The power of public patients
Kylie Minogue had a very public battle with breast cancer.
When a celebrity such as Kylie Minogue or Kerri-Anne Kennerley is diagnosed with cancer, their personal tragedy has the potential to save the lives of thousands.
After Kennerley revealed this week that she had been diagnosed with breast cancer, staff at the 500 BreastScreen offices across the country readied themselves.
At BreastScreen Victoria, which usually receives about 1200 calls a day, 3750 appointments for mammograms were made in the two days after the announcement, its chief executive, Vicki Pridmore, said.
The late Jane McGrath.
And 100 of those appointments came through its Facebook page and website, compared with between 20 and 50 on a usual day. People were talking.
The director of cancer services and information with the Cancer Institute NSW, Professor Sanchia Aranda, says these conversations are vital to getting women checked.
While there are no firm figures for BreastScreen NSW, anecdotally clinics reported an increase in bookings. Many women, staff said, mentioned Kennerley when they called.
The late Belinda Emmett.
Aranda says whenever a woman is diagnosed with breast cancer, increased awareness circulates among her friends and acquaintances.
''High-profile people influence our lives in lots of ways, from the clothes we wear to the products we buy, and often our health behaviours,'' she says. ''Kerri-Anne Kennerley has been in our living rooms for many, many years and people feel a connection to her and they feel more vulnerable.''
This increased awareness and sense that ''it could happen to me'' is vital in improving screening rates, which remain stubbornly low across the country.
Australia has a target of 70 per cent of women aged between 50 and 69 getting a mammogram every two years. At the moment, just under 55 per cent are screened.
Aranda says it is also important that Kennerley found her cancer herself, which could encourage more women to examine their breasts - something which, unlike mammograms, is recommended for every age group (see panel).
But it is not just women talking among themselves.
The chief executive of the Breast Cancer Network Australia, Maxine Morand, says the media interest in Kennerley's case has been phenomenal.
''It was on every national TV program [on Monday] night as far as I could see, so there is enormous interest,'' she says.
When Kennerley told her story to New Idea, she said she was shocked by her diagnosis because she ''didn't have any of the risk factors''. In fact, Kennerley, who is 58 and has no children, already ticks three boxes for breast cancer risk.
''The No.1 risk factor is being a woman and No.2 is age,'' Morand says. ''And there is a small statistical difference if you haven't had children.''
Morand, a former Victorian government minister who herself received a breast cancer diagnosis in June last year, believes the impact of Kennerley's public declaration will reverberate for a long time as the media follows her progress.
''I really commend her for going public with it,'' she says. ''Initially, I just wanted to keep it quiet. You are processing it, it comes as a shock.''
Many have been surprised by Kennerley's decision to put off her treatment for a week but Morand did the same - in her case, because her husband had work commitments and she wanted to wait until he was free.
''A week is not going to make a difference,'' she says. ''Everybody just knows what she is doing because she is on television.''
A professor of public health at the University of Sydney, Simon Chapman, says health campaigners sometimes resist the idea that celebrities can do so much towards raising awareness of issues that might otherwise struggle to gain traction in the media.
''There are some uncomfortable subtexts just beneath the disdain for celebrity engagement in health,'' he says. ''The main one seems to be an arrogant 'what would they know?' reaction.''
But he has seen the difference celebrity news can make. In 2005, Chapman had just undertaken a massive project overseeing media reporting of health issues when the news broke that Kylie Minogue had been diagnosed with breast cancer.
Chapman and his colleagues were recording every news bulletin and current affairs show on free-to-air television and so had a ready-made way to examine the impact of the announcement.
They found that in the 13 days before the publicity about Minogue's cancer, there were six news items broadcast on breast cancer, which took about 13 minutes in total. In the seven days after the news, there were 74 items and 147 minutes of coverage.
At the same time, Chapman found a 40 per cent increase in average weekly BreastScreen bookings across four states.
There was only one problem - a bigger increase in younger women asking for mammograms than in women who needed them most. Screening for women aged 50 to 69 increased 25 per cent, while screening for women aged 40 to 49 increased 69 per cent.
But University of Melbourne researchers who used Medicare data to look at breast screening for women aged 25 to 44 in the six months afterwards found a 20 per cent rise in screening. They also found an increase in the number of breast biopsies, but a big decrease in the number of biopsies that went on to require cancer surgery.
''The findings raise serious questions about whether the thousands of additional imaging procedures and biopsies ordered in Australia in the wake of Minogue's highly publicised diagnosis resulted in improved breast cancer detection among young women,'' they wrote in the International Journal of Epidemiology. ''More generally, our findings reinforce existing evidence that both patients and doctors are susceptible to behaviour change in response to celebrity health events.''
Chapman acknowledges the potential for inappropriate screening and treatment, causing anxiety and unnecessary invasive treatment. But he says this should not discourage public health campaigners from engaging with celebrities willing to talk about their cancer.
''The ambivalence about 'the Kylie effect' reflects enduring debate about the wisdom of breast screening but it should not blind us to the potential value of celebrity engagement in important causes,'' he says.
As Kennerley put it: ''I don't want to become a pin-up girl for anything or anyone really, but this is a bit of a serious message.''
My Journey Kit, a free, comprehensive, information resource for people newly diagnosed with breast cancer, is available from 1800 500 258 or bcna.org.au
Check at all ages, get mammograms later
Under 40 years
Breast cancer among younger women is extremely rare, and is not increasing. About 700 women under 40 are diagnosed annually in Australia. Mammography is not recommended because of the dense nature of the breast tissue of younger women. It is recommended women check their breasts regularly so they can be aware of any changes to the way they feel.
Again it is recommended the first action should be for a woman to regularly check her breasts, and to remain alert for any changes. Free mammograms are available but women are not targeted for screening at this age as cancer is less common and harder to detect. In 2007, about 2300 women in this group were diagnosed.
About 75 per cent of breast cancers occur in women over 50. Self-checks are recommended, with free mammograms every two years. A screening mammogram can detect lesions of cancer as small as a pea, whereas physical examination can pick up cancers only about 2.5 centimetres in diameter. In 2007, 6409 Australian women aged 50 to 69 were diagnosed.
Free screening is available every two years, but this age group is not actively targeted. Whether you attend screening is a personal choice based on your general health and whether you have any other diseases or conditions. In 2007, about 3140 women aged over 70 were diagnosed.