Friday, the NY Times described the relatively paltry efforts in cancer prevention, compared to those for heart disease. Not that researchers haven’t been busy figuring out how to prevent various cancers:
Then, in 1999, he had a chance to do another breast cancer prevention trial, this time of an osteoporosis drug, raloxifene, or Evista, which did not have the cancer drug taint. It was to be compared with tamoxifen.
The $110 million study, involving 19,000 women, ended in 2006. The two drugs were found to be equally effective in preventing breast cancer, but with raloxifene there was no excess uterine cancer and the clotting risk was 30 percent less.
“It was a spectacular clinical trial,” Dr. Vogel said. But, he added, “Once again, the world met the result with a shrug and a harrumph.”
Mind you, we’re talking about lowering breast cancer probabilities from twenty percent to ten percent: this isn’t some ridiculously low probability event that becomes a ridiculously low probability event divided by two. So what gives? I think it’s patient fear:
He cannot understand why no one cares, but some doctors say they see a number of problems. It is usually not the cost; tamoxifen is about 30 cents a day and raloxifene $3.30 a day. It is doctors’ practices and women’s concerns.
Most doctors, said Dr. Therese B. Bevers, medical director of the Cancer Prevention Center at M. D. Anderson, do not take the first step — calculating a woman’s lifetime risk of getting breast cancer — in part because that can lead to the next step, spending an hour or so discussing cancer risk and drug risks and benefits.
Dr. Bevers suggests the drugs for women whose lifetime odds exceeds 20 percent. That could include, for example, a 55-year-old woman who began menstruating early (increasing the risk), had her first child late (again increasing the risk), and whose mother and sister got breast cancer. About half the time, though, women with that kind of risk turn down the drugs, Dr. Bevers said. “The No. 1 reason I hear is, ‘Oh, I just don’t like to take medications,’ ” she added.
I’m guessing, but a lot of people just don’t like thinking about the possibility of being sick (understandable), and decide to ignore the problem (fucking stupid). But some people go farther, and engage in ‘woo-istic thought’ (based on ScienceBlogling Orac‘s derogatory phrase, woo, for altie medicine):
Others, like Cecilia Anderson, who is 57 and lives in Houston, worry about side effects. “I felt like my quality of life was in question,” she said. “I am busy, I am out there. I totally love my life and don’t want it to be compromised.” Her lifetime risk of breast cancer is 20.5 percent, compared with an average risk of 9.8 percent for a woman her age. Ms. Anderson declined the drugs. “I live a different lifestyle,” she said. “I eat organic foods, I exercise. Through all of that comes a spiritual element as well. Mind, body, and spirit are all connected.”
I could understand if you tried the medication, and you felt lousy. Somehow, I don’t think “a spiritual element” is going to halve the probability of breast cancer. (Before anyone thinks I’m picking on women, men seem just as idiotic regarding prostate cancer prevention–which has a much lower survival rate). But people who are frightened will engage in activities that lend the illusion of control (there is little conclusive evidence that diet can significantly lower breast cancer rates in older women*). The terror of knowing that there’s is a one-in-five chance of getting cancer, combined with the knowledge that, even with medication, there is still a one-in-ten chance of getting cancer has to be terrifying.
Woo-meisters prey on this fear: false certitude is far more comforting than statistical probabilities.
In a larger context, this irrationality–and it is irrational–affects all of us: when we, as a society, do not engage in prevention, we all end up paying more in healthcare costs. I’m not sure how to do it, but somehow we have to figure out a way to reach frightened patients.
*A healthy diet and exercise are good for you for other reasons.