What does NAEDI think is the ‘core curriculum’ for cancer awareness?

The reason I’m asking is because I still wonder how cancer awareness is supposed to work. I’m in a key target audience – over 50 and getting older. I don’t have cancer, as far as I can tell, at the moment. As I might in the future, with a 1 in 3 chance that I jolly well will, what cancers should I know?

 

I don’t smoke. So I can ignore lung cancer, for instance? No actually, I can’t. About 10% of lung cancers occur in non-smokers. So that’s 1700 or so non-smoking women who get it each year. That puts me in a group of equivalent  size to men who get testicular cancer and we know there’s a lot of public interest in making them ‘aware’….. so perhaps I should be aware of lung cancer.

 

But hang on a minute….. testicular cancer has a 95% survival rate, because of some effect of self examination and fantastically effective treatment.  So it’s not like lung cancer at all, which has one of the lowest survival rates and the highest mortality . So maybe I don’t need to be aware of lung cancer particularly, as I can’t do a lot about it if I get it. I might gain a bit through noticing it early I suppose, and I’m sure I’d appreciate that ‘bit’……

 

So would lung cancer be in NAEDI’s core curriculum for women like me, or not?

 

I know breast cancer would be in a core curriculum for me. I’m hacked off that it has become the vehicle by which currently unaffected women are expected to view all cancers but for core curriculum purposes I ‘get’ why I should consider it.  I’m coming up to my first ever breast screening appointment and I am already well aware of what information is missing, the absence of which will have a bearing on whether or not I finally decide to have a screening mammogram, or not.

 

Bowel screening is going through interesting times and not in the ancient Chinese curse kind of way – I do mean genuinely positively interesting. Leaps in screening technological progress are waiting on some policy decisions, not some intangible medical progress. That’s good. Mum died of bowel cancer. And I’m getting to the age for thinking about it.

 

After those biggies things get vague in my curriculum. Is anyone going to help make a judgement on which cancers aren’t ‘worth’ mentioning to me? That’s certainly unacceptable to single issue cancer charities and to advocates for the causes of rare, short survival, non behaviour related or non screen-detectable cancers.

 

Everyone who knows gets reticent and shifty around ‘awareness’ for those. Everyone else just assumes awareness is still somehow empowering – it’s the main cancer meme even though for some cancers early detection and awareness are useless concepts.

 

No one likes to mention pancreas, lung, oesophageal, brain and stomach cancers where survival is lowest, selling us instead the positive but generic spin that cancers survival has increased markedly. Well, yes, but not where the research spend is low, unsurprisingly. That’s where the wider definition of awareness could make a difference – to build a fully resourced research agenda for all cancers.

 

We need some ‘awareness’ that points out the subset of cancers where no behaviour modification reduces the risk, where there are no early tests and  symptoms turn up late in the disease trajectory or there are no treatments that materially alters the likely outcome. These are not NAEDI concerns though as a result of their intractable nature.

 

What is the point of cancer awareness? If you can improve outcomes by awareness and early detection, go for it. But what about people who will get rare, or lethal cancers? Which are the ones we really need to know about? Is it the top three or four and then 'the rest'? But then, the rest aren’t one or two vanishingly rare ones, they are just over half of all cancers diagnosed.

 

Maybe there can only ever be the least wrong way to do cancer awareness, not the  right way.

 

We’re left with an awareness curriculum led by single issue cancer charities that doesn’t work and won’t ever work. Keep avoiding a detailed analysis and stick with sentimentality, so you need never notice the reality. It’s a choice I suppose.