Cancer and Risk

Now, as mentioned in the past I am a big fan of the Respectful Insolence blog and I regularly use it as a jumping off point when I go blogsurfing. Also, I have in the past been forced to admit I am wrong and where required correct previously posted statements. Today, it seems I may be heading down this road again, but I am not sure yet.

Previously, I mentioned to apparent oddity of British people thinking that developing cancer or not was down to fate. This was fairly quickly challenged by a post here (albeit by a biased poster) which initially I ignored. My take on heather‘s post was that it was just a bit of semantic pedantry and I could ignore it. Today, however, after reading Orac’s post I see I may have been making too much of a broad brush judgement.

Now, heather quite rightly points out (as does a lot of Orac’s post) that chance does have the “final say” as to whether or not a person will develop a cancer. I agree and this isn’t what my complaint about poor education was meant to imply. Heather points out:

My point is that – even cancers caused by heavy irradiation are due to chance, although the chance may approach 100% with regard to certain substances. With most cancers, you can only consider the impact of lifestyle choices statistically. (And having some acquaintance with epidemiology, I can say this is a pretty arcane art).

And I cant really say anything which disagrees with this.

My point is, and I am painfully aware now that this is an assumption, the way I read the study was not that people believed their chance of developing cancer was a risk which was affected by various lifestyle and genetic factors but remained (non the less) a “chance” event.

I read the report on the survey as suggesting that the people thought the chance of them developing cancer was entirely down to fate with no impact from their lifestyle choices. My own discussions with British people (whilst not exactly being a survey) suggests this is about right. I know people who smoke 20 a day with almost no fear of cancer (putting developing it down to “fate”) but baulk at the thought of eating a foodstuff which may prove to contain a minute trace of a carcinogenic compound.
This leads nicely to one part of respectful insolence I actually don’t agree with.

Only people who have never tried to convince patients to change such lifestyles for the benefit of their health would so blithely attribute this belief in “fate” to stupidity or ignorance. In some cases it may be stupidity or ignorance, but in the majority of cases it probably is not. For instance, 90% of the people in the U.K survey knew that smoking increased the odds of developing cancer, and that still didn’t stop a significant proportion from attributing whether smokers get cancer or not to “fate.” It’s all easy from the air to dismiss patients as being “ignorant” or “stupid,” but it won’t help to persuade them that there are indeed actions that they can take themselves to decrease their risk of developing cancer.

Now, it strikes me that here Orac is no longer arguing that the people thinking developing cancer is down to fate are ignorant or not, he is simply saying the “patient” should not be thought of as ignorant. This is a wonderful point of view for a doctor to take but, at the risk of being rude, is fairly meaningless. Yes, it may not help persuade patients to modify their lifestyle but that certainly does not falsify the idea.

All in all, I stand corrected with the automatic assumption that the report implied the people thought it was Fate / Chance and no other factor. I (currently) still think that people who do think it is Fate / Chance and not lifestyle factors are poorly educated or stupid (or both).

I will try to retain an open mind though.