Cancer on Facebook

[liv]

I've got drawn into a couple of discussions about cancer marketing on Facebook recently. Facebook is utterly useless for having any kind of actual discussion, so I'm moving my long-winded thoughts to here.

First, there's another of those breast cancer "awareness" memes doing the rounds. As far as I can tell, this is just another way to get people to pass on chain FB statuses, using cancer as the guilt lever. I hate those things. A few years ago a couple of teenage boys convinced female friends on FB to post pictures of their breasts on FB "for cancer", and their prank went viral and millions of people posted underwear pics. It probably did do some tiny amount of indirect good for awareness in that it did start conversations that might not otherwise have happened. But seriously, even on the slacktivism level, there are better ways to do something about breast cancer than providing some teenage boys with wank material.

Then in subsequent years there have been several waves of women messaging all their female FB friends with instructions to post certain code-words in their FB status. The first few iterations it was something vaguely breast related (eg bra colours), and then it was something vaguely innuendo-ish, and by now it's morphed into mere cryptic codes where fruits represent the answers to tiresome questions. Because playing some game that's "girls only" and making all the "guys" scratch their heads is apparently going to "raise awareness" of breast cancer. I mean, look, people can play whatever memes they want if it seems fun and helps maintain their online social groups. But really this is nothing to do with cancer, this is a standard selfish meme which propagates purely because it has a propagation advantage, in this case provided by people's strong emotional feelings about cancer.

Instead of continuing the chain, I posted a grumpy status to the effect that I'm perfectly well "aware" of breast cancer, given that several people close to me have been diagnosed with it in the past couple of years and given that a large part of my full-time job is doing research to find better treatments. This led to a few comments about breast cancer marketing and gender and the infamous pinkification, lots of intelligent people participating but FB threads just don't work for expressing complex ideas.

The thing is, breast cancer awareness was actually a good idea a couple of decades ago. Breast cancer is incredibly common. Despite being vanishingly rare in men, way more people get it than any other cancer type. Breast cancer affects young (in cancer terms young means under 60) women a lot more frequently than other cancer types. And in the 80s, it was killing a lot of women needlessly, because of a combination of two problems. Firstly, there wasn't as much research into the disease as you'd expect when it's such a major killer, because medical research tends to assume people are male-by-default. Secondly, though, stigma and embarrassment about a disease that affects breasts, which are regarded as sexual, meant that women weren't getting diagnosed until it was too late. I don't want to give the impression that women back then were silly flighty little things who were too embarrassed to mention breasts in front of their doctors; no, the problem was that women who did get breast cancer kept it a secret from their peers, and there was almost no discussion of the disease in the media. So people really didn't know how common the disease is and therefore didn't seek treatment, while those who did get breast cancer were completely isolated and thought they were suffering alone.

As far as I understand it, the breast cancer awareness campaign was kicked off by American feminists and largely modelled on patient lobbying by people with AIDS. So there are parallels: the twisted ribbon symbol, the dual pronged approach of political campaigning for more research money and public awareness raising to inform people about the disease and help to address the stigma. I would say the campaign has been pretty successful; breast cancer is extremely well known, and more likely than just about any other cancer type to be diagnosed early enough to be treatable. The evidence is equivocal for systematic screening programmes like regular breast self-exams or offering mammograms to all women in the vulnerable age-group, but I think nowadays few women die simply because they (or their doctors) don't know that major changes in breasts should be investigated. At the same time funding earmarked specifically for breast cancer research is now really good, to the point where people complain that it's disproportionate and other cancers, let alone other rarer diseases are being neglected in favour of breast cancer research. And breast cancer research has been largely a success story; we know quite a lot about the pathways that frequently go wrong in breast cancer and there rational, targeted drugs available to treat them. It also helps that breasts are accessible to surgery, and while a mastectomy can be extremely distressing, the long-term physical health consequences are much smaller than with the removal of most other body parts. This is probably another good consequence of the awareness campaigns: people who have had breasts removed no longer have as much need to go to huge lengths to hide the unusual shape of their torso. I wouldn't say that there's no stigma, because we live in a culture that's obsessed with a narrow idea of physically beautiful, "perfect" bodies, but from what I've read the stigma is much less than it used to be.

