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Article

Nickolas Surawy-Stepney and Carlo Caduff

Cancer is a relatively new subject for the discipline of anthropology, but scholarship on the topic has already yielded a distinct and important body of literature. In biomedical terms, cancer can be thought of as the wide range of conditions characterized by the uncontrolled (and ultimately pathological) proliferation of cells. It is a disease that is responsible for the deaths of millions of people worldwide each year. As such, it is the focus of a vast number of discourses and practices in multiple areas, ranging from scientific research and media discussion to health insurance and government regulation, to name just a few. Anthropologists concerned with cancer typically use the methodology that is a hallmark of the discipline, long-term ethnographic fieldwork, in order to investigate these discourses and practices. This involves conducting participant observation among doctors, patients, nurses, family members, scientists, politicians, policymakers, and pharmaceutical representatives. Cancer is examined as a lived experience, revealing the numerous ways that local, regional, national, and transnational histories and politics shape the embodied realities of disease. Anthropologists also investigate the regimes of risk and statistical analysis to which bodies are subjected and the technologies around cancer, such as methods of screening or vaccination that aim to prevent it and the different ways in which these and other interventions and technologies fit into—or push uneasily against—the local words in which they are implemented. Anthropologists aim to look beyond the problem as simply one of biology and medicine, instead investigating cancer as pervasive within multiple dimensions of social, cultural, political, and economic life. Anthropological studies displace the prominent biomedical notion that cancers are the same in diverse locations and reveal the incoherence and intractability of cancer as an object. In paying close attention to this object in varied settings, anthropologists offer a critical account of discourses and practices that destabilize and decenter some of the assumptions on which global oncology is based.

Article

Sex is a biological variable that affects immune responses to both self and foreign antigens (e.g., microbial infections) in the central nervous system (CNS) as well as in peripheral organs. The sex of an individual is defined by the differential determination of the sex chromosomes, the organization of the reproductive organs, and the subsequent sex steroid hormone levels in males and females. Sex is distinct from gender, which includes self-identification as being a male or female as well as behaviors and activities that are determined by society or culture in humans. Male and female differences in immunological responses may be influenced by both sex and gender, with sex contributing to the physiological and anatomical differences that influence exposure, recognition, clearance, and even transmission of microbes in males and females. By contrast, gender may reflect behaviors that influence exposure to microbes, access to health care, or health-seeking behaviors that indirectly affect the course of infection in males and females. Though both sex and gender influence the immune response, the focus of this article is the biological factors that influence immunological differences between the sexes in both the CNS and peripheral tissues to alter the course of diseases across the life span.

Article

The goal of cancer prevention and control is to reduce cancer risk, morbidity, and mortality through transdisciplinary collaborations across biomedical, behavioral, and social sciences. Risk reduction, early detection, and timely treatment are the rationales behind policy efforts to promote cancer prevention. Economics makes three important contributions to cancer prevention and control research. Firstly, research built upon the human capital model by Grossman and the insurance model by Ehrlich and Becker offers solid theoretical foundations to study human behaviors related to preventive care. Secondly, economic evaluation provides useful analytical tools to assess the “cancer premium” (through the stated preference research approach) and to identify the optimal screening strategy (through cost-effectiveness analysis). Lastly, the rich set of quantitative methods in applied economics contributes to the estimation of the relative contribution of prevention versus treatment in the reduction of cancer mortality and the evaluation of the impact of guidelines to regulate screening practices or policy initiatives to promote cancer screening.

Article

Marie M. Lauria

Oncology social work is a specialization of social work in health care. Its practitioners provide supportive services and programs, patient navigation, education, research, administration, policy development, and advocacy to address the social, psychological, practical, and spiritual concerns of cancer patients, their families, and caregivers from pre-diagnosis through treatment, survivorship, and end of life care or bereavement. The coming decades will present many challenges and opportunities for oncology social workers in helping patients, families, and caregivers overcome barriers to quality of life and care.

