AICR report reveals new angle on ‘mismatch repair’ in cancer
The World Health Organization designated Feb. 4 as World Cancer Day.
I know this only because I happened to see it mentioned on Twitter. Otherwise, I would have been unaware of what seems as though it should be a notable day for those of us involved in cancer care.
Coinciding with World Cancer Day, the American Institute for Cancer Research (AICR) released its 2015 Cancer Risk Awareness Survey Report. My exposure to this report was prompted by a “junk” email; otherwise, I probably wouldn’t have seen it.
Picking up on the theme of awareness — or lack of it — the AICR report offers interesting insights into how well we, as health care professionals, communicate with the public about cancer risk and modifiable risk factors.
It’s pretty disturbing.
The survey asked more than 1,100 randomly selected Americans questions to gauge their understanding of risk factors for cancer. The good news is that more than 90% of respondents have gotten the message about tobacco, and more than 80% are aware of the dangers of excessive sun exposure (although this number has actually fallen slightly since AICR began its surveys in 2001).
The more disheartening news relates to other well-established cancer risk factors: obesity, inadequate physical activity, diets low in vegetables and fruits, alcohol consumption, and diets high in red meats and cured meats.
With the exception of obesity — which 52% of respondents identified as a risk factor for cancer — awareness of these key risk factors is less than 50%. In some cases, it has fallen over time.
An unheard message
The most recent Cancer Statistics 2015 report from the American Cancer Society puts these data into context.
The society estimates that in 2015, breast cancer in women will be the leading cancer in terms of the number of new cases, and it will be the second leading cause of cancer deaths among women. At least three of the six risk factors listed above are well documented to increase breast cancer risk.
Perhaps even more concerning is that colorectal cancer — which has been linked to all six risk factors listed by AICR — is projected to remain third among men and women in terms of both new cases and cancer deaths.
There is nothing new in the message that most common cancers are, at least in part, related to modifiable lifestyle-related risk factors. What is concerning is that the message doesn’t seem to be getting across.
Even more concerning is the public’s ranking of cancer risks. Although tobacco is ranked No. 1, the next of the six well-established risk factors comes in at No. 15 in public awareness. In between, respondents ranked cancer genes, radiation, industrial pollution, nuclear power, food additives, genetically modified foods, stress and hormones in beef among the factors they associate with cancer.
Some of these factors are linked with cancer etiology, but the magnitudes of the risks in population terms are — for many — likely to be relatively small. Cellphones, power lines, grilling meat and coffee also are among the top 29 risk factors perceived by the public.
Of course, understanding lifestyle-related factors that can affect cancer incidence is one thing. Modifying behaviors is another. This is a complex scientific, social, economic, political and emotional issue.
Many researchers, health care professionals, cancer organizations, advocacy groups and politicians are involved in efforts to educate the public and explore ways to change behaviors that expose the population to excess cancer risk.
Reports such as this pose challenges to us as cancer care professionals in terms of our responsibility to help get this message across. The AICR report tells us there is a mismatch between what we have learned about cancer risk and what the public understands.
Repairing that mismatch is a shared responsibility.
In his most recent editorial for HemOnc Today, Derek Raghavan, MD, PhD — the publication’s Chief Medical Editor for Oncology — wrote about our social responsibility as physicians in the context of Medicaid reform.
It seems to me this is another issue of which we, as oncologists and hematologists, should be taking some ownership.
As individual physicians, our ability to influence policy, research and funding decisions may be limited, but there are areas where we could have some influence.
We should encourage our professional societies to be more active in the area of public education. There is no doubt that many such organizations are strong advocates of public communication and education — ASCO, in particular, has been very active in this area and recently has made major efforts toward highlighting the impact of obesity on cancer incidence.
That said, these organizations are our societies, and we have the ability to influence their priorities.
Take a look at the most recent “Clinical Cancer Advances” publication from ASCO. This has become a widely read and important annual report, highlighting achievements in cancer care in the previous year. The 2015 report also provides a 10-year retrospective.
As usual, it is an excellent summary of cancer care advances in the fields of prevention, screening and treatment. However, even a superficial glance through the report shows the content is highly skewed toward treatment advances, and the prevention sections are largely based around medical interventions aimed at prevention rather than education or behavioral changes.
No intended criticism — the themes of the report are clearly directed at the impact of research on cancer outcomes, but because the readership of this report is so wide, the failure to address some of the awareness and behavioral issues is at least a missed opportunity.
We also can have influence within our own institutions. During the past couple of weeks, I have received reports from 12 major cancer centers in the United States. All of these are impressive, mostly glossy, highly produced brochures that highlight scientific and treatment advances. The public websites of many of our centers also highlight important groundbreaking programs, and most contain some educational material.
At least one recent study of cancer center advertising to the public showed that the emphasis is placed on treatment advances.
It probably would be very instructive for all of us to take a close look at the information our centers make available to the public though print material, the Web and social media to see how much is truly directed at educational efforts about cancer risk.
As physicians, we should be playing our part at a local level by influencing our own institutions and societies to advocate for greater public awareness, and we should be advocating for research funding to investigate the best way of getting this message across.
American Institute for Cancer Research. The AICR 2015 Cancer Risk Awareness Survey. Available at: www.aicr.org/assets/docs/pdf/education/aicr-awareness-report-2015.pdf. Accessed on Feb. 9, 2015.
Masters G, et al. J Clin Oncol. 2015;pii:JCO.2014.59.9746.
Siegel R, et al. CA Cancer J Clin. 2015;doi:10.3322/caac.21254.
Vater L, et al. Ann Intern Med. 2014;doi:10.7326/M14-0500.
For more information:
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 email@example.com.
Disclosure: Sweetenham reports no relevant financial disclosures.