A really quite stupid Cancer Research UK/NAEDI survey

They’ve only gone and repeated it.

 

Luckily it didn’t get a huge amount of coverage. It was shoulder charged out of the way by a much more interesting cancer story about the possible benefits of daily, low dose, long term aspirin in reducing the risk of a cancer diagnosis. But I did find the all-new, all-stupid survey on the BBC website so there was some coverage which qualifies it for a detailed drubbing.

 

I dubbed the 2007 effort the ‘Top of the Shocks’ survey and cancer came right in there, at Number 1. As CR-UK's 2010 version the Press Release has it “Cancer is the nation’s number one fear but more than a third think getting the disease is down to fate and there is nothing they can do to avoid it – according to a Cancer Research UK survey out today” (Wednesday 8 December 2010).

 

CR-UK must have missed my critique. I doubted the value of measuring the adult UK population’s neuroticism. Now I’d add that if it did anything useful (the jury is back and says ‘No, it flaming didn’t… but still…) the survey may reflect the efforts of various lobbies in setting down different problems in front of the public. None of these ever include any relative risks – so those campaigns stop the public arriving at any sense of proportion. This is a situation that all high profile single issue pressure groups with a campaigning remit (not just cancer, not just health) will be responsible for creating! So don’t say ‘wake-up call’ – which they do in the Release - it’s not the public’s fault they don’t have fact based, proportionate fears!….

 

I also speculated on what meaning we're supposed to ascribe to ‘fear most’. If ‘fear most’ has a relationship to ‘likelihood’, say, many people wisely ‘fear’ cancer over the alternatives given, as there’s a lifetime risk of 1 in 3 of us getting a cancer diagnosis, but that’s nowhere near likelihood of being in an air crash. What is survey getting at? What is the right amount of fear for ‘cancer’?  

 

I have the stats from last time to hand ….

 

In 2007 - Which of the following do you fear most?

 

1.    Cancer                                   26%

2.    Alzheimer’s                            18%

3.    Heart attack                           11%

4.    Terrorism                                 8%

5.    Car accidents                           7%

6.    Murder                                    7%

7.    Motor neurone disease              5%

8.    Plane crashes                          4%

 

In 2010 there’s less published detail to compare, save on the top line result.

 

“When asked to choose what they feared most from a list including developing Alzheimer’s, being in debt, old age, being the victim of knife crime, cancer, being in a plane crash, motor neurone disease, being in a car accident, having a heart attack, losing your job and losing your home – more people (20 per cent) overall chose cancer than anything else."

 

So, on the one result I can compare – ‘what do you fear most?’ cancer is still the leader. It’s gone down from 26% to 20% though. Questions form…..Is this a statistically significant change? Who knows? If it’s a real change, is it progress? In what sense? Who knows?  

 

We can’t tell if cancer is, qualitatively, just as bad in people’s minds as it has always been but some extra and worse things have come along in the interim to frighten them, or if indeed people are genuinely a bit less fearful of cancer than they were.

 

The real answer though is more prosaic. Claims of any real change (note, none were made and any reference to the previous survey are mine, not CR-UK’s, as they never made any) fly straight out the window as the result of one methodological flaw.

 

Based on what I can see they seem to have including 11 ‘fears’ in the current survey when there were only 8 in the first. So now there’s a wider distribution of possible responses so, unsurprisingly, there’s apparently less fear of cancer. So we now know no more than we did, and we didn’t discover anything last time.

 

Here's the actual release.

 

There’s no data at all that relates to the second part of the release’s headline on the 34% who put cancer down to “fate and there is nothing they can do to avoid it”. I really have no idea what single piece of information the Release was supposed to be about - containing as it does the random sweepings from the floor of CR-UK's office - the survey of top fears, something (unspecified) about cancer and fate and another bit was about an awareness campaign starting in January on three named cancers. 

 

Oh, what’s the point? This is all just stupid. Please STOP.

