While it’s not the only disease that inspires fear, cancer might be singular in the amount of terror it can incite. Recent advances in diagnosis and treatment may have alleviated some of those fears, but “cancer fatalism,” the belief that cancer is incurable or beyond a patient’s control, remains a significant barrier to early diagnosis.
In a new UK study, between 26% and 38% of women who belong to an ethnic minority believe that cancer is incurable. But no white women did, according to researchers at Britain’s Department of Epidemiology and Public Health, who recently measured the differences in fatalism between ethnic groups. The study, published in the British Cancer Journal in February 2016, was authored by Charlotte Vrinten and colleagues.
Destiny & Death: Two Views Of Fatalism
Having a fatalistic view of cancer makes patients less likely to have their symptoms checked out, less likely to seek out diagnostic testing, and ultimately, less likely to receive treatment in time. But defining “fatalism” in this context is difficult. To do so, the British researchers quoted two influential studies from the recent past:
- predetermination – “the belief that a cancer diagnosis is a matter of fate and therefore beyond the individual’s control” or
- incurability – “the belief that death is inevitable when cancer is present”
Note that these aren’t mutually exclusive definitions. One can certainly believe that cancer is incurable, and in all cases a death sentence, but not believe that getting cancer is a matter of one’s personal destiny. Destiny, for that matter, need not imply an inevitable death; one can believe that, while a diagnosis was the work of fate, cancer remains a curable disorder. Remarkably, while several past studies have used both definitions to measure fatalism, this is the first to report separate findings.
Cancer Fatalism In Minority Women Prevents Early Diagnosis
In either case, however, a fatalistic attitude about cancer has been shown to reduce the likelihood of a patient seeking out preventive diagnostic screenings. In short, people who believe that cancer is incurable, or a matter of fate, are less inclined to actively participate in cancer screening and detection programs. In an earlier study, for which Vrinten polled the same 720 women, between 44% and 71% of the women from ethnic minority backgrounds didn’t get annual cervical cancer screenings, which are paid for by England’s National Health Service. Only 12% of white women, on the other hand, didn’t get screenings.
This is, to a certain extent, a self-fulfilling prophecy. Women who believe cancer is a matter of destiny, or incurable, are less likely to pursue proactive screenings, and thus less likely to be diagnosed at an early stage. Later diagnoses limit treatment options and increase the chance of death.
White women were more likely to consider themselves at risk for cervical cancer, and far more likely than women from Indian, Pakistani, Bangladeshi and African backgrounds to separate the presence of symptoms from the need for screening. In contrast to white women, between 57% and 65% of women from Indian, Pakistani, Bangladeshi and African backgrounds believed that receiving a Pap smear was only required if you had symptoms of cervical cancer.
In the most recent study, researchers asked 720 women whether they agreed or disagreed with the statement, “if someone is meant to get cancer, they will get it no matter what they do”:
- 6% of White women agreed
- 11% of African women agreed
- 23% of Caribbean women agreed
- 50% of Indian women agreed
- 52% of Pakistani women agreed
- 63% of Bangladeshi women agreed
Women who were not born in the UK, did not speak English as a primary language and those who the researchers found “had difficulty understanding health leaflets” were more likely to believe that a cancer diagnosis is a matter of fate. When asked whether or not they believed that cancer was incurable:
- 35% of African women said yes
- 26% of Caribbean women said yes
- 34% of Indian women said yes
- 27% of Pakistani women said yes
- 38% of Bangladeshi women said yes
The ethnic minority women who held this view did so regardless of whether their views were fatalistic in general, and regardless of how long they had lived in the UK.
Explaining Cancer Fatalism
Fatalism is a wildly complex phenomenon. Factors contributing to these beliefs, that cancer is incurable or an act of fate, likely run the gamut. Socioeconomic status, culturally-constructed worldviews, religious beliefs and education levels have all been implicated.
One theory proposed specifically by Vintner and her co-authors is that cancer outcomes are particularly unfavorable in minority communities, and that members of those communities, often poor and under-served, have been conditioned through personal experience to view cancer as an intractable catastrophe.
Of course, they may be absolutely right: survival rates for impoverished cancer patients are worse than those for wealthier patients, and that fact has been shown in numerous studies. As just one example, a 2008 study of US federal data spanning from 1975 to 2000 found that people living in poorer counties have a 13% higher death rate from cancer than people living in more affluent counties.
Smaller minority communities may lack ready access to treatment options, Vintner continued. Diagnoses often come late, and many members of these communities only begin to receive treatment at a late-stage, when the prospect of a favorable outcome is much lower. Thus cancer, for these people, may be effectively incurable, even though it’s not in principle. Socioeconomic factors, the researchers suggest, may be at the root of these higher cancer fatalism rates observed in ethnic minority women.
Vintner and her colleagues also believe cancer fatalism may, in part, originate in cultural beliefs. “In some cultures,” they write, “cancer is considered a ‘taboo’ […].” They cite a 2012 study, conducted in Ghana, which found that many women in the West African nation “displayed a high level of reliance on God for protection from [breast cancer], as well as on divine intervention and healing.” Financial constraints, however, were seen to be just as much of a barrier to receiving preventive screenings and adequate treatment as any belief in religious or spiritual intervention.
Socioeconomic Status & Fatalism
While we would never seek to equate race or ethnicity with socioeconomic status, the two are intimately intertwined. So are socioeconomic status and cancer fatalism. Studies have found that generally, members of socioeconomically disadvantaged groups are more likely to hold fatalistic views toward cancer than advantaged groups. This remains true even in countries that provide their citizens with “free” publicly-subsidized healthcare.
In 2015, a group from University College London took a nuanced approach to this correlation, sending out questionnaires to 6,965 British adults 65 or older. The questionnaire proposed six “belief items,” statements like, “I would not want to know if I have cancer.” Three of these statements, like “cancer can often be cured,” framed cancer in a positive light, while three framed cancer negatively. The results, while interesting, should be taken with a grain of salt, since the study used a respondent’s level of education as an index of socioeconomic status, and the two cannot be considered equivalent in all cases.
With that being said, the study found little difference in how respondents viewed positive statements about cancer. People agreed with these positive beliefs in around 90% of cases, and that was true for both highly-educated respondents and less-educated respondents. Negativity, however, had a profoundly different effect. For example, while 57% of the people with low education levels agreed with “treatment is worse than cancer,” only 34% of the highly-educated respondents did. When prompted with the belief that “cancer is a death sentence,” 16% of less-educated respondents agreed, while only 6% of highly-educated people agreed.
Optimistic views of cancer “attract near-universal agreement,” the researchers concluded. But negative opinions seem more prevalent in less-educated, and thus socioeconomically disadvantaged communities, than more-educated, wealthier groups. Similar results have confirmed these findings elsewhere.