That said, people do still die of breast cancer, particularly metastatic breast cancer. For reasons that are not yet entirely clear, breast cancer often follows a pattern where the primary tumour is completely removed, the person is disease-free for a long time (a decade is not untypical) and then the cancer returns in an aggressive form which tends to spread to the bones and spine, at which point it's rarely curable. This is why in my opinion you should continue giving money to charities which fund breast cancer research! But at least you don't have large numbers of women dying young purely because of sexism and stigma.

The problem of course is that at some point breast cancer awareness turned into a business opportunity. With the groundwork of tackling the stigma done by activists, breast cancer became a "sexy" disease. That is, it primarily affects affluent women, including young women, which gives it much more immediate emotional appeal than diseases of poverty and old age. And it's all too easy for companies to indulge in what's become known as pink-washing where they market pink products and claim they're "supporting" breast cancer victims. Charities tend to get in on the act a bit, because a climate where people are willing to give money for anything at all dyed pink does to some extent funnel more money towards breast cancer charities with little effort. This is a problem partly because pink-washing companies range from the actively dishonest who are just selling pink shit with vague promises of "support", to companies making really minuscule donations to actual breast cancer charities, cheaply improving their corporate image and also attracting more customers who feel virtuous about contributing to a good cause through shopping.

The other problem is that, well, breast cancer has become a brand. A brand which has many of the worst features of lowest common denominator advertising. It's all about young, thin, conventionally sexy women doing princess-femininity with lots and lots of pink and sparkles. This is kind of horrible for everybody who isn't sexy and ultra-feminine, and particularly for people who actually have breast cancer who aren't sexy and ultra-feminine! Like, ok, 20% of women who get breast cancer are under 60, but most of them are still too old to be what our culture considers sexy, never mind that that ignores the great majority of women with breast cancer who, like most other cancer sufferers, are elderly. And honestly, even most 20-year-olds aren't "sexy" according to marketing standards, and even if they are, cancer is just. not. sexy. Treatments for breast cancer may be effective but they are also seriously debilitating, and the sexy sexy branding is just adding insult to injury for people who are coping with the side-effects of chemo, radiotherapy and surgery as well as the fear of what is still a potentially fatal disease.

Oh, and some people with breast cancer are male. Even if men account for only 1% of total breast cancer cases, because breast cancer is so extremely common, that's still a few hundred men diagnosed each year in the UK. And imagine how hard it is for those men, not only dealing with cancer but on top of that being dumped into the world of sparkly pink princesses! If there's an awareness problem, it's probably the lack of knowledge that men can get breast cancer in the first place. This is partly because people in general don't realize that men have breasts, fully functional breasts in fact, we just don't call them breasts, which is mainly just a quirk of language. The reason men are a hundred times less likely to get breast cancer is because (normal or cancerous) breast tissue growth is extremely dependent on steroid hormones, and most men have a very different balance of sex hormones from women. (As for trans men, I assume men who transition socially only have an equal risk as cis women, whereas trans men who use exogenous hormones may have a somewhat reduced risk compared to cis women but probably higher than cis men. But that's a guess, I don't know the prevalence of breast cancer in trans men.)

