With both the Princess of Wales and King Charles undergoing treatment for cancer, one of the world’s deadliest diseases is back in the headlines in a big way.
There is no doubt the news has left many worrying not only about the fate of the King and Princess, but about their own health as well. After all, nothing strikes fear in one’s heart more than the C-word. The very mention of it feels like a death sentence.
However, a recent book argues that our fear of cancer is excessive and, in some cases, even a phobia.
In Curing Cancerphobia: How Risk, Fear and Worry Mislead Us, former journalist and Harvard University instructor David Ropeik argues that “our emotional relationship with the Emperor of All Maladies is out-of-date.”
Cancer is, without a doubt, a major killer, claiming more than nine million lives worldwide annually, and an estimated 86,700 in Canada alone last year.
But Mr. Ropeik, an expert in risk communication, says many of our beliefs about cancer are wrong, or out-of-date. In fact, his book challenges many truisms, saying:
- A diagnosis of cancer is not a death sentence. There are 200 types of cancer and about two-thirds are treatable, and some even curable. Cancer mortality is also down sharply from the early 1990s – there’s been a 40-per-cent reduction in mortality rates for breast cancer, and 50-per-cent reductions for prostate cancer and colorectal cancer.
- Not all cancers inevitably grow, spread and harm. Many grow slowly and don’t metastasize.
- Cancer is essentially a disease of aging, and largely a result of natural biological processes; 87 per cent of people who die of cancer are over the age of 50.
But the bulk of the book focuses on the value (or lack thereof) of screening. Mr. Ropeik says the evidence shows that the common mantra around cancer – that finding it early is essential to survival – is not true. While it may seem heretical, he argues that not every cancer needs to be detected early, nor treated aggressively.
This flies in the face of “common wisdom.” One of the most frequent messages for cancer advocacy groups in the wake of the Royal cancer diagnoses has been to urge more people to get screened.
In Curing Cancerphobia, Mr. Ropeik makes the case that, while screening saves lives in some cases, it has a modest lifesaving benefit overall, and also causes a fair bit of harm through overdiagnosis and overtreatment.
Take mammography screening for breast cancer: Screening 2,000 women for 10 years prevents one death. Meanwhile, 200 will receive false positives and 10 will undergo unnecessary treatment. (Other research has noted more impactful outcomes for breast-cancer screening, however.)
While the impression is that screening improves survival, that’s largely because screening is best at detecting low-risk, slow-growing cancers. Early detection makes it seem like people are surviving longer, but makes no difference to mortality.
This is true with prostate cancer as well. You need to screen 1,000 men aged 55 to 69 every one to four years for at least a decade to prevent one death.
Not to mention that the PSA (prostate-specific antigen) test itself is poor, correctly identifying cancer in only 25 per cent of cases. Sixty per cent of men receive a false positive, and 15 per cent a false negative. There is a lot of overtreatment, with consequential side effects such as incontinence and erectile dysfunction.
The most effective screening program is for colorectal cancer. For every 1,000 people screened, you save 22 lives. But a colonoscopy is an invasive test, and there is a lot of overdiagnosis and overtreatment, especially outside the recommended screening ages of 50 to 75.
Cervical cancer screening is also quite impactful, though it is a cancer that is far less common and deadly, and there are a lot of false positives that cause angst.
To be fair, Mr. Ropeik also notes that there is a fair bit of underscreening. Fear of cancer not only drives people to get testing and treatment they don’t need, but it also scares some away who would benefit.
Far too many people have their cancer diagnosed too late, when there is little that can be done to help them. That, too, is a symptom of cancerphobia. Cancer treatment has improved dramatically in recent years.
The overall message of the book is an important one: Follow the science to find the right balance.
Screening programs are important, but they should be targeted at those at the highest risk. Treatment, too, should be focused on those who will most benefit. Less can be more.
As Mr. Ropeik says, combatting cancerphobia comes down to “not letting fear fly the plane.”
Editor’s note: A previous version of this article incorrectly stated there are 2,000 types of cancer. There are 200 types. This version has been updated.
André Picard