Fatalism may fuel cancer-causing behaviors.

O ne of the most important concepts in public health today is that many cancers are avoidable through exercise, eating right, and not smoking. What’s more, death rates for the 10 most common cancers have declined steadily, reflecting treatment advances. But even so, millions of people hold fatalistic views on cancer. Fatalism has been shown repeatedly to thwart screening and treatment; those who believe cancer is a guaranteed death sentence typically don’t pursue early detection, says Barbara Powe, Ph.D., who directs underserved population research at the American Cancer Society. Now, a new study has found that fatalism also deters people from taking basic steps to prevent cancer. Lead author Jeff Niederdeppe, Ph.D., an associate professor of population health at the University of Wisconsin – Madison, says the study reveals widespread confusion among Americans about the causes of cancer and pessimism about their chances of preventing it. “We were surprised at how pervasive these views are,” he says of the study, published in May in Cancer Epidemiology, Biomarkers, and Prevention . “There’s been an explosion of information about cancer, and solid recommendations about prevention, but many people still feel like there’s nothing they can do to avoid it.” Niederdeppe and his colleague Andrea Gurmankin Levy, Ph.D., an assistant professor at the Harvard School of Public Health in Boston, analyzed phone interview data from NCI’s Health Information National Trends Survey, gathered in 2003. Their fi ndings show that 47% of the more than 6,000 Americans queried felt that “everything causes cancer,” while 27% agreed there is “not much people can do to lower their chances of getting cancer.” Another 71.5% said that “there are so many recommendations about preventing cancer, it’s hard to know which ones to follow.” Those who held fatalistic beliefs, the researchers found, were also less likely to get regular exercise, less likely to eat fruits and vegetables, and more likely to smoke. Smoking is of particular concern because 30% of U.S. cancer deaths can be attributed to smoking. In Niederdeppe’s view, the combined evidence suggests that those who hold fatalistic beliefs about cancer are less likely to lead healthy lifestyles, which in turn increases their risk. Niederdeppe found that fatalistic beliefs about cancer prevention tend to be strongest among those without a high school or college degree, even after controlling for socioeconomic status (SES). At fi rst, that conclusion contrasts with earlier fi ndings, which show more evidence of fatalism among those with lower SES and with low income in particular. However, most prior investigations have evaluated fatalism in regard to cancer screening and survival — not prevention behavior — so their fi ndings may not be comparable to Niederdeppe’s results. “This is an area that needs further study,” Powe says. “But I’d suggest you can’t separate these things: Education and SES tend to be intertwined.”