Talking of men, some people very reasonably complain that prostate cancer is ridiculously under-funded compared to breast cancer. Prostate cancer is overwhelmingly likely to affect men rather than women, since cis women (that is at least 99.9% of women, possibly even higher than that depending how you count) don't have prostates. Prostate cancer is very nearly as common as breast cancer, but receives much less funding. That's certainly at least in part because it doesn't have a sexy awareness campaign; Movember most certainly doesn't have anything like the coverage that the relentless pink-for-breasts marketing does. It's also partly because prostate cancer is a much less tractable disease than breast cancer. For one thing it tends to affect old men, in fact mostly ETA: frequently, though not always, extremely old (defined as over 80) men are the ones who get the most aggressive form. Octogenarians are much less likely than under-50s to be in good enough general health to be able to handle extremely aggressive treatments, and also by the time someone reaches such an advanced age, they probably have all kinds of mutations, making it that much more likely they will develop resistant or highly malignant cancers. Also prostate cancer seems to be more diverse, it just hasn't proved possible to identify a few critical genes which determine either who will get the disease or which treatment to use.

Some people in the FB discussion mentioned a preference for breast cancer awareness ads that show scars, huge quantities of chemo drugs, generally the grim reality of cancer treatment with no pink. I think there is definitely a place for some pushback against the pinkification, but there can also be a problem with that as a strategy. The thing is, part of the stigma of breast cancer was caused by the stigma against breasts, and now things have gone too far the other way in terms of making breast cancer seem "sexy" and (marketing idea of) feminine. But part of the stigma against breast cancer was and is caused by the stigma against cancer. Portraying cancer as the most terrible thing that can happen ever can also be a negative thing. Yes, cancer is a scary and frequently fatal disease. Yes, the treatments available for cancer are pretty horrible; I'm proud to be part of the teams of scientists working on treatments with fewer side-effects, but the reality is that for most cancer patients, chemotherapy and radiotherapy are more unpleasant than the symptoms they experience from the disease itself. But if cancer is the ultimate in terribleness, that first of all prevents people from seeking treatment because they're afraid of a diagnosis, and secondly makes people who are diagnosed more miserable even than they need to be. Their social group may avoid them, it becomes very hard to talk about (even in a culture of relatively raised awareness) because the subject is so fraught with Horror and Tragedy. Making cancer into a relatively normal everyday thing, albeit an extremely unpleasant normal thing is, I think, desirable. Though preferably without trying to make it sexy, which it really isn't!

Anyway, while I'm on the subject of cancer on Facebook, a friend posted a link to an article claiming that Ginger Destroys Cancer More Effectively than Death-Linked Cancer Drugs, and asked me to debunk it. The article in question is a really terrible article, and actually I felt I wasn't needed; my friend who tagged me, who has no specialist scientific education, could easily see that it was utter nonsense. Plus again I was stymied by trying to make carefully thought out points in the discussion under a FB link.

To be honest, the article looked as if someone like, say, a bright homeschooled teenager had picked up a press release from a research department and written a report based on a very partial understanding of the article. For example, the writer has read "metastasize" as "metasize" which they interpret as [tumours] come back bigger and more stronger than their original size. Note that "metastasis" means that small pieces of the original tumour break off and form new tumours elsewhere in the body, not exactly a novel concept in cancer research. There is no such thing as "metasizing", the article has just made this up.

They quote one Raghu Kalluri, who I think is this guy, as saying Whatever manipulations we’re doing to tumors can inadvertently do something to increase the tumor numbers to become more metastatic, which is what kills patients at the end of the day. I quacked the phrase to see if I could identify the original press release being reported, and found a whole lot of articles with very very similar wording to the article linked on FB, mostly from dodgy SEO type sites where the text is there just to sell advertising. Anyway, for reference, this isn't the press release being quoted, but it refers to some of the same research: Tumor cells can prevent tumor spread; here's a Gizmodo piece which gives a somewhat better lay account of the actual implications of Kalluri's research, and even (wonder of wonders!) contains a link to the original publication, although sadly it's in the restricted-access journal Cancer Cell. Still a bit scare-mongering, but basically true: Kalluri's results don't refer to all anti-cancer drugs in general, just a particular treatment in particular circumstances may promote metastasis. This is still an important finding and a useful cautionary note about being over-excited about new generation cancer drugs; there can often be hidden, long-term risks that aren't found until the drug is in quite general clinical use. But it certainly doesn't justify "death-linked cancer drugs".

