By Sophie Cousins
“Be tested and enjoy life.” Sam Newman could hardly have guessed the impact of his words uttered during a feature on his prostate cancer diagnosis that aired on Channel 9’s 60 Minutes in March 2008.
The retired AFL star and controversial TV celebrity might have hoped his experience would touch a nerve with some male viewers, but he probably wasn’t expecting almost 40,000 men to take his advice. For the year before Sam Newman’s story was broadcast, the average monthly number of PSA (prostate specific antigen) tests for prostate cancer was 72,064. In April 2008, it was 107,633.
A few years earlier, Kylie Minogue’s breast cancer diagnosis had a similar impact. The news was splashed on magazine covers and dominated headlines in the print and online news media and on all the major TV stations.
Women called in to radio stations worried it could “happen” to them. In one study, Australian researchers found a 20-fold increase in news coverage of breast cancer in the 10 days following Kylie Minogue’s diagnosis.
The news also led to an unprecedented increase in bookings for mammograms. The number of women aged over 40 who booked mammograms in the Victoria, Queensland, Western Australia and Tasmanian BreastScreen programs rose 40 per cent in the two weeks of media frenzy, with the highest increase seen among women in the eligible age group of 40 to 69 who had never been screened before. Six weeks later, bookings remained more than one-third higher in this group.
Celebrities endorsing health interventions have the kind of impact most public health campaign directors can only dream of. One reason is the sheer volume of news they generate, says Professor Sandra Jones, director of the Centre for Health Initiatives at the University of Wollongong.
“People think the more they hear about it, the more likely it is going to happen to them,” she says.
Then there’s our tendency to feel a strong emotional connection to some celebrities. “It’s like a family member getting cancer,” Professor Jones says. “They feel ‘This could happen to me’. Women like Kylie — people relate to her, she’s a household name.”
Nobody doubts that celebrities like Kylie Minogue and Sam Newman have good intentions. On the other hand, their power to influence huge numbers of people is often understated and misunderstood. Cancer screening is more complicated than a celebrity simply telling the audience or the reader to “get tested”.
Concerns have been, and continue to be, raised over the risks involved with cancer screening — and prostate and breast cancer screening are no exception.
Those concerns range from the risk of over-diagnosis and over-treatment, to the psychological distress a cancer diagnosis can have on a person and her family and friends. And those subtleties can get lost in the simple messages delivered by celebrity patients.
Professor John Boyages, director and professor of breast oncology at the Macquarie University Cancer Institute, says the celebrity factor can have good and bad impacts.
On one hand, he notes that Australia still has relatively low rates of breast cancer screening.
“The reality is that screening rates remain low in Australia and in some ways, this sort of publicity reminds the general public that if celebrities can get cancer, then they can, too.”
Yet sometimes such endorsements of cancer screening can do more harm than good, he says. “It may increase the number of women being screened who may have less benefit from screening.”
That’s a view shared by Associate Professor Robin Bell, an epidemiologist at Monash University, who says the BreastScreen program is resulting in thousands of women potentially being diagnosed with breast cancer when the cancer would not have become clinically apparent in a woman’s lifetime. And in her view, the media is largely to blame.
Among cancers, there is no doubt breast cancer has received more media attention than any other cancer in Australia. While advocates have hailed the successes of the BreastScreen program — a reduction in deaths and improved technology — the flipside is rarely talked about.
While deaths from breast cancer have decreased by 30 per cent since the program’s inception in 1991, Professor Bell says women need to be better informed of the potential risks of over-diagnosis and over-treatment.
She says the BreastScreen program needs an overhaul so women are informed of the potential downsides of cancer screening.
While there are conflicting views concerning women and breast cancer screening, Professor Simon Chapman, lead author of the Medical Journal of Australia study into the effect Kylie Minogue’s diagnosis had on screening, says there is a very good reason why cancer screening is recommended in certain age brackets.
