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Ads and Health Care

Many have seen the new ad campaign about cervical cancer. In one ad, a perfume bottle is labelled 'cervical cancer', and the ad admits it had to get your attention. It then states a woman is diagnosed with cervical cancer every 47 minutes. I wanted to see if this was true, and to put this ad in a perspective of women's health care.

The following data comes from SEER, a compendium of national data on cancer diagnosis and prognosis.

There were 11,270 new cases of cervical cancer. This does indeed work out to one every 47 minutes, as there are 8736 hours in a year. The lifetime risk of cervical cancer to a US woman is 0.96%. How important is this in the realm of women's health? Let's not put it in the perspective of societal health to avoid any claims of sexism. How important is this to women?

In looking at data trends over 30 years (all this is on SEER), the incidence of cervical cancer has continued to decline. There was a sharp decrease in cervical cancer with the introduction of paps in the late '50s, but the downward trend has continued. The reason is simple- paps are easy to do, relatively non-invasive, and ongoing improvements in technology, while increasing the price of paps, has also increased accuracy. There are also excellent, non-onvasive ways of making definitive diagnosis of pre-cancerous cervical disease and treating it. Taken together, the control of cervical cancer is a triumph of public health- cheap mass screening leading to readily available non-invasive pre-cancerous treatment.

What about ovarian cancer? Anyone who has seen a woman die of ovarian cancer weeps. It is one of the uglier and more painful deaths available to humans. Somehow ovaries, so central to the unique characteristics of women, just aren't sexy as an organ or a disease. And yet, 21550 women were diagnosed with ovarian cancer in the time 11270 women were diagnosed with cervical cancer. The incidence of ovarian cancer is unchanged over 30 years. Its mortality is also much higher than cervical cancer. There is no effective screening tool, no non-invasive treatment. Treatment- surgery and chemotherapy, is painful and long. Lifetime risk is 1.4%, or 50% higher than cervical cancer.

So, ovarian cancer is more lethal, more common, harder to find and harder to treat than cervical cancer. Why doesn't it have a perfume bottle awareness ad? Three reasons, as I see it.

First, given there is little that can be done to improve ovarian cancer detection and survival at this time, and with our existing technology, it is a waste of money and time to advertise despair and insufficiency.

Second, cervical cancer is produced by HPV, a sexually transmitted disease. Increasing awareness may reduce incidence by reducing SYDs. Not likely, but I'm assuming the best.

Third, the issue can be readily manipulated. Ovarian cancer data is not subject to spin simply because it is so bad. There is no way to make the presentation of ovarian cancer sexy.

I don't mind trying to raise awareness of cervical cancer. What troubles me is the lack of comparison with regard to statistics, even accurate ones like this ad. Federal budget numbers get manipulated like this all the time, and without seeing data and understanding something of accounting it is not possible to tell which politician is right in shouting his opponent is a liar. Compared with ovarian and endometrial cancers, cervical cancer is not quite an afterthought, but it pales in significance. When compared to breast cancer, colon cancer and heart disease, I don't want to say cervical cancer is trivial, but it is very minor as a cause of mortality. You would never know that from the ad.

Ted

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