The junky, SEO article is even more vague on the details of the study that's supposed to show that ginger "destroys" cancer cells than on Kalluri's findings. But I think the original press release is Researchers uncover anti-cancer properties of whole ginger extract from 2011, including a link to the actual article. Again, closed-access and honestly in a fairly minor, though reputable, journal. So, ok, we have some actual peer reviewed research which is somewhat vaguely related to the absurd claims of the article. Cui bono? I don't know if the recirculated churnalism about the magical properties of ginger is designed to support quacks who want to sell whole ginger extract, or simply to attract page hits by making a shocking claim, or some combination. But anyway, it's spreading medical misinformation for the sake of a small financial gain, which is something I find morally abhorrent.

That said, I have no reason to doubt the integrity of Ritu Aneja, the person who's been working on ginger as an anticancer agent. So given she did in fact do scientifically meaningful experiments showing that whole ginger extract shrinks tumours in animal models, why in fact shouldn't we stop giving patients horribly toxic chemotherapy drugs and instead give them lots of ginger? Well, mainly because there are literally thousands and thousands of compounds which shrink xenograft tumours in mice and have relatively mild toxic effects on the mice, but the overwhelming majority of them are not in fact safe, effective cancer drugs. Real cancers are considerably more complex than xenografts, which are quasi-artificial tumours implanted in mice for the purpose of testing anti-cancer compounds without making the mice suffer unnecessarily by giving them full-blown cancer. So basically you can use xenografts to rule out potential drugs; if they don't work in xenografts they're really unlikely to work in real cancer. But a positive result in mouse xenografts is simply an indication that it's worth continuing to investigate the compound. Meanwhile cancer is still a deadly disease; not treating it or delaying treatment with the best available proven cancer drugs greatly increases the chance that the person with cancer will die of it.

However, the best available cancer drugs are by no means perfect. They don't work in all patients, and they do cause extremely unpleasant and not infrequently deadly side-effects. So in some sense it's not completely untrue to talk of death-linked cancer drugs. Look, for any given group of people with cancer, a proportion will die whatever treatments you use; some people might very reasonably prefer not to have to go through surgery and chemotherapy if they're just going to die anyway, but would rather make the most of the last few months or years of life available to them. A proportion will also get better pretty much whatever treatments you do or don't use, because some cancers just spontaneously get better via the body's natural defences or just good luck or perhaps they were never deadly in the first place. So you'll always get some anecdotes of people who eschewed all conventional treatments in favour of holistic or alternative or magical therapies, and lived many happy decades without experiencing the misery of a course (or several) of chemotherapy. The aim of actual scientific cancer research is to keep people alive who would otherwise have died of their disease or at least to postpone the inevitable; even if cancers do eventually become resistant and metastasize, there's some benefit in having a few months or years of good health you wouldn't have had otherwise. Does that justify the cost, financial and personal, of undergoing conventional cancer treatment? That's by no means an easy decision, either for individuals or for health services.

Comments

[jack]

*hugs* Yes, I agree completely :)

Writing about whatever disease ought to have more awareness and less stigma seems like a good response, trying to channel the ridiculous oversubscription rather than a futile attempt to curtail it. What disease most needs a higher profile? Prostate cancer? A different cancer? Alzheimers? Malaria?

[liv]

More awareness and less stigma? Hmmm, all your suggestions are good candidates. I'd probably add schizophrenia, which everybody associates with violent "craziness," and which seems to have a very clear neurological origin so is likely to be tractable to pharmacology if only there were better research. And I could make an argument for autoimmune conditions, which are about as much one single disease as "cancer" is, inflammatory bowel and coeliac and rheumatoid arthritis and MS and lupus and type I diabetes. There's a whole collection of things in that category that can affect any age, are under-diagnosed and not taken seriously enough, and can be incredibly debilitating / disabling.

