Cancer: Tackling Fear Of The Known
Our medical correspondent Dr. Jon LaPook shares his first-hand knowledge about why some patients don't get cancer screenings that could save their lives.
We all welcome the good news, but we have to guard against easing up in the fight against cancer. Over 500,000 Americans still die each year from cancer. And African Americans have significantly higher death rates than Whites: 38 percent higher for men and 18 percent higher for women.
We must get our priorities straight. Personally, my top three priorities are research, research, and research. Basic research is crucial to developing new strategies for detecting and fighting cancer. The budget for the National Institutes of Health doubled from 1998 to 2003, but has not kept pace with inflation since 2003. In addition to maximizing government support, we need to remember that U.S. business has contributed mightily to cancer therapy over the past decade, especially in the area of "targeted therapies" that have, for example, led to effective treatment of some forms of leukemia and breast cancer. Let's be creative in exploring new ways to increase effective partnership between government, corporations, non-profits, and philanthropic organizations.
Aside from understanding the causes and treatments of cancer, we need to improve our understanding of why patients don't get cancer screening, why they don't get regular checkups. One obvious explanation is lack of access to medical care. The odds of early cancer detection are stacked against the almost 50 million uninsured Americans and who knows how many "underinsured" Americans. But in addition, there are patients who avoid screening because of fear. When I was a third year medical student, a woman came into the hospital with a breast cancer that was literally the size of a softball. She told me that she had first noticed the growth many months earlier, but was too afraid to go to a doctor. It still breaks my heart to think about her. She did not do well. Despite all our progress in treatment and prevention, the word "cancer" still means "death sentence" to many people, especially to older people who developed their understanding of cancer way before the recent advances.
In my book, fear of the known is right up there with fear of the unknown. I have well-educated, intelligent patients who do not follow through on standard cancer screening measures such as colonoscopy, mammography, and gynecologic and skin exams. It's hard to tease out the real reasons, but a frequent explanation is along the lines of "I would rather not know if I have cancer." This is not a logical response and all the beautiful charts in the world showing the effectiveness of screening colonoscopy will likely make no difference to this person. What does make a difference is reducing the person's fear.
Just as I will never forget the woman with the large breast mass, I will also never forget the man with rectal bleeding who admitted that he only came in for colonoscopy because he saw Katie Couric's colonoscopy on television. "If she can do it I can do it," he explained. His early colon cancer was cured. We need more public awareness campaigns to educate people and to help decrease fear of the known.