Article

Julianne S. Oktay and Bradley Zebrack

Oncology social work researchers have made (and continue to make) important contributions to the knowledge base that supports the profession. This article discusses the profession of oncology social work, its roots in medical social work in the United States, the development of cancer treatment, and the body of research that informs its art and practice. Oncology social work research is placed in the broader contexts of the social work profession, the field of oncology, and the specific field of oncology social work. Through the decades, the profession of oncology social work has grown, gained stability and legitimacy. Oncology social work itself, along with oncology social work research, have made rapid strides in the 21st century and accelerating in impact and relevance. Oncology social work research is stronger now than ever. Recent developments, such as the addition of a research institute at the annual AOSW conference and initiatives to establish a “practice-based research network” are expanding capacity in the field. Oncology social work researchers bring a unique perspective to their research. Social work’s patient-centered perspective is reflected in research that explores the cancer experience of patients and family members and leads to new interventions based on that experience. Social work’s focus on human development over the life course results in research that reflects a developmental framework or focuses on specific age groups, such as children, adolescents, young adults, or the elderly. Social work’s conceptual model of “Person-in-Environment” is reflected in research on cancer patients in the context of their interpersonal relationships. The values of social justice and cultural competence are reflected in research on health disparities, minority populations, and multicultural perspectives. Finally, the field of oncology social work itself has been the focus of recent research on distress screening and its implementation. In the 21st century, oncology social work research stands in a pivotal position. Although this type of research is now widely recognized as important, it is still a challenge to access the level of support from major funders of cancer research required to establish and reinforce a strong and vibrant knowledge base for the profession.

Article

Starting in the 1920s, the first initiatives to organize the control of cancer in Argentina soon revealed the presence of different actors and interests, a specialized cancer institute, a women’s voluntary organization, state authorities, university departments, cancerologists, and gynecologists. Initially concentrated around the activities of the Institute of Experimental Medicine for the Study and Treatment of Cancer in Buenos Aires, cancer interventions expanded in the following decades through university departments and gynecology services, which outlined a decentralized approach for reining in the centralized efforts from the institute. While a therapeutic-based approach with substantial funding for research institutes characterized industrialized countries’ initiatives until the end of World War II, in Argentina it was within the field of cancer diagnosis where specialists sought to create the foundational structures of cancer organization. Early detection of tumors, it was argued, favored a good prognosis with surgical treatment, placing the burden of cancer control on public education, the availability of diagnostic services, and doctors’ knowledge of cancer identification. From the 1920s to the early 1980s, three distinct periods can be identified: first, an institutional approach, where the first cancer institute attempted to concentrate all the activities related to the control of cancer, that is, lay education, scientific research, diagnosis and treatment, patients’ support, and cancer statistics; second, a state approach, inaugurated by the arrival of Juan Domingo Perón to government, where the centralization of cancer initiatives became a state affair; and third, a long period characterized by the retirement of the state—marked by political unrest and a succession of military governments until the return of democracy in 1983—informed by decentralizing policies, the prominent role of civil society actors, such as voluntary organizations and medical societies, and the relative sway of the Pan American Health Organization. Throughout these three periods, all these actors played a role, and their ambivalent relationship and, often poor, interaction shaped the country’s efforts to control and prevent a disease that, since the 1940s, has steadily occupied the second cause of death. As the early detection strategy prevailed, responsibility for cancer control and prevention was constantly redistributed among the public, doctors, educators, and those who financed cancer services. The national state emerged as a feeble agent in cancer governance and, as discussed in the final section, this legacy is still felt today.

Article

Kami J. Silk and Daniel Totzkay

The Breast Cancer and Environment Research Program (BCERP) is a transdisciplinary program of research created to investigate environmental exposures and their relationship to breast cancer with a particular focus on puberty as a potential window of increased susceptibility to environmental exposures. A transdisciplinary approach has a strong focus on translating scientific findings into usable health practices as well as health prevention messages so that current research informs practice as well as communication to the lay public. BCERP engaged in communication science to develop health messages for lay audiences, health professionals, and outreach organizations. The precautionary principle, used as a primary guide in regards to message translation and dissemination, yields a useful discussion of the BCERP organizational structure. An exploration of formative communication science efforts in BCERP, areas of sensitivity for creating BCERP messages, and resources created for BCERP toolkits serves to illustrate and describe this one approach to designing health and risk messages.

Article

Valuing the benefit of reduced exposures to environmental health risks requires assessment of the willingness to pay for the risk reduction. Usual measures typically estimate individual local rates of substitution between money and the reduced probability of the adverse health impact. Benefit-cost analyses then aggregate individuals’ willingness to pay to calculate society’s willingness to pay for the health risk reduction benefit. The theoretical basis for this approach is well established and is similar for mortality risks and health outcomes involving morbidity effects. Researchers have used both stated preference methods and revealed preference data that draw on values implicit in economic decisions. Continuing controversies with respect to valuation of environmental health impacts include the treatment of behavioral anomalies, such as the gap between willingness-to-pay and willingness-to-accept values, and the degree to which heterogeneity in values because of personal characteristics such as income and age should influence benefit values. A considerable literature exists on the value of a statistical life (VSL), the local tradeoff between fatality risk and money, which is used to value mortality risk reductions. Many VSL estimates use data from the United States for regulatory analyses of environmental policies, but several other countries have distinct valuation practices. There are empirical estimates of the benefits associated with reducing the risks of many environmental health effects, including cancer, respiratory diseases, gastrointestinal illnesses, and other health consequences that have morbidity effects.