Hell, you know that literally no drug company is currently developing new antibiotics for the commercial market? Because we're in a situation where resistance to new antibiotics develops faster than a new drug can turn a profit. Infectious diseases are definitely not sexy, but we could really really do with some novel antibiotics.

[ptc24]

Hell, you know that literally no drug company is currently developing new antibiotics for the commercial market?

For a long while, I've thought that the current division of labour - academics do basic research, the commercial sector does drug development - doesn't cut it, and we need (more) public sector or third sector drug development.

[liv]

It's kind of a commonplace that the set-up where academics take all the risks and the commercial sector gets just about all the profit isn't very fair. I think there's starting to be a bit of movement towards a different balance, but it needs pretty vast sweeping changes (and really, at least a little bit more funding for research that isn't directly profitable).

[swaldman]

Hell, you know that literally no drug company is currently developing new antibiotics for the commercial market? Because we're in a situation where resistance to new antibiotics develops faster than a new drug can turn a profit.

That is one of the most depressing things I've read in a long time. And this from somebody who follows climate science....

[liv]

I know, right? People are working on ways of killing bacteria that are not traditional antibiotics, and better ways of combining antibiotics to decrease the chances of getting resistance. But still, it's a pretty grim outlook.

[(Anonymous)]

For reasons that are not yet entirely clear, breast cancer often follows a pattern where the primary tumour is completely removed, the person is disease-free for a long time (a decade is not untypical) and then the cancer returns in an aggressive form which tends to spread to the bones and spine, at which point it's rarely curable.

How long has this been known? I can't say for certain if my mother knew this, but certainly what she repeated on to me is that she was told that if the cancer hadn't come back within five years after her initial treatment, she could consider that the all-clear. It was a shock to me, and I believe also to her and my father, when the cancer did come back, metastasised to her bones, after eleven years.

(Replying anonymously for the sake of my mother's privacy; probably not essential but better safe than sorry.)

[liv]

I'm afraid I don't know the answer to this. The thing where breast cancer usually metastasizes to the spine and bones has been accepted for as long as I've been working in the field. The fact that it can take a very long time to do so I really don't know how long established that is. I would guess that it may be somewhat more recent, because for a long time breast cancer was being diagnosed really late, and there weren't good treatments, so I imagine a lot of people never lived to experience the 10 years without disease.

[atreic]

This is probably in the top three posts about cancer I have ever seen on the internet :-)

However, I do feel I have to nitpick with For one thing it tends to affect old men, in fact mostly extremely old (defined as over 80) men. I mean, mostly is a weasel word, so maybe you didn't mean it in the strict '50%' sense. But 25% of prostate cancers are diagnosed in men aged under 65, and only 20% in men 80 or older (approximate stats here). It is true that the average age at diagnosis of prostate cancer is older than the average age at diagnosis of breast cancer, and it's an important difference, but I think it gets over-egged.

[liv]

Aww, thank you! I'm really, really glad that you liked this, and also grateful to you for being involved in the work that means I had plenty of epidemiological information available to be able to write it.

Thank you for nitpicking; I was using "mostly" loosely, and you're quite right that it's important to be accurate about these things. Prostate cancer is a bit of a weird case because while it's often diagnosed fairly young, it's sort of two different diseases, the benign or nearly benign slow-growing kind that affects men in late middle age, and the aggressive metastatic androgen insensitive kind it sometimes develops into, typically after a 20-year lag time so it's most commonly seen in the extremely old. But you're right, I shouldn't write sloppily and give the impression that 60-year-olds never get prostate cancer. Will update :-)

[atreic]

Yes, prostate cancer is a very weird case, and I don't have any easy answers. I'm glad intelligent people like you are thinking about it sensibly!

