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Report on the Post's cancer prevention survey

Saturday Evening Post - March 1, 1986

REPORT ON THE POST'S CANCER PREVENTION SURVEY

Dr. Vincent DeVita, the director of the National Cancer Institute, was interviewed in an article appearing in the July/August 1984 issue of the Post. In that article, Drs. DeVita and Cory SerVaas discussed the prevention of cancer, the relationship of diet to cancer risk, and the importance of smoking cessation. In a related article, other National Cancer Institute (NCI) scientists discussed the importance of screening and early detection for breast

cancer.

The Post worked with members of the National Cancer Institute in preparing a questionnaire about breast cancer. The NCI wanted to know why it is that the vast majority of women who are in the high-risk age group are not getting mammograms yearly as they should, even though it has been shown that women are far more likely to survive breast cancer if their lumps are discovered by a mammogram when the lumps are still too small to be felt by physical examination.

In this country it has been determined that only about 14 percent of women over 50 receive an annual mammogram. Of the 3,534 Saturday Evening Post readers in the survey, those over 50 were comparable to the national average--only 15 percent were receiving annual mammograms. Fully 47 percent of the women over 50 years of age had never had even a single mammographic exam. These women should discuss the need for a mammogram with their physicians.

The women over 50 who answered that they never or only occasionally had mammographic exams were asked their reasons for not having regular exams. The answers were quite intriguing: An astounding 65 percent said that their physicians had never recommended the examinations. More than 21 percent said they felt it was unnecessary because they had no symptoms. Another 21 percent claimed they were worried about X-ray exposure. About 20 percent answered that the costs were prohibitive and that mammograms aren't covered by health insurance.

Each of these reasons for avoiding mammographic exams must be reexamined by women who want the best in preventive health care. Mammography, a screening procedure, should be conducted regularly after the age of 50. Its purpose is to detect cancer in its early stages, even before there are any symptoms. The earlier the breast cancer is detected, the better the chance for cure. And although some X-ray exposure occurs during a mammographic exam, it is insignificant compared to the benefit of the exam. Newer equipment and careful monitoring of radiation exposures have reduced the need to worry about mammographic X-ray exposures. A woman should ask her doctor a few simple questions: Is the X-ray machine "dedicated' (i.e., is it designed primarily to take mammographic pictures)? Is the radiation dose less than 1 rad? If the answers to these questions are yes, a woman should feel confident she is receiving a safe procedure. The cost of mammograms may vary considerably, between $50 and $250; it is rarely covered by health insurance. One wat to reduce the cost of the exam is to price the mammographic services offered by various care providers in your community, who can assure you that they use dedicated equipment, with exposures of less than 1 rad per breast.

The most commonly mentioned reason for not having mammography was that physicians do not recommend it.

Yet, women can influence their physicians. Most physicians are willing to discuss any topic with their patients, especially if the patient asks the question. Women should make a point of speaking with their physician about their breast cancer risk and the means of reducing it

Cancer screening examinations are a most important weapon in the war against cancer. Cancer detection checkups are particularly important for women, because breast and cervical cancers can frequently be detected quite early. Cancers detected early are more easily treated, and have a better chance for cure than cancers detected in advanced stages.

Women readers were asked in the survey how often they practiced preventive screening procedures for breast and cervical cancer. Breast self exams (BSE) were practiced regularly by about 30 percent of the women. Slightly fewer young women were practicing BSE regularly than were older women. More than 60 percent of the women claimed to conduct breast self exams at least occasionally. We would like to encourage this group of women to step up their selfexams to a monthly practice, for monthly breast exams are considerably more effective than occasional exams in detecting breast lumps early.

Women also receive breast exams from their physicians. Over 60 percent report that they are given breast exams regularly when they see a physician. This percentage drops a bit among older women, which is unfortunate since age increases the risk of developing breast cancer. For the sake of their health, women should speak up and ask their doctors to perform this simple examination.

Pap smears were the screening procedures most used among women in the survey sample. Almost 68 percent were having regular Pap smears. The figure rises to more than 95 percent when women having occasional Pap smears are included.

Diet and Cancer

Because a large portion of the DeVita interview was devoted to the association between diet and cancer, we asked the survey respondents if they planned to change their eating habits after reading the article. Sixty-two percent said yes. When asked if they intended to make changes in their consumption of high-fat dairy products, and fats added to foods in cooking or at the table, about one-half responded that they definitely intended to eat less of these foods. In regard to eating whole-grain products such as breads, cereals, bran products, fruits, and vegetables, more than half responded that they definitely intended to eat more. All these dietary changes are consistent with the NCI recommendations. Those who believed most strongly that they could reduce their risk of cancer were the most likely to claim that they intended to modify their eating habits accordingly.

On the other hand, 38 percent of the survey respondents indicated they did not intend to change their diets. But when asked why not, nine out of ten reported that they "already eat the foods the article suggested.' So, as it turns out, the people who didn't plan to change were the ones who had already changed their diets or who always had good diets.

Smoking

Because smoking is the single most preventable cause of death in the United States, we were quite interested in the readers' smoking habits. Nearly 40 percent of the respondents had been smokers at one time or another. Remarkably, only 8 percent claimed to be smokers at the time of the survey, a much lower percentage than the national average of 32 percent (or 29.5 percent among women). Of those people who were still smoking, 18 percent had never tried to quit, 57 percent had tried once or twice, and 23 percent had tried repeatedly. We know that exsmokers make numerous attempts to quit before actually succeeding. This shows us it is important that smokers keep trying to quit. Unsuccessful attempts should not be seen as failures, because a successful attempt will usually follow a number of unsuccessful attempts. The more times smokers try to quit the habit, the more likely they are to succeed.

The large majority of exsmokers in the survey said that when they did finally quit, they did so primarily on their own. Encouragingly, more than half of the smokers in the survey said the article had prompted them to try to quit. For the most part, those smokers who indicated they would try to quit said they would take the self-help approach. Enlisting the support of family, friends, coworkers, and physician is often very helpful. It makes kicking the habit much easier.

Of the 3,534 reader responses to the survey, most were well-educated, older white women. More than 92 percent were women, and nearly 98 percent were white. Nine out of ten who completed the survey were over 40 years old and, indeed, almost half were over 60. Only 5 percent of the group had less than a highschool education, 28 percent were high school graduates, 24 percent had some college training, 25 percent had college degrees, and 17 percent had some postgraduate training.

Before reading the articles about cancer prevention, about 30 percent of the survey respondents felt there was "quite a lot' they could do to reduce their risks of ever developing cancer. After reading the articles, more than 65 percent felt this way. These are dramatic improvements. Similarly, before reading the articles, 10 percent did not believe they could reduce their cancer risks at all, but afterward only 2 percent felt this way. This very encouraging trend shows that Post readers clearly understand that lifestyles and health behaviors can be used to reduce the risk of developing serious diseases such as cancer.

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