 

And another thing. Cancer is only one thing, only some of the time. Each cancer shares characteristics of every cancer - that’s what makes then cancer after all - but the reverse is not true. I’d hate to get breast cancer and I know I might die quickly but I also know it's more likely I’d have a good prospect of survival and might achieve a decade, or two, or even three. Conversely I’d be a long, long way up sh*t creek as soon as I got a pancreatic, lung or brain cancer diagnosis. I’d be being overly optimistic if I expected to still be alive 18 months after diagnosis of any of those. These, plus stomach and oesophageal cancers, I respectfully point, out are cancers ‘worth’ fearing.

 

Which leads neatly on to Sara Hiom, Cancer Research UK’s director of health information.

 

Her name is on the Press Release. 

 

“The fear factor is a serious wake-up call for the British public. It’s absolutely vital for us to get the message out that people can do something to alleviate their emphatic fear of cancer. Cancer is no longer the death sentence people still seem to dread. Long-term survival has doubled since the 70s thanks to better diagnosis, improved treatments and the development of nationwide screening programmes ……"

 

A small point first. The weird English doesn’t help. “The fear factor is a serious wake-up call?” Fear factor? Is that like the 'X' factor? She's exhorting the British public to wake up and ….do what exactly? Arrange their fears rationally? Based on what? It won’t be based on the Health Information you are head of, if you chose to articulate it by using the phrase “Alleviate their emphatic fear of cancer”.

 

Eh?

 

But there's a bigger error. “Cancer is no longer the death sentence people still seem to dread”. Some cancers Sara, some cancers are no longer the death sentences people still seem to dread. My friend Sue would be surprised by your confidence on the point, if she was still alive to read it. Single Mum. Brain tumour. No early warning symptoms, no screening opportunity. 15 months from diagnosis to death. Her treatment was twenty years old because there had been no major research advances in that time. 

 

Her fear was felt acutely by her and those around her and it was well informed and quite, quite rational.

 

Did you know forty years ago five year survival for men and women with pancreatic cancer was 3%. And it still is, today. What does a death sentence look like, if not that? And that's forty years of no progress at all. So what about your cheery rhetoric that 'Long-term survival has doubled since the 70s'. On average, probably, across cancer. But no one has an average cancer.    

 

Woeful release. Witless story. Useless data. And a naive, nay insensitive presentation of the complex truths of cancer.

 

I can’t fathom why such a crap survey would be “commissioned by Cancer Research UK on behalf of NAEDI”. CR-UK should commission something better, of more potential public benfefit. Why does NAEDI want to know how frightened people are of knife crime say, or motor neurone disease, in comparison to cancer? I can see why CR-UK might, but that’s PR/corporate intelligence for them, not a public policy issue on cancer awareness the rest of us should be paying for. Ask some other awareness questions – e.g. find out if men perceive cancer as a women’s disease, and whether consequently they are tardy about cancer symptoms because they think it’s not a man’s problem; or maybe ask older people if they understand increasing age is a risk factor for getting cancer and how this influences their response to possible symptoms.

 

NAEDI (National Awareness and Early Detection Initiative) is a partnership under the Cancer Reform Strategy between CR-UK and the Department of Health. The DoH are using my tax pounds, and yours, to service that partnership. These surveys are cheap and cheerful. So a bill of two or three thousand quid is nothing. But so is the data. Why should I support any of my tax pounds paying for this survey?

 

Which bit of this amounts to high quality evidence of anything on which to develop policy on cancer awareness, which is what I would like some of my tax pounds to be spent on?

 

No one should forget that fear sells cancer very effectively. The doom laden tone of much cancer fundraising, particularly for research, works. If cancer wasn’t a problem, fear and manipulation of it, wouldn’t be such a powerful driver in fundraising. Does no one recall the CR-UK TV adverts from only a few years ago where family members with cancer faded and vanished from family events, photographs and sitting rooms? If that isn’t the subliminal promotion of fear to raise funds I’m not sure what is.

 

Does CR-UK have a conflict of interest in surveying 'fear', albeit pointlessly and badly, given their partnership in NAEDI? Anyone else think it’s analogous to the controversial food and drink industry tie-ins to policy on the emerging public health agenda?

 

Discuss.