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May 21, 2020

How (or Do) People “Think” About Cancer Risk, and Why That Matters

Author Affiliations
  • 1Behavioral Research Program, National Cancer Institute, Bethesda, Maryland
JAMA Oncol. Published online May 21, 2020. doi:10.1001/jamaoncol.2020.0170

Much of clinical oncology hinges on the assessment, management, and communication of risk. Screening and genetic testing help identify future cancer risk; treatment decisions involve weighing competing risks; and early-phase clinical trials help determine acceptable risk of new therapies. Of course, in the current COVID-19 pandemic, oncologists have been forced to consider the risk of virus exposure among patients receiving ongoing treatment. When attempting to communicate about risk with patients in these contexts, the first instinct is to provide information that will help them think about risk effectively and then act accordingly. Yet doing so makes the implicit assumption that people really do “think” about risk—that is, that they devote logical reason to the exercise. Although a sensible assumption, much research in decision science does not support it. People often construct risk estimates and other relevant judgments such as preferences de novo, struggle with numerical information, and respond “don’t know” when given such an option on surveys in which they are asked to estimate their risk.1 Moreover, attempts to communicate personalized risk in clinical and other settings often reveal little to no effect on risk-reducing behaviors.2

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    1 Comment for this article
    Are Non-medical Specialists Aware of Cancer Risk?
    Michael McAleer, PhD(Econometrics),Queen's | Asia University, Taiwan
    The highly informative and prescriptive Viewpoint by specialists at the National Cancer Institute should be required reading for everyone, including medical specialists.

    Unlike the SARS-Cov-2 virus that causes the COVID-19 disease, about which everyone on earth must be aware, not many non-medical specialists would seem to think about cancer risk in advance of a positive diagnosis.

    I was one of the unaware multitude until the potentially grim news was detected as a side-effect of concussion.

    Impending mortality can clear and focus the mind, though the good fortune to have access to excellent private health insurance, skilled surgeons, talented oncologists,
    devoted nursing staff, and state-of-the-art hospital facilities, cancer treatments, new therapies, and genetic screening, as well as family and close friends, can perform modern-day miracles. 

    The presence of COVID-19 has led to increased risk management and health security for protection against exposure of immune-challenged patients undergoing cancer treatment.

    Simple and informative recommendations can lead to effective behavioural changes in advance of contracting cancer.

    The cancer specialists recommend the following productive and prescient approaches to mitigate cancer risk :

    (1) communicating accurate information abut cancer risk;

    (2) encouraging "thinking " about risk effectively and acting accordingly;

    (3) reducing risky behaviour through broadening the scope of understanding;

    (4) expanding awareness of cancer risk through broader comparative cohorts;

    (5) emphasizing the importance of preventive behavioural , emotional and intuitive decision making;

    (6) highlighting risk factors beyond reduction in smoking;

    (7) reducing misperceptions about cancer risk;

    (8) reducing overscreening of some types of common cancer;

    (9) changing the social identity of different types of cancer;

    (10) highlighting personal narratives, especially the experiences of celebrities, to modify risk behaviour;

    (11) modifying behaviour by highlighting social comparisons and identities;

    (12) being pro-active about state-of-the-art cancer risk factors.

    Cancer specialists are well aware that, in terms of insightful understanding and innovative mitigation of cancer risk, prevention is better than the cure.