[swaldman]

thank you for writing this. The last time an "awareness" meme did the rounds on FB I grouched about how there probably aren't a load of scientists sitting around drinking tea who will say "look! Facebook wants us to cure cancer! we'd better get on with it!". and I got unfriended by a couple of people, called heartless, etc... :-\
And the rest of your post was interesting too :-)

[siderea]

Many years ago, when I was temping at MIT's Lab for Nuclear Science, I saw someone had stuck up on their door a comic strip. It was a Sunday strip from Robotman, and opened with the two protagonists sitting on a blanket at the beach. A middle aged guy in vacation clothes walks by them, sets out his own sun umbrella and blanket and beach chair. And he sits there for a little while looking more and more uncomfortable, until finally he bursts out, saying something along the lines of, "OKAY OKAY I ADMIT IT I'M A PREEMINENT CANCER RESEARCHER I DON'T KNOW WHAT CAME OVER ME TAKING TIME OFF I'M SO SORRY" grabbing his things and rushing back off the beach.

[swaldman]

*grin*

[liv]

I really don't know what started the idea that, contrary to all other industrial psychology, cancer researchers are supposed to be more productive at curing cancer if we never take breaks... I mean, hey, I'd willingly sacrifice beach holidays if someone could provide me with enough funding to spend my time actually doing research rather than applying for grants.

[liv]

Heh. I've only been called heartless for refusing to repost a similar thing about depression. Mostly I ignore the memes rather than post grumpy responses. Glad you enjoyed the post, anyway.

[swaldman]

I think the actual comment was "If you had a relative who had had cancer you would understand".

I have had, as (I imagine) have a majority of people, but I didn't feel the need to explain that....

[liv]

Oh dear. Seriously, there really aren't that many people who don't have any relatives who've had cancer, and regardless that was a completely obnoxious rhetorical move. Sounds like the person had bought into the chain status far too much.

[atreic]

So it's what, 1 in 4 deaths due to cancer, and 1 in 2 people expected to get cancer in their life, or approximately that? And most people have 2 parents, and four grandparents, and other relatives as well. But I guess there's familial disease risks that lead to 'people dying of cancer' or 'people dying of strokes' being quite clustered.

Nope, I can't think of any way of working out what proportion of people aren't related to someone who's had cancer, but I guess it's vanishingly low.

[liv]

Yeah, I was thinking along those lines too. My guess is the only people who don't have relatives with cancer are pretty young and have fairly small nuclear families. If you only have two parents and four grandparents, and the grandparents are in their 60s and you don't have a cancer-prone family, then you might well say, no relatives have cancer. But if you have, or at least if you count, aunts and uncles and cousins and in-laws, and if you have more than a couple of relatives over 60, it works out vanishingly unlikely.

[lilacsigil]

The ones that really get me are the "If you care about curing cancer, you'll reblog this" (and the commercial products that follow the same line). I care about cancer a lot, but I surely don't care for emotional blackmail. If I do reblog, I reblog with thyroid cancer statistics, because at least 75% of the thyroid cancer stories I know (including mine) begin with "I felt terrible and gained lots of weight but the doctor just told me to go on a diet." There's a simple blood test for hypothyroidism - a common symptom to most kinds of thyroid cancer - and lack of awareness is delaying treatment to many women. The men seem far more likely to get timely diagnosis and treatment.

[liv]

Bah, that's awful. Memes with explicit guilt trips about if you really cared about the cause are even worse, aren't they? Definitely worth actual awareness raising about rarer cancers like thyroid. It's really depressing that you've come across so many stories of diagnosis being missed because the medical profession thinks weight gain is a disease rather than a symptom, though :-(

[ptc24]

I remember the time I did a trawl through some all-causes mortality statistics by age and gender. It was very notable how cancer defied the usual trend for under-55 mortality from fatal illnesses, in that in under-55s it killed more women than men, and that reversal seemed to be entirely due to breast cancer. This made all the pink breast cancer stuff seem a little less unfair.

Ah, here's a chart.

