‘Tales of mind over cancer’: Cancer risk and prevention in the Canadian print media

This paper investigates coverage of cancer in three Canadian newspapers in order to explore how the print media presents issues related to cancer risk and prevention. Six months of newspaper coverage was coded and analysed quantitatively to identify trends in coverage. A small subset of these articles was then analysed qualitatively to identify latent and underlying messages. Results from the analysis suggest that coverage emphasised risk management through individual choice and lifestyle change, privileging a discourse of individual control. Conversely, social and environmental risks related to cancer were minimised, despite the emerging academic consensus around the central importance of social and environmental determinants of health. Lifestyle was the most frequently mentioned source of cancer risk. Social and environmental health links were mentioned sparingly, and when environmental links were presented they were contested in ways that lifestyle risks were not. The coverage reflects the prevalent discourse in Canadian society that responsibility for health management risk lies primarily with the individual.     

Coverage of breast cancer in the Australian print media--does advertising and editorial coverage reflect correct social marketing messages?

Early detection of breast cancer by mammographic screening has the potential to dramatically reduce mortality rates, but many women do not comply with screening recommendations. The media are an important source of health information for many women--through both direct social marketing advertisements and indirect dissemination of information via editorial content. This study investigated the accuracy of breast cancer detection messages in the top-selling Australian women's magazines and three weekend newspapers in the six-month period from December 2000 to May 2001 that included any reference to breast cancer and found that current coverage of breast cancer in the Australian print media conveys messages that are unlikely to encourage appropriate screening.     

Risk factors and epidemiology of breast cancer

Breast cancer is the most common form of cancer and the principal cause of death from cancer among women worldwide. Risk factors for breast cancer are manifold. Certain risk factors, such as age and family history are well established. Research in the past decade has further elucidated disease aetiology, in particular the role of hormones and the discovery of breast cancer susceptibility genes (e.g. BRCA1, BRCA2). In spite of the evidence concerning the risks of breast cancer, women often have a poor understanding of its causes and limited personal risk perception. The media are an important source of health information for many women, but the popular and general-interest media often misrepresent risk factors. Knowledge of breast cancer risk factors and perception of personal risk are significant behaviour motivators to prevent, detect and manage disease. This article will review the risk factors for breast cancer, and examine the research on women’s perception of risk and understanding of risk factors, and the reporting of breast cancer in the media.     

Read all about it: the over-representation of breast cancer in popular magazines

BACKGROUND: While women are far more likely to develop and die from cardiovascular disease (CVD) than breast cancer, research has shown that they markedly overestimate their personal risks of breast cancer and underestimate their CVD risks. The source of this disparity is not yet known, although increased media attention to breast cancer relative to CVD has been suggested to play a role. The purpose of the present study was to provide a first critical test of this possibility. Two hypotheses were tested: (a) the number of breast cancer articles would be greater than the number of CVD articles; and (b) this disparity in coverage would increase over the years. METHODS: A web-based search engine was used to quantify all breast cancer and cardiovascular disease articles (keyword search) in 73 popular magazines on a annual basis for a 10-year interval (1990-1999). RESULTS: Consistent with study hypotheses, breast cancer articles outnumbered CVD articles, and this disparity widened over the years (P < 0.0001). This disparity was not limited to specific magazine categories (e.g., women's interest). CONCLUSIONS: Over-representation of breast cancer vis-a-vis CVD is pervasive in popular magazines. Future research should investigate how such disparities in the media may influence risk perceptions, adoption of preventive health behaviors, and compliance with screening guidelines.     

Uncovering differences across the cancer control continuum: a comparison of ethnic and mainstream cancer newspaper stories

