Widespread Fear of Cancer, But Little Knowledge About Reducing RiskAmerican Institute for Cancer Research Cancer Experts Concerned that Popular Misconceptions May Instill Feelings of Helplessness A new survey commissioned by the American Institute for Cancer Research (AICR) reveals that Americans are deeply worried about cancer but are misinformed about the steps they can take to prevent the disease. According to the survey, released at the 11th Annual Research Conference of the American Institute for Cancer Research (AICR), cancer is the number one day-to-day health concern in America. Additionally, half of all Americans believe it is impossible or next to impossible to prevent cancer.  Respondents were also asked about their beliefs regarding the causes of cancer. The vast majority of Americans was able to identify a variety of proven risks - 92 percent say they believe tobacco causes cancer, and 90 percent cite excessive exposure to sunlight. But the AICR experts who conducted the survey expressed considerable surprise and dismay that most Americans overlooked other factors that have also been proven to increase cancer risk. Only 46 percent identified diets low in fruits and vegetables as a cancer promoter, only 42 percent believed alcohol to affect cancer risk, and only 35 percent cited obesity or insufficient physical activity. These four factors alone have been convincingly linked to 11 different types of cancer. AICR Director of Nutrition Education Melanie Polk, RD, presented the survey findings along with Dr. Richard M. Niles, Professor and Chair of the Department of Biochemistry at Marshall University School of Medicine. "Americans are telling us three things: they are worried about cancer, they feel it is inevitable, and they are largely unaware of the steps they can take to reduce their risk," said Polk. "Anxiety, Feelings of Helplessness, and Lack of Knowledge - it's a dangerous combination. "Luckily," she continued, "there is clear and convincing evidence that the choices we make everyday - choices like what foods we eat and whether or not we exercise, drink, or smoke - have a dramatic impact on our risk of getting cancer. In fact, making these decisions in a healthy way can prevent 60 to 70 percent of all cancers. That's an empowering message, and one that desperately needs to be heard." Americans Deem Cancer Number One Concern, Impossible to Prevent Respondents to the survey were first asked to rank various diseases and conditions according to the amount of personal, day-to-day concern each caused. Table I: What Are Americans Most Concerned About? Disease or Condition : Percentage of Americans Who Rate it Their Top Health Concern Cancer 36% Cancer was the number one concern of 36 percent of Americans, which represents a plurality of those surveyed. Cardiovascular disease, which is actually the number one killer of Americans, came in a distant second, with 23 percent of Americans citing it as their primary health concern. "That's an interesting difference," Polk said. "Why are Americans so much more concerned about cancer when cardiovascular disease claims about 400,000 more American lives than cancer each year? When we saw those results, we wondered what it was about cancer that could cause such a disparity." She added that they didn't have to look far for the answer, because the very next survey question asked Americans about their beliefs on whether or not various diseases and conditions can be prevented. Americans were asked to rank various diseases and conditions on a scale from one to five, with one representing "highly preventable" and five representing "cannot be prevented." Table II: What Diseases or Conditions Do Americans Believe to be Impossible to Prevent? Disease or Condition : Percentage of Americans Who Say it Cannot Be Prevented Common Cold 35% According to the survey, one in four Americans believe cancer is impossible to prevent - 27 percent of respondents gave cancer a rating of "5" for "cannot be prevented." Diabetes came next at 20 percent, followed by AIDS (13 percent), cardiovascular disease (7 percent) and obesity (6 percent). Only one condition earned more "cannot be prevented" ratings than cancer - the common cold (35 percent). Table II: Highly Unlikely / Impossible to Prevent Disease or Condition : Percentage of Americans Who Say it is Either Highly Unlikely or Impossible to Prevent Common Cold 50% When the results were adjusted to collectively reflect the ratings at the bottom end of the scale (both "4" and "5") - a whopping 48 percent of Americans said preventing cancer was either highly unlikely or impossible to prevent. Once again diabetes came next, with 37 percent of Americans deeming it highly unlikely or impossible to prevent. Cardiovascular disease was considered highly unlikely or impossible to prevent by only 19 percent, AIDS by 18 percent, and obesity was considered highly unlikely or impossible to prevent by 13 percent of those surveyed. "Here's the solution to the mystery," said Polk. "Americans are concerned about both cancer and cardiovascular disease, but they're much more confident that they can control their risk of heart disease. Unfortunately, cancer is still regarded by half of the US population as something that they cannot defend against, a disease that strikes at random." The truth, she said, is that following the same well-known strategies to reduce risk for cardiovascular disease will also reduce risk for cancer. AICR has adopted a series of Diet and Health Guidelines for Cancer Prevention (see page 9) to urge a diet that is rich in a variety of plant-based foods (especially vegetables and fruits), low in fat and salt and moderate in alcohol. The AICR Guidelines also advise maintenance of a healthy weight and regular physical activity. Few Americans Know About Cancer Risks Associated With Diet The AICR survey asked Americans about their beliefs regarding causes of cancer. Although many were able to correctly identify known cancer risk factors like tobacco (92 percent) and excessive exposure to sunlight (90 percent), other factors that have been convincingly linked to cancers were consistently overlooked. "The top three cancer causes mentioned by Americans - tobacco, excessive exposure