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Raising awareness or spreading fear?

   Cancer charities, radio shows, medical journalsthey are all in the business of getting messages across to the public. If you can't capture the reader's or listener's interest, there is no way he or she will take in the important messages that you want to deliver. One way to grab that interest is to scare the audience rigid, but can it be justified?

The Imperial Cancer Research Fund is currently running a major advertising campaign that shows three little girls sitting on a wall. Over each head is a different labelteacher, lawyer, cancer. Meanwhile, in The ArchersRadio 4's long running soap opera of "everyday farming folk"women's worst fears of breast cancer are exploited as an unfeasibly young character undergoes a mastectomy.

The cancer charity's campaign arose from a survey showing that the public thought an individual's lifetime risk of getting cancer was one in 10 or less. The "correct" risk is two in five. The charity then commissioned an advertising agency, Abbott Mead Vickers, to educate the public. Unfortunately, the advert creates the impression that only two of the three children will grow up to have a career. Alternatively, even if the third does grow up, her life will be defined by her disease. Four lines of print at the bottom, stating that survival rates are improving, fail to mitigate the harsh message.

Stacey Adams, the charity's head of communications, explains: "We did wonder about the cancer caption. However, our oncologists told us that, at the time of diagnosis, cancer does become the most significant thing in the patient's life. This is true if they are teachers, lawyers, or work in the local supermarket." She admits that politics underlie the timing of the campaign: "Decisions are being made now in terms of funding, service delivery, and treatment. Cancer needs to be on the front burner now."

However, if the charity's campaign causes newspaper readers to wince and turn the page, The Archers cancer story line is harder for listeners to escape: it provides a steady drip feed of misery. Ruth Archer, a 32 year old farmer and mother of two, finds a breast lump. Before you can say "combine harvester" a solemn oncologist is telling her that the disease is multifocal and that she must have a mastectomy. The radio audience shares Ruth's stunned reaction, her tearful telephone calls to her family, her worries over body image, her fears of death, her anguish over her two lisping young children, the last bedtime stories before the operation, her revulsion at the sight of her temporary prosthesis, and much much more.

The realitythat such young women have a 100th the risk of breast cancer of older women, that multifocal breast cancer is found in only 5% of cases, and that mastectomy is seldom performedis conveniently lost in the wallow of emotion. Ruth could have chosen reconstruction at the time of her mastectomy, but that would have meant losing the sexy storyline about what it feels like to be a woman who loses her breast.

(Credit: ICRF) Overestimating the danger

Dr Margaret Spittle, consultant clinical oncologist at the Middlesex Hospital, was disappointed that the scriptwriters had already selected a "premenopausal victim" when they asked for her help with the medical details. Dr Spittle said: "I did explain that this could cause anxiety in younger women. The answer was that they were under no obligation to choose an average patient. Nevertheless, although they chose an atypical case, the care they have taken in getting the medical details right has been impressive."

Ruth's mastectomy was conceived at a story conference in the Pebble Mill studios about a year ago, when the writers decided to explore the effects of mastectomy on a farmer and mother. The Archers editor, Vanessa Whitburn, explains: "We were interested in the situation of a younger woman finding herself diagnosed with this disease. We could have given her a lumpectomy, or we could have chosen an older character, but in drama you don't necessarily go for the most obvious thing. We very much hope it won't frighten people. We want to show a positive side to this very difficult disease. The Ruth character is essentially a strong woman, and eventually I hope we will show how women can fight this disease. If you embark on a story like this and you don't show some of the dark nights of the soul, you are not being honest with the listeners."

Michael Baum, emeritus professor of surgery and visiting professor in medical humanities at University College, London, takes a different view: "I am utterly dismayed by the choice of the age group and the pathology, especially when the vast majority of breast cancers are now treated conservatively. The messages which are being given out create fear. The prognosis for women under the age of 34 is poor. How will they deal with that?" He agreed that this kind of cancer, in a woman of this young age, was about as likely as a man of any age developing breast cancer.

Professor Baum is also angry about the "awful" campaign of the Imperial Cancer Research Fund. He says: "It is true that one in three people will get cancer if they live long enough. It does not mean that one person in three dies of the disease. Public anxiety has been inflamed by all the recent political manoeuvring and the setting of deadlines for patients to be seen within two weeks."

Both the charity's advert and The Archers frighten people by creating the impression that cancer is a disease of the young. But is this the only way of raising awareness of cancer? The Imperial Cancer Research Fund's Stacey Adams points out: "The media are staggeringly ageist. They don't want to talk about old people getting cancer, and in the case of breast cancer they want case histories involving young women. All you can do is try to educate the press and get them to mention somewhere in the article that most breast cancers occur in older women."

Ann Kent, health writer and author of "Life After Cancer".