OBJECTIVE: The use of the news media to disseminate control research could play a pivotal role in reducing the cancer burden. An important first step is to understand how newspapers cover cancer and if differences exist between mainstream and ethnic newspapers. METHODS: Cancer news in the major U.S. (MAJN) (N=5327) and ethnic (ENW) newspapers (N=565) appearing in 2003 were content analyzed. Comparisons of mainstream and ethnic newspapers utilized Pearson x(2) tests of two-sided statistical significance and independent samples t tests for interval-level variables. RESULTS: Breast cancer dominated coverage: 27% of MAJN and 35% of ENW stories mentioned breast cancer. Coverage focused primarily on cancer treatment (MAJN: 60%; ENW: 52%) rather than on primary or secondary prevention. Compared to mainstream newspapers, the ethnic newspapers required lower literacy levels for understanding news stories, were substantially more likely to cover primary and secondary cancer prevention, and paid more attention to cancer awareness and education. CONCLUSIONS: The ethnic media are a promising vehicle for dissemination of cancer control messages. However, the successful utilization of any U.S. newspaper as a dissemination mechanism requires a greater understanding of the root causes for imbalances in cancer coverage and work with journalists to reframe cancer news coverage.     

XRAYS (eXamining Relevance of Articles to Young Survivors) Program Survey of Information Needs and Media Use by Young Breast Cancer Survivors and Young Women at High-Risk for Breast Cancer

Women age 45 years or younger with breast cancer, or who are at high-risk for breast cancer due to previously having the disease or to genetic risk, have distinct health risks and needs from their older counterparts. Young women frequently seek health information through the Internet and mainstream media, but often find it does not address their particular concerns, that it is difficult to evaluate or interpret, or even misleading. To help women better understand media coverage about new research, Facing Our Risk of Cancer Empowered (FORCE) developed the CDC-funded XRAYS (eXamining Relevance of Articles to Young Survivors) program. To assure that the XRAYS program is responsive to the community’s needs, FORCE launched a web-based survey to assess where young women seek information about breast cancer, and to learn their unmet information needs. A total of 1,178 eligible women responded to the survey. In general, the breast cancer survivors and high-risk women between ages 18–45 years who responded to this survey, are using multiple media sources to seek information about breast cancer risk, prevention, screening, and treatment. They place trust in several media sources and use them to inform their medical decisions. Only about one-third of respondents to this survey report discussing media sources with their health care providers. Current survey results indicate that, by providing credible information on the quality of evidence and reporting in media reports on cancer, XRAYS is addressing a key need for health information. Results suggest that it will be useful for XRAYS to offer reviews of articles on a broad range of topics that can inform decisions at each stage of risk assessment and treatment.     

Tobacco cessation and weight loss: trends in media coverage

OBJECTIVE: To examine time trends in amount of media coverage on tobacco cessation versus weight loss and test whether the 2 topics compete for limited media attention. METHODS: Monthly print and broadcast media coverage from 1995 to 2003 was estimated. RESULTS: Tobacco and weight coverage were uncorrelated. Tobacco coverage peaked in 1997-98, whereas coverage of weight increased linearly between 1995 and 2003. CONCLUSION: Tobacco and weight topics do not appear to compete for media coverage. Interest in weight topics is rising, consistent with its growing public health importance. Coverage of tobacco is declining, suggesting a need to keep tobacco and cessation in the public eye.     

Newspaper reporting on legislative and policy interventions to address obesity: United States, Canada, and the United Kingdom

This article analyzes the content of articles in major newspapers in the United States, Canada, and the United Kingdom that discuss legislative and policy measures to control obesity. The aim was to identify and compare measures that attract media attention in the three jurisdictions: the tone of print media coverage, the characterization of obesity, and attitudes toward government interventions to address obesity. We collected 360 articles published between January 1989 and April 2009 in 12 major newspapers: 83 were published in the United States, 85 in Canada, and 192 in the United Kingdom. Articles in the three jurisdictions discussed the nature and causes of obesity in similar terms, but revealed differences in attitudes toward obesity and toward legal and policy interventions to control rising obesity rates. Obesity is reported principally as a lifestyle problem, but articles state (in varying proportions) that individuals, governments, and industry all share a role in addressing modern environments to promote healthier choices.     

Pink Ribbons and Red Dresses: A Mixed Methods Content Analysis of Media Coverage of Breast Cancer and Heart Disease

This research examined media coverage of breast cancer (n = 145) and heart disease and stroke (n = 39) news articles, videos, advertisements, and images in a local Canadian context through quantitative and thematic content analyses. Quantitative analysis revealed significant differences between coverage of the diseases in placement, survivors as a source of information, health agency, human interest stories, citation of a research study, the inclusion of risk statistics, discussion of preventative behaviors, and tone used. The thematic analysis revealed themes that characterized a “typical” breast cancer survivor and indicated that “good” citizens and businesses should help the cause of breast cancer. Themes for heart disease and stroke articulated individual responsibility and the ways fundraising reinforced femininity and privilege. Findings provide insight on how these diseases are framed in local Canadian media, which might impact an individual’s understanding of the disease.     

