On my way to or from a home visit, I will sometimes catch a snippet of Radio 4’s Last Word programme and recently heard the show’s obituary for the late Joyce Robertson.
Robertson was a pioneering writer and researcher who had a profound impact on the care of young children in hospital in the 1950s and -60s. She was so troubled by the effect on her own children’s enforced separation from her when they had to spend time in hospital that she made several documentaries, recording the effect of a young child being removed from its mother.
These were so disturbing to health professionals – who routinely banned mothers from even visiting their children in hospital at the time – they were initially only viewed by those within the profession. The fear was that if the general public saw the material they would refuse to allow their children to be admitted to hospital, and mayhem would result.
If only this paternalistic attitude had been left in the 1950s. Macmillan Cancer Support recently released a report concerning projections for future cancer diagnosis rates – with the headline that by 2020 almost half of Britons will be diagnosed with cancer in their lifetime, but that more will survive the disease than ever before.
It is a useful document, which raises important questions about how to resource the health needs of the future. What bothers me, though, is the limited explanation given for the increase.
Macmillan’s own site gives a single, unequivocal reason – we are living longer, older people are more likely to get cancer and so more of us will get cancer. I don’t doubt this, and suspect it is the major reason, but is it likely that something as complex as increasing cancer diagnosis rates will be so one-dimensional when it comes to causative factors?
I have scoured BBC news, the broadsheets (excluding The Times, of course, with its paywall) and even ventured onto the Daily Mail website. The Guardian was the only site to offer any other possible factors in this important demographic change - having gleaned a quote from the charity that ‘poor diet, alcohol consumption and physical inactivity’ may also be factors – otherwise known as the ‘when in doubt, blame the patient’ explanation.
Do we lack the wit, the imagination, or the will to ask if there might be any other factor involved in the increase? Could there possibly be anything that doctors are doing that could be contributing? The important factor is that more people are being diagnosed with cancer, not dying from it. The fact is that the more we look for cancer, the more we will find it - and what we don’t like to confess in public, is that not all the cancer we find needs to be found.
We are screening for cancer like never before. We have just introduced a new screening programme for bowel cancer and there are calls to widen this to other types, with lung cancer leading the charge. Despite the absence of an approved national screening programme for prostate cancer, many men still put themselves forward for a PSA check. We have even redefined what we mean by cancer: DCIS is now labelled as breast cancer and treated in kind, while terms like ‘melanoma-in-situ’ and ‘prostatic intraepithelial neoplasia’ are increasingly more common.
While screening for cancer may save lives, we know that it also increases diagnosis rates and is associated with significant over-diagnosis and over-treatment.1 Every over-diagnosed cancer will have added to this statistical increase, and - since these ‘cancers’ will probably be easy to treat - will have falsely contribute to the improved survival rates quoted in the report. This may be a price worth paying, but can we at least be honest about it?
I don’t think doctors or cancer charities lack the wit or imagination to understand this. It is a matter of will; there is a conspiracy of silence on the issue, a practised paternalism that really believes that if the general public were to understand health issues, they might refuse to do as they are told – and mayhem would result.
As for the media – if they understand it, why don’t they report it? Why do they consistently fail to challenge cancer charities, health professionals and politicians who paint only half the picture? Is it down to lazy reporting? A lack of scientific understanding among journalists with backgrounds in the arts? Editorial censorship?
Whatever the reason, if we are ever to bring honesty to this debate then this needs to change – because the powerbrokers in this game are not going to change on their own.
Dr Martin Brunet is a GP in Guildford and programme director of the Guildford GPVTS. You can tweet him @DocMartin68