“To raise anxiety and to have very young women screened and for them to then have a mastectomy is not rational medicine at all,” Professor Chapman says. “If you’re looking at an action that is not recommended, it doesn’t matter how effective the campaign is, it’s not going to produce something that is applauded.”
Despite these concerns, Australian cancer organisations regularly use well-known figures to deliver messages.
These campaigns don’t always go down well with observers, who raise concerns about messages being oversimplified. However, Professor Ian Olver, chief executive officer of Cancer Council Australia, says celebrities help raise awareness and help to get the message across.
“Celebrities are able to grab the public’s attention, and promoting cancer screening is all about awareness,” he says. “The appropriate use of celebrities has been most helpful for us.
“We have used Michael Clarke to promote sun protection because he’s had skin cancer and he spends a lot of time outside,” he says. “It is appropriate for him to talk about skin cancer — it is real to him.”
Professor Olver argues that the simplicity of those messages is not the problem.
“Simplicity doesn’t worry me – it’s important to make the message. Accuracy of the message is what’s important. People should know that irrespective of screening programs, there will be over-diagnoses and false-positive test results.
“Weighing the positives of screening against the potential negatives will make it suitable or unacceptable. At the end of the day, evidence is still in favour of cancer screening — it does greater good than harm.”
The Prostate Cancer Foundation of Australia has also employed several celebrities to promote awareness about prostate cancer and screening. Actor Daniel Amalm, who starred in the television series Underbelly, is one of several Australian celebrities who appeared in the advertisements to say that prostate cancer can kill men “just like me”.
This is one example of celebrity endorsement that has infuriated Professor Chapman. “Amalm is 31. Yet, of the 75,433 men who died from prostate cancer between 1968 and 2007, just two were aged 30-34,” he wrote in an editorial in the Sydney Morning Herald in 2010.
“The Prostate Cancer Foundation advertisements feature men in their 30s being role models for screening — that is just off the radar in terms of absurdity,” Professor Chapman says. “The odds of finding cancer in a man that young is less than winning the lottery.”
Dr Anthony Lowe, chief executive officer of the Prostate Cancer Foundation of Australia, defends the use of celebrities and their message, while acknowledging that getting the message across has been difficult because of the lack of consensus on the issue.
“Our message is: ‘Talk to your doctor about being tested’,” he says. “However, sometimes the subtlety of that message gets lost. It is a difficult message to get out in a TV advertisement.
“It’s complicated because the medical profession doesn’t speak with a single voice. We’d like a national roundtable to develop a consensus approach so we don’t confuse the public any longer.”
While Dr Lowe acknowledges the issues of over-diagnosis and over-treatment, he doesn’t believe using celebrities to advocate for a PSA test is the problem.
“We think it’s important to make a distinction between getting tested and what happens afterwards,” he says. “The test is not the problem. It’s not a test for prostate cancer. It’s a test for prostate problems. The public need to understand this.”
For now, at least, cancer charities have decided that the benefits of using celebrities to raise awareness outweigh the risks. While Dr Lowe agrees men need to have all the information to make an informed decision, he says it is important they are aware of their health from an early age.
“Celebrities engage with younger men, not just older ones,” he says. “We will absolutely continue the use of celebrities.
“When people come to us and want to lend their support to a campaign, it’s important to get the message out. They want to make a difference and they make an important contribution.”
The Prostate Cancer Foundation will continue to use two types of celebrities, says Dr Lowe. In the first group are those involved with the formal promotion of prostate cancer awareness, such as entertainer Bert Newton and cricketer Steve Waugh.
“People identify with them, listen to what they have to say and are interested in what they have to say,” he says.
The second group comprises high-profile people who have been diagnosed with prostate cancer, such as Alan Jones and Wayne Swan.
“This is about permission,” Dr Lowe says. “Men are reluctant to talk about health and prostate cancer. Cancer is a no-go subject for men. We feel that identities create permission to talk about it.”
Professor Olver has a similar view. “We will continue to use celebrities and select ones that who are appropriate to send out our message,” he says.