Endogenous sex hormone levels and breast cancer risk

Sex-steroid hormones are a major determinant of the risk of breast cancer. We evaluated the relationship between obesity and endogenous estrogen levels in 79 healthy, postmenopausal women. Thirty-nine of the women were siblings of patients with postmenopausal-onset breast cancer; the remaining women were age-matched (+/- 10 yr) controls. Our hypothesis was that the siblings of the breast cancer patients would weigh more and that this excess weight would lead to higher serum estrone levels. The choice of unaffected family members of breast cancer patients reduces the concern that results may have been influenced by the cancer rather than antecedent to its development. Our findings demonstrated a statistically significant excess estrone level in the siblings compared to the controls (58.9 vs 47.8 pg/ml, P = 0.005). The siblings weighed 4.3 kg more than the controls. Matched pairs analysis (sibling-control), adjusting for weight, also showed significant differences in serum estrone levels. These differences were observed despite comparability in dietary intake, medication use, and personal medical history. These findings represent the first time that higher estrogen levels have been measured in siblings of postmenopausal breast cancer patients. This observation may represent an important link in our understanding of the relationship between genetic and environmental risk factors of breast cancer. One approach to subsequent genetic studies of breast cancer may be to focus on the possible biological determinants such as sex-steroid hormone level receptors, oncogenes, and gene products and not on the "familial aggregation" of breast cancer.     

A comparison of breast, testicular and prostate cancer in mass print media (1996-2001)

This paper compares the portrayal of breast, testicular and prostate cancer in mass print English language magazines in the United States and Canada from 1996 to 2001. It is a follow-up of three papers that examined each of these three diseases separately in high circulating magazines up to 1995. It includes both quantitative and qualitative analyses of magazine stories and notes the continuing dominance of a medical perspective regarding disease as well as the association of each type of cancer examined with stereotypically individualized yet feminine and masculine characteristics and pursuits. It notes the conflation of breast cancer, since the discovery of BRCA1 and BRCA2, with the family. To be a 'feminine' woman is to be vulnerable to breast cancer and to be a 'masculine' man is to be vulnerable to testicular cancer when young and prostate cancer when older. The association of disease not just with personhood but also with the specifics of stereotyped masculinity and femininity may construct a more intimate, more personal link between disease and identity. This close attachment of gender and disease may shore up and exacerbate a fear reaction. It may also serve to diminish the awareness of other, more prevalent, causes of death for men and women. The social control consequences of potentially exacerbated disease-specific fear are discussed.     

Media coverage of women's health issues: is there a bias in the reporting of an association between hormone replacement therapy and breast cancer?

Media coverage of scientific research plays a major role in shaping public opinion and influencing medical practice. When an association is controversial, such as with hormone replacement therapy (HRT) and breast cancer, it is important that a balanced picture of the scientific literature be reported. The objective of this study was to assess whether scientific publications that do and do not support an HRT/breast cancer association were cited in the media in proportions similar to those with which they appear in the scientific literature. Scientific publications reporting on the HRT/breast cancer association published from January 1, 1995, to June 30, 2000, were identified through a systematic Medline search. Media reports from newspapers, magazines, television, and radio that reported on HRT and breast cancer were retrieved from an online database. Investigators independently recorded characteristics of the scientific publications and media reports. A total of 32 scientific publications were identified: 20 (62.5%) concluded there was an increased risk of breast cancer associated with HRT (positive publications), and 12 (37.5%) concluded there was no evidence for an association (null publications). Nearly half (47%) of the scientific publications were not cited by the media. There were 203 media citations of scientific publications: 82% were of positive publications and 18% were of null publications, representing a significant excess of citations of positive publications (p < 0.01). Media coverage of this controversial issue is based on a limited sample of the scientific publications. Moreover, the excess of media citations for positive scientific publications suggests a bias against null scientific publications.     