I think I've seen a few times where people have used pink in association with "cancer" rather than "breast cancer" - just because breast cancer is the most common cancer, doesn't mean it accounts for most cancers, is the biggest killer (it seems that lung cancer takes that role), or is even the best example of a cancer.

[liv]

I do love CRUK's stats pages! But yeah, breast cancer is a huge statistical outlier, it really does make a major impact on mortality stats for young to middle-aged women. I honestly can't find it in me to object that it's unfair to regard breast cancer as a female disease, given there's a hundred-fold difference in incidence between sexes. What's unfair is assuming that something that's associated with femaleness should also be associated with eye-searing amounts of pink. Breast cancer marketing looks like it's aimed at some unholy mix of 6-year-old girls and teenaged boys, not at 50-year-old women.

I do agree with you that breast cancer isn't a useful metonymy for cancer in general, though.

[ptc24]

Erm. There's some disentangling needed here. When I implied that "all the pink breast cancer stuff ... seemed unfair" I think what I was saying was that my sense of unfairness was being twinged by the sight of all the breast cancer campaigning, without saying what it exactly it was that seemed unfair. It was a while ago, and I can't even remember whether my sense of unfairness "showed its working" or not.

I think the cause of that twinge was the apparent singling out of breast cancer as a particular cancer to campaign heavily about - hence some of the sense of unfairness fading when I looked at some stats and did see it standing out. The extent to which singling out is actually going on - and how much it is warranted - is another matter. As you say, the singling out was done in an eye-searing manner, and there are various oddities to do with attention and gender (eg the famous case of when people perceive groups as "male-dominated" or "female-dominated").

[liv]

I see what you're saying, yeah. It's not unfair that women get all the breast cancer attention, it's unfair that breast cancer gets all the cancer attention. And you're right, that is exacerbated because of the very gendered marketing.

[nanaya]

Great post! Have you read Barbara Ehrenreich's 'Smile Or Die!' btw? Talks about the relentless impact of "positive thinking" on US cancer treatment & related stuff. Not perfect but I think you might find some of I interesting.

[liv]

Cool, glad you enjoyed! (I'm a bit surprised to see you here, but definitely pleasantly surprised.) I've seen references to Smile or die and it sounds like a worthwhile line of argument, though I've not read it. Forcing people dealing with cancer to be happy and perky is definitely not the answer, but random people who are just discussing the issue in the abstract should also not make it more awful and Tragic than it needs to be; that doesn't help patients either.

There is actually an evidence base for a correlation between attitude and survival, but it shows that cheerful patients and stoical patients do worse, not better. The best outcomes are for patients who get angry and resent what's happening to them, apparently. I don't know about cause and effect, of course, but attitude isn't as irrelevant as you might think.

[atreic]

There is actually an evidence base for a correlation between attitude and survival, but it shows that cheerful patients and stoical patients do worse, not better. The best outcomes are for patients who get angry and resent what's happening to them, apparently. I don't know about cause and effect, of course, but attitude isn't as irrelevant as you might think.

Oooh, that's interesting and I'd never heard it before! Do you have a link or citation?

[liv]

Not at my fingertips, I'm afraid; it was in the tutor notes for a first year seminar on psychosocial aspects of cancer and stuck in my mind because it seemed so very counter-intuitive. I will do some digging and get back to you, cos it really is the sort of thing where you want to see the evidence!

[iddewes]

I totally agree. I keep getting sent those 'secret messages to raise awareness of breast cancer' and I NEVER take part in them because, like you, I hate them and I cannot see how they can possibly 'raise awareness'. Some message about examining your breasts would work better really and that should be public, not only shared with a few women.
Not being science or medically minded there are a few things in your post I did not know about before - particularly the part about the xenografts - so I have found it interesting to read for that reason.

[liv]

Thank you! It seems really contradictory, doing something secret in order to raise awareness. And I'm glad you found the medical bits interesting; I do have a bit of a tendency to talk shop sometimes, and I don't think many non-specialists really know about xenografts, it's a pretty obscure thing.