Missing images in cancer: ageing and the old

Cancer is a disease of ageing. This means that the risk of getting it go up as you get older, all the more so after age 50. This remarkable fact goes unremarked – or at least lacks all conspicuous examples - on most cancer charities’ websites.

It won’t be obvious from the case studies they offer to the media, either. In fact, some charities seem to go out of their way to choose images or stories of unusually young people with ‘their’ cancer, hardly murmuring any dissent if a 'young person' is what the media asked for, even though it’s not the ‘norm’ for most cancers.

It’s as if charities and the media agree that being older with cancer is a) only to be expected b) so well known a story it wasn’t worth the column inches and c) indicative of a fact, universally acknowledged, that men and women aged over 80 are lesser beings.

None of the above are correct.

Charities bundle ‘outrage’ for their donors - it’s outrageous when an unusually young person gets cancer. Lo! the money comes in. However, the law of unintended consequences does too. The bundling of outrage for donors buggers things up for potential beneficiaries. The endlessly repeated narrative of ‘youth’, alongside the matching imagery, undermines cancer awareness of age as a significant risk factor. The lack of older people becomes the context within which cancer resides, a context where inattention to old people with or at risk of cancer seems to make complete sense.    

Can NAEDI (National Awareness and Early Detection Initiative) ever work for older people, given the absence of any visual prompts in the general media that cancer should be of interest to them?    

A few cancer lobbies have an excuse for some level of disengagement from older age as a key message. Sarcoma, for instance, where the challenge is first and foremost its rarity; or pancreatic, brain and lung cancers where survival is so short getting to a second year after a diagnosis is remarkable for anyone, regardless of age. The big cancer charities, the ones lobbying for breast, prostate and bowel cancers, have no excuse for their age aversion, though there are many explanations for why it occurs. The fact that no tumour specific charity, especially the high profile and larger ones, has ever lead on older age as a key message means that age aversion has become the conventional charity approach; there are no stock images of older people; no media stories about old people; no habit of thinking about older people; no proportional representation of older people on charity websites; no concerted effort to challenge media ageism.

There’s news value in the ‘exceptional’. I know that. Young people with cancer are newsworthy where most 80 year olds are not – unless they are a celebrity or notorious. But sorting out news coverage can come second to putting one’s own house in order first. Charities’ websites are under the control of the charity, not the news media and quite particularly should be challenging the -isms, not fitting snugly in with them.

A lot of the obliteration of age may be because the charities are particularly responsive to their own ‘user voice’. It is unlikely that their user voice is representative of most cancer epidemiology. Call it a skewed sample. This is because most of their active user voices will be relatively young men and women with cancer who won't identify personally with the image of a person 20 or 30 years older than themselves but with the same cancer. They may also chafe against anyone else identifying them with an older person with the same cancer.

Breast cancer charities and their user voice, I suggest, may be particularly prone to this bias. Women’s health and beauty media sectors find ageing repellent and are ill at ease with the idea of ageing women. They have built an entire industry based on encouraging all woman to adopt and share the same discomfort. 

As a result, there are far fewer pictures of older people than there should be.

As older people are invisible, no one is talking about them and no one is looking for them either. Consequently they aren’t missed. Given this dearth of imagery, old men and women and the society of which they are part, can only conclude cancer is for younger people.    

There are 73,000 men and women diagnosed with cancer every year at age 80 and above. That is 22% of the total - over a fifth. Well over one third (36%) of cancer related deaths - 56,300 of them - are in men and women aged 80 and over. Those numbers are a very meaty proportion to be totally invisible in the media and totally invisible on cancer charity web pages. This invisibility may be a huge ‘contribution’ to the shaky cancer awareness, treatment and care in this age group.

May be? Who am I kidding? I mean ‘is’.