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Perceptions of Cancer Risks, Reality May Be Out of Sync

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Milwaukee Journal Sentinel


MILWAUKEE - Kenneth Kilpela has some theories about what caused the throat cancer that cost him his voice box a decade ago.

"I worked three years in a steel mill. There was dirt, dust, smoke and a very difficult atmosphere," he said. He also was a carpenter and sometimes handled fiberglass insulation and sanded drywall.

It's understandable that he'd worry about conditions he found unpleasant at his jobs and whether they may have caused or contributed to his cancer.

But doctors are more likely to focus on something else in the 61-year-old Michigan man's past: 20 years of smoking.

While no one can say with certainty that any one person's cancer is due to any one risk factor, tobacco causes the vast majority of throat and oral cancers - not just lung cancer, as Kilpela had thought, said his doctor, Bruce Campbell, interim director of the cancer center at Froedtert Memorial Lutheran Hospital and the Medical College of Wisconsin.

"We don't know everything about what causes cancer, but patients are quick to find things, to look in other directions" besides smoking and other behaviors they chose, Campbell said.

Kilpela's case illustrates a common problem: Perceptions of risk often are out of kilter with reality.

That's especially true of cancer, which is so dreaded that emotion often overwhelms reason, causing some risks to be feared too much and others too little.

The problem is compounded by the skepticism and mistrust that many patients feel toward doctors, drug companies, chemical manufacturers and government regulators. The resulting misperceptions can lead people to damaging decisions as they avoid risks distorted by their fears.

An example:

Many people spend $1,000 for a full-body scan marketed as peace of mind for those worried that they may have a hidden cancer.

In reality, such scans deliver 100 to 250 times the radiation of a single chest X-ray - a potential health hazard for a test that's usually unnecessary in the first place, a Food and Drug Administration advisory panel has warned.

These same people may worry about radiation exposure from power lines and irradiated foods, contrary to scientific evidence that they cause no harm. And they may balk at the cost of a health club membership that offers them opportunities to exercise and cut their risk not just of getting cancer but also many other diseases.

Sometimes seeking emotional balm lets us avoid facing self-inflicted risks. Rather than focus on our potentially harmful behaviors, we go to great lengths to force others to take action against something we fear and can't control.

Prominent cancer physician and educator Larry Norton of Memorial Sloan-Kettering Cancer Center in New York recalls such scenes during hearings several years ago into suspected higher rates of breast cancer on Long Island.

"I remember a woman with a cigarette in her mouth complaining that the water in Nassau County must be contaminated," Norton said.

"We don't know a whole lot about the science of how people make decisions," or what it takes to motivate them to change behaviors they know are risky, Norton said.

To learn more, two major cancer groups recently teamed up to conduct a national telephone survey on attitudes toward cancer risk, the first such survey of its kind. The poll was sponsored by the Cancer Research and Prevention Foundation and the American Society of Clinical Oncology, the largest organization of cancer treatment specialists.

About 1,000 randomly selected adults were interviewed in April and May, and results were presented at ASCO's annual meeting in Chicago in May.

Most people know that smoking, exposure to secondhand smoke and a family history of cancer increase the risk of getting the disease.

But there's a disconnect when asked what they personally can do to lower their risk.

"Only a third of Americans believe maintaining a healthy weight will reduce their risk," but obesity and poor diets are the second major contributing factor to cancer after tobacco use, said Bernard Levin, a cancer prevention expert at the University of Texas' M.D. Anderson Cancer Center in Houston.

Asked what they thought could be done to reduce risk, the top answers were: change their diet, 56 percent; stop smoking, 50 percent; get more exercise, 33 percent; and get cancer screening tests, 26 percent.

About 24 percent said they use sunscreen, but other research shows that only about 12 percent actually do it.

Half of those in the survey think that vitamins and herbals will help. "But in fact, there are no studies on herbal supplements that show they have any effect on reducing cancer risk," Levin said.

Seven out of 10 said they believe that vitamins and herbals are as safe as or safer than drugs they can buy over the counter, yet supplements are not regulated by the Food and Drug Administration and can vary greatly in purity and active ingredients, unlike prescription drugs, which are regulated.

Diane Blum, executive director of Cancer Care Inc. and former editor of ASCO's Web site for patients, thinks the popularity of supplements is due to a strong desire for a sense of control, especially among cancer patients who feel the disease and even the medical establishment have robbed them of that.

"People are looking for things they can do themselves," as opposed to things doctors can do to treat their disease, she said.

Ellen Stovall, executive director of the National Coalition for Breast Cancer Survivorship, said this desire for control colors how people view risk and what they do about it.

"People who think everything's happening to them have a different perception of risk as opposed to people who take control," she said, citing attitudes toward obesity and losing weight as an example.

"People would rather take a pill than do the lifestyle modifications that will reduce risk," Stovall said.

But even when people are aware of risks and fearful of getting cancer, it's often not enough to motivate behavior change.

In the survey, 84 percent said they believe that smoking increases their chance of getting cancer. Yet 57 percent said they had smoked cigarettes and 39 percent said they still do. Of those who still smoke, 82 percent said they had tried to quit.

"Knowing and doing are two different things. It's a lot harder to change your behavior. Most people who smoke say they would love to stop," said Peter Greenwald, director of cancer prevention at the National Cancer Institute.

So besides quitting smoking, which everybody now knows would cut cancer risk, here are other things that the American Cancer Society recommends:

-Eat a variety of foods with an emphasis on fruits and vegetables.

-Maintain a healthy weight.

-Exercise - at least moderate activity for at least 30 minutes a day, five or more days a week.

-Limit alcohol consumption.


(c) 2003, Milwaukee Journal Sentinel. Distributed by Knight Ridder/Tribune News Service.

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