So you’ve bought a ribbon to fight breast or prostate cancer. But if you want to do the most to save lives, you should be going on a walk-a-thon for colon cancer or putting money in the tin for rectal cancer.
Data released from the Australian Bureau of Statistics this week shows a clear disconnect between the types of cancers that get the media attention and donations — breast, prostate, skin — and the cancers that are killing the most Australians.
The ABS looks at the causes of death for 2012, a year in which 147,000 Australians died. Here are the top 10 causes (with the cancers in bold):
- Heart disease (angina, heart attacks)
- Diseases of the brain and its blood vessels (haemorrhage, stroke)
- Dementia / Alzheimer’s
- Lung cancer
- Respiratory disease
- Diabetes
- Colon, rectum and anus cancer
- Blood / lymph cancer (mainly leukaemia)
- Diseases of urinary system
- Heart failure
Two of the most high-profile cancers — breast and prostate — are not in the top 10. Both are significant killers, and the fact that each disease primarily affects one sex (a small number of men do get breast cancer) helps explain why they’re not the biggest killers overall. But this data raises uncomfortable questions around whether there’s a disproportionate focus on certain cancers, while “yucky” cancers — or cancers where we blame the victims — miss out.
Here’s how the number of deaths from different cancers compare:
Australia’s biggest cancer killers
Some cancers are frequently in the media and are fundraising gold. Breast cancer has the ubiquitous pink — ribbons, ladies, products, even the entire SCG turned pink for a cricket match. There are two successful breast cancer foundations, an annual pink AFL match at the MCG, and a Mother’s Day Walk “in all capital cities and major metropolitan cities” that raised $5 million last year. As to prostate cancer, men grow moustaches for Movember, raising $26 million last year. The Prostate Cancer Foundation of Australia has blue ribbons and is supported by the Commonwealth Bank.
Compare this to colorectal cancer, which kills more Australians. Colorectal cancer — mostly cancers of the colon and rectum, although there are other types — is usually called bowel cancer. Bowel cancer doesn’t have a ribbon. You might never have heard of its awareness day, Red Apple Day. And it was easy to miss Anal Cancer Awareness Day last Friday.
As to lung cancer, the nation’s biggest cancer killer, there is a Lung Foundation Australia, but have you ever heard of a fundraising drive? Breast cancer lobbyists have made the point that it’s not a zero-sum game; the high profile of breast cancer doesn’t necessarily mean there’s less focus on bowel or lung cancer. But if people have the wrong idea about cancer risks it could be a problem.
Graham Newstead, professor of colorectal surgery at the University of New South Wales, describes awareness about bowel cancer as “terrible”. He says people are dying of it because they don’t know about symptoms and screening, yet “it’s a totally preventable disease”.
Newstead explains bowel cancer is associated with growing older on a Western diet, with family history also a factor. Polyps can form in the bowel, which might turn into cancer. Screening usually identifies problematic polyps, making bowel cancer preventable in most cases. The federal government pays for free screening for people aged 50 to 65; that means taking a sample of your poo and mailing it to a lab.
But many people aren’t doing the test. “If the population knew about bowel cancer as they know about breast, then it would be a no-brainer,” Newstead said. “People don’t want to talk about bowels at the dinner table, but it’s time we did … we all have bowels, we all go to the toilet, it’s a fact of life. We shouldn’t be hiding this stuff.”
Newstead points out that millions go to breast cancer, and prostate cancer is “a bit more trendy”. He’s an advocate for sexing up bowel cancer and using humour — Bowel Cancer Australia (he’s a spokesman) has a “don’t be a fool, check your stool” campaign, and urges people to “join the bowel movement”.
“There are pink ribbons on every jar of Vegemite; for bowels I think we should have brown ribbons to make the jokey point,” Newstead said.
A factor in breast cancer’s profile is celebrities who’ve gone public about having it: Kylie Minogue, Sheryl Crow, Olivia Newton-John, Jane McGrath. Few celebrities have spoken about bowel cancer (an exception is model Lara Bingle, whose father died from it). “I know of many high-profile people that have had bowel cancer; they don’t want to talk about it,” Newstead said.