to the sun, and inherited predisposition - are certainly legitimate ones," said Polk. "It's gratifying to see that the word is getting out about tobacco, which is single-handedly responsible for 87% of all lung cancers, and one in five deaths in the United States today. Americans also seem to know about excessive sun exposure, which will cause approximately 1.3 million cases of skin cancer this year." But, Polk said, the story about the third most-often mentioned factor, inherited predisposition, is considerably more complex. An overwhelming 89 percent of Americans cited inherited predisposition (i.e., "cancer genes") as a cause of cancer. Yet researchers estimate that only about five to 10 percent of all cancers can be attributed to a genetic predisposition. "When you consider that 30 to 40 percent of cancers can be attributed to poor diets, lack of physical activity and excessive body weight - and that far fewer Americans were able to identify those three factors - it's clear that people's priorities need to change." Polk added that those who do inherit BRCA1, APC, p53 and other so-called "cancer genes" are indeed at a higher cancer risk than the rest of the population. But even these people can significantly reduce their cancer risk by making healthy changes to their diet and lifestyle. Environmental Cancer Fears Rank Highly, But Hard Evidence Lacking Industrial pollution was believed to be a cause of cancer by 84 percent of those surveyed. Radiation came next, at 83 percent, followed by asbestos (81 percent), pesticide residue on produce (72 percent), nuclear power (66 percent), radon (60 percent), viruses and bacteria (56 percent), food additives (53 percent), stress (48 percent) and breast implants (47 percent). "Americans are focusing their cancer concerns on environmental factors," Dr. Niles said, "which means they are much more likely to blame cancer on the things that happen to them. But there is as yet no clear scientific consensus on the precise role these factors play in human cancer, if any. More research is needed." Compounds found in industrial pollution have been linked to human cancer in several studies, but mostly at high-dose occupational exposures that the general public never encounters. Similarly, exposure to radiation, asbestos and pesticides have been linked to cancer in some studies, but only as a result of long-term, accidental or occupational exposures. "There is a dearth of hard evidence on environmental risks," said Polk. "And what has rushed in to fill that gap is fear. AICR is out to change that." The irony, Polk said, is that the risks Americans can and do control - those associated with diet and lifestyle - have a proven and dramatic impact on cancer risk. "Simply by becoming educated about healthy diets and healthy lifestyle choices, Americans could replace their growing sense of helplessness with the power to make the practical and effective everyday decisions that lower cancer risk." Proven Risks Associated with Diet Lifestyle Overlooked Diets Low in Vegetables and Fruits were identified as a cancer promoter by only 46 percent of those surveyed. Such diets have been convincingly linked to cancers of the mouth, pharynx, esophagus, lung, stomach, colon and rectum. Evidence is considerable, though less definitive, for cancers of the larynx, pancreas, breast, bladder, liver, ovary, endometrium, cervix, prostate, thyroid and kidney. Diets High in Fat were cited by only 44 percent of respondents, despite possible links to five different cancers. Alcohol has been definitively linked to five cancers, including the liver, and is probably linked to three more cancers. Surprisingly, however, only 42 percent of Americans identified it as a cause of cancer. There is evidence linking Diets High in Red Meat to five cancers, yet only 39 percent of Americans believed such diets are associated with increased cancer risk. Insufficient Physical Activity, strongly linked to colon cancer and possibly to cancers of the lung and breast, was considered by only 35 percent of Americans to be a cancer cause. Obesity, though convincingly associated with cancer of the endometrium and less convincingly with five other cancers, was also believed to be a cancer promoter by just 35 percent of respondents. The lack of public knowledge about this cancer link is particularly distressing, Polk said, because about 60 percent of Americans are overweight. Survey Methodology The survey was conducted on behalf of AICR by International Communications Research over a five-day period during May, 2001. 750 respondents over the age of 18 were contacted, and results were weighted to reflect the general US population. Weighting is employed to provide nationally representative and projectable estimates of the adult population 18 years of age and older. The weighting process takes into account the disproportionate probabilities of household selection due to the number of separate telephone lines and the probability associated with the random selection of an individual household member. Following application of these weights, the sample is post-stratified and balanced by key demographics such as age, sex, region and education. Results Contrast Sharply with Scientific Opinion Polk concluded her presentation by reporting on the findings of an informal poll of scientists involved with cancer research. The Institute wanted to see how the opinions of those in the scientific community contrasted with the beliefs of the American public. Though informal and unscientific, the results of the researcher poll yielded some telling differences from the opinions expressed by the American public. According to Polk, cancer researchers were 23 percent more likely than the public to implicate Diets Low in Fruits and Vegetables in cancer incidence. Cancer researchers were also 23 percent more likely than the public to implicate Diets High in Grilled Meats in cancer incidence; 18 percent more likely than the public to implicate Diets High in Cured Meat in cancer incidence; 14 percent more likely than the public to implicate Diets High in Fat in cancer incidence, and 14 percent more likely to implicate Obesity in cancer incidence.
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