highly seasoned food, pneumonia, pesti-cides and stress. The author would hazard a guess that ifthe public were asked in 1984 stress would be mentionedvery often. The difference between stress as a possiblepromoter more than a causative factor also appears to belittle understood. Table 3 summarises the percentage ofrespondents who agreed with a particular statement inrelation to cancer causation made by the interviewer in</p><p>, particular studies.- Belief in smoking is shown more clearly here andparticularly in men. Again there are moral overtonessuggested, as about a third of respondents agreed withbad living as a cause. Bad living on probing meanssexual intercourse outside marriage but also treatingfamily members badly!</p><p>Physical cleanliness is also thought to be causative byabout a quarter of respondents. May be this is due toemphasis on hygiene in early health education. The onlyevidence to confirm this is a correlation between poordental hygiene and cancers of the mouth and one studysuggesting increased cervical cancer in the wives of menwho are employed in dirty jobs&amp;dquo;. Figure 2 shows cervixstandardised mortality ratios for wives of men in particu-lar occupations. Very few people now appear to believethat cancer is catching but approximately a third believeit to be hereditary. However many of the public believethat if something is hereditary that if your father ormother had it then you are also bound to develop it.Inheritance of a higher potential than average does notseem to be understood and that one still needs to beexposed to a carcinogen such as cigarette smoke.</p><p>Figure 2.</p><p>Cervical Cancer - Standardised Mortality Ratios</p><p>Table 3.</p><p>% Agreeing with Interviewer Suggesting Cancer Causative factors</p><p>How can cancer be prevented?:When asked for spontaneous answers in relation tocancer prevention not many are quoted. The realisationthat having a cervical smear can be considered a first stepin cancer prevention has increased from 8% in 1966 to33% by 1973. Several answers made in 1973, the originsof which are debatable, will be quoted: dont eat burntfood; stop tumbling; dont think too much about it; keepblood in good condition; dont eat tinned food.</p><p>THE PUBLICS MOST COMMON QUESTIONSIN 1977-80 several U.K. organisations with a remit forCancer Education under the auspices of the CancerEducation Co-ordinating Group of the U.K. kept arecord of the questions that were asked by the publicafter cancer talks. The information was collated and a</p><p> at The University of Edinburgh on November 17, 2014rsh.sagepub.comDownloaded from </p><p></p></li><li><p>164</p><p>report produced by Davison2. These questions aresummarised in Table 4.</p><p>Table 4</p><p>Publics Most Common Questions in Relation to Cancer 1979-80</p><p>As can be seen in almost 60% of the talks someoneasked whether cancer is inherited - suggesting personalvulnerability felt by individuals. Many of the audienceswere all female and therefore it may not be surprisingthat there are several questions relating to cervicalsmears. However it may be useful for health profession-als to note that education and publicity in relation tocervical smears does not appear to be adequate.Almost half of the audiences asked whether cancer is</p><p>on the increase. Cancer is now given increasing publicity,although often undesirable in format or content, andtherefore it would seem reasonable that the public wouldthink it to be on the increase. However it must beremembered that the general public do not realise thatsome increase could be accounted for by an ageing pou-lation and much increase in relation to smoking. How-ever it is useful to remember that standardised mortalityratios for cancer by period of birth have decreased stead-ily since 1900 for men although not until 1930 forwomen&amp;dquo;.</p><p>Other questions asked are quite predictable from theprevious discussion.</p><p>PROFESSIONAL BELIEFS ABOUT CANCERAre the publics negative feelings about cancer just areflection of professional attitudes?It has been suggested that as health professionals andparticularly doctors are opinion leaders in relation tohealth, it would seem reasonable to consider whether thebeliefs and opinions of lay people have been influencedby those of health professionals. There has been no...</p></li></ul>


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