So is the country’s peak cancer organisation, The Cancer Council, doing enough to accurately reflect which cancers are killing the most Australians? The council tends to focus on breast and skin cancer in its public communications. Crikey analysed the 114 tweets from @CancerCouncilOz this year, finding 21 were about skin cancer/sun protection, eight about breast cancer and three about bowel cancer. The homepage contains direct references to breast and skin cancer but not to bowel cancer.
The organisation’s director of advocacy, Paul Grogan, told Crikey: “Bowel cancer is the cancer we have focused on more than any other.” He points out, correctly, that bowel cancer has been the Cancer Council’s main policy priority recently (advocating for more screening). Crikey analysed the council’s media releases since January 2013 and found the most were about bowel cancer and skin cancer (six releases each).
“We know [bowel cancer] has an image problem,” Grogan said. “It is one of those unfortunate anatomical perceptions.” He adds “there’s no doubt” people are dying of bowel cancer because they don’t know about it. The Cancer Council is developing a modest TV campaign.
Australia’s biggest cancer killer, lung cancer, seems to have even more of an image problem than bowel cancer. Lung cancer advocates, lobby groups and fundraising drives are all but invisible. Yes, there have been extensive anti-smoking campaigns and policies from government, so awareness is not such an issue. But is anyone advocating for more lung cancer nurses? Are people walking laps of the oval or selling chocolates at work to fund research into a cure for those with lung cancer? It’s hard to avoid the conclusion that there’s less interest because people blame the victims.
CORRECTION: The original version of this story said free bowel cancer screening was available to people aged 60-70. It’s available for people aged 50, 55, 60 and 65.
The fact that skin and breast cancer affects young people probably boosts their profile, and I’ve seen plenty of promotions for leukemia and childhood cancer issues. Lung cancer would seem to be largely covered by the campaign against smoking so for me the only minimaly covered area is colorectal cancer. Even then once you reach 50 there is an information pamphlet mailed out for bowel/colon cancer and a free test kit. There’s always room for improvement and more resources – esp if you are one of the unlucky ones affected. The question is though how do you split a limited amount of resources fairly? I don’t think there is a real answer to that.
It’s not correct to claim breast cancer affects young women. The publicity is mainly about young women, but most cases occur in older women. The risk of developing breast cancer increases with age: with 23 per cent of new breast cancer cases diagnosed in women under 50; 51 per cent in women aged 50–69 years; and 26 per cent in women aged 70 years and over.
I suspect that if older women were featured in the campaigns to raise money for breast cancer, less would be donated.
Brown Mt Franklin bottles coming soon!
Very interesting point Rosemary. I do see quite a lot of breast cancer material that features younger women, and they do tend to get the media coverage (Kylie Minogue, Jane McGrath, Angelina Jolie). Perhaps this inspires people to get involved / donate; the sense that saving younger people is “worth more” than saving older people.
This may explain why, despite dementia rising to be the third largest killer of Australians (ahead of any cancer), there’s not as much fundraising / campaigning as with some cancers (I know this is starting to change).
When you think of coverage of sick people in the tabloids, it’s almost always a child or “young mum” or “young dad of 3”. You don’t see many people over 40 in those stories. Interesting.
Finally the media revealing uncomfortable truths about disease prevalence vs public awareness. Breast cancer has a very high survival rate, despite public perceptions that show most women think breast cancer is the most common cause of death for women. The large number of breast cancer survivors have been excellent advocates for improved support for services and research. Unfortunately lung cancer has a very high death rate, which means there are very few people to advocate for this disease. “Victim blaming” is very selective, as it “obvious that people develop lung cancer due to smoking” but there is a significant group who have never smoked. Women with breast cancer are never “blamed” yet both smoking and obesity are significant risk factors for breast cancer. ( in fact smoking is implicated in increased risk for most cancers) I think the concept of a brown ribbon is great and love the ” bowel movement” . Just need some good catchy phrases for lung cancer!