State of the Evidence: The Connection Between Breast Cancer and the Environment

Abstract

A substantial body of scientific evidence indicates that exposures to common chemicals and radiation, alone and in combination, are contributing to the increase in breast cancer incidence observed over the past several decades. Key recurring themes in the growing scientific literature on breast cancer and environmental risk factors are: (a) the importance of understanding the effects of mixtures and interactions between various chemicals, radiation and other risk factors for the disease; and (b) the increasing evidence that timing of exposures matters, with exposures during early periods of development being particularly critical to later risk of developing breast cancer. A review of the scientific literature shows several classes of environmental factors have been implicated in an increased risk for breast cancer, including hormones and endocrine-disrupting compounds, organic chemicals and by-products of industrial and vehicular combustion, and both ionizing and non-ionizing radiation.     

Prevention and genetic testing for breast cancer: variations in medical decisions

The discovery linking the genes BRCA1&2 to familial breast cancer played an important role in the clinical practice of geneticists and physicians. The availability of genetic tests for BRCA gene mutations prompted cancer geneticists to give information about genetic risk and to assess many women with a personal or family history of breast or ovarian cancer to inform them of preventive measures. These consist mainly of breast self-examination, mammography screening, chemoprevention and prophylactic surgery (mastectomy, oophorectomy). This paper examines clinical practices related to hereditary breast cancer testing and introduces a number of results from a survey carried out, between 1996 and 1998, in three clinics located in Montreal (Quebec, Canada), Marseilles (France) and Manchester (Great Britain). Results show substantial differences in the way cancer geneticists deal with environmental risk factors, breast and ovarian cancer testing, and chemoprevention and prophylactic surgery. Differences across cities persist in the multivariate analysis, suggesting that attitudes towards preventive measures may be partially explained by cultural factors. Different dimensions of culture are discussed including the social representation of health and risk, the interpretation of scientific evidence and the role of innovation leadership.     

Objectivity and ethics in environmental health science

During the past several decades, philosophers of science and scientists themselves have become increasingly aware of the complex ways in which scientific knowledge is shaped by its social context. This awareness has called into question traditional notions of objectivity. Working scientists need an understanding of their own practice that avoids the naïve myth that science can become objective by avoiding social influences as well as the reductionist view that its content is determined simply by economic interests. A nuanced perspective on this process can improve research ethics and increase the capacity of science to contribute to equitable public policy, especially in areas such as environmental and occupational health, which have direct implications for profits, regulation, legal responsibility, and social justice. I discuss research into health effects of the 1979 accident at Three Mile Island near Harrisburg, Pennsylvania, USA, as an example of how scientific explanations are shaped by social concepts, norms, and preconceptions. I describe how a scientific practice that developed under the influence of medical and nuclear physics interacted with observations made by exposed community members to affect research questions, the interpretation of evidence, inferences about biological mechanisms in disease causation, and the use of evidence in litigation. By considering the history and philosophy of their disciplines, practicing researchers can increase the rigor, objectivity, and social responsibility of environmental health science.     

‘The living death of Alzheimer's’ versus ‘Take a walk to keep dementia at bay’: representations of dementia in print media and carer discourse

Understanding dementia is a pressing social challenge. This article draws on the ‘Dementia talking: care conversation and communication’ project which aims to understand how talk about, and to people living with dementia is constructed. In this article I draw on the construction of dementia manifest in two data sets – a corpus of 350 recent UK national newspaper articles and qualitative data derived from in‐depth interviews with informal carers. These data were analysed using a thematic discursive approach. A ‘panic‐blame’ framework was evident in much of the print media coverage. Dementia was represented in catastrophic terms as a ‘tsunami’ and ‘worse than death’, juxtaposed with coverage of individualistic behavioural change and lifestyle recommendations to ‘stave off’ the condition. Contrary to this media discourse, in carers' talk there was scant use of hyperbolic metaphor or reference to individual responsibility for dementia, and any corresponding blame and accountability. I argue that the presence of individualistic dementia ‘preventative’ behaviour in media discourse is problematic, especially in comparison to other more ‘controllable’ and treatable chronic conditions. Engagement with, and critique of, the nascent panic‐blame cultural context may be fruitful in enhancing positive social change for people diagnosed with dementia and their carers.