Article

At the heart of cancer communication research is an effort both to increase knowledge and to identify practical strategies for improving cancer communication and for improving prevention and control of cancer, as well as for addressing cancer care issues from theoretical and applied communication perspectives across the continuum of cancer care. One important theoretical approach to consider in cancer communication science is taking an intergroup approach to cancer care. The challenge moving forward is to develop cancer communication research programs that combine important theoretical and applied perspectives, focusing on prevention strategies that can help reduce cancer risk, incidence, morbidity, and mortality, and to promote the highest quality of life for people of every age and every background.

Article

Pierluigi Cocco

The fight against agricultural and household pests accompanies the history of humanity, and a total ban on the use of pesticides seems unlikely to happen in the foreseeable future. Currently, about 100,000 different chemicals, inorganic and organic, are currently in the market, grouped according to their function as insecticides, herbicides, fungicides, fumigants, rodenticides, fertilizers, growth regulators, etc. against specific pests, such as snails or human parasites, or their chemical structure—organochlorines, organophosphates, pyrethroids, carbamates, dithiocarbamates, organotin compounds, phthalimides, phenoxy acids, heterocyclic azole compounds, coumarins, etc. Runoff from agricultural land and rain precipitation and dry deposition from the atmosphere can extend exposure to the general environment through the transport of pesticides to streams and ground-water. Also, the prolonged bio-persistence of organochlorines generates their accumulation in the food chain, and their atmospheric drift toward remote geographical areas is mentioned as the cause of elevated fat contents in Arctic mammals. Current regulation in the developed world and the phasing out of more toxic pesticides have greatly reduced the frequency of acute intoxications, although less stringent regulations in the developing world contribute to a complex pattern of exposure circumstances worldwide. Nonetheless, evidence is growing about long-term health effects following high-level, long-lasting exposure to specific pesticides, including asthma and other allergic diseases, immunotoxicity, endocrine disruption, cancer, and central and peripheral nervous system effects. Major reasons for uncertainty in interpreting epidemiological findings of pesticide effects include the complex pattern of overlapping exposure due to multiple treatments applied to different crops and their frequent changes over time to overcome pest resistance. Further research will have to address specific agrochemicals with well-characterized exposure patterns.

Article

Communication privacy management theory (CPM) argues that disclosure is the process by which we give or receive private information. Private information is what people reveal. Generally, CPM theory argues that individuals believe they own their private information and have the right to control said information. Management of private information is not necessary until others are involved. CPM does not limit an understanding of disclosure by framing it as only about the self. Instead, CPM theory points out that when management is needed, others are given co-ownership status, thereby expanding the notion of disclosing information; the theory uses the metaphor of privacy boundary to illustrate where private information is located and how the boundary expands to accommodate multiple owners of private information. Thus, individuals can disclose not only their own information but also information that belongs to others or is owned by collectives such as families. Making decisions to disclose or protect private information often creates a tension in which individuals vacillate between sharing and concealing their private information. Within the purview of health issues, these decisions have a potential to increase or decrease risk. The choice of disclosing health matters to a friend, for example, can garner social support to cope with health problems. At the same time, the individual may have concerns that his or her friend might tell someone else about the health problem, thus causing more difficulties. Understanding the tension between disclosing and protecting private health information by the owner is only one side of the coin. Because disclosure creates authorized co-owners, these co-owners (e.g., families, friends, and partners) often feel they have right to know about the owner’s health conditions. The privacy boundaries are used metaphorically to indicate where private information is located. Individuals have both personal privacy boundaries around health information that expands to include others referred to as “authorized co-owners.” Once given this status, withholding to protect some part of the private information can risk relationships and interfere with health needs. Within the scheme of health, disclosure risks and privacy predicaments are not experienced exclusively by the individual with an illness. Rather, these risks prevail for a number of individuals connected to a patient such as providers, the patient’s family, and supportive friends. Everyone involved has a dual role. For example, the clinician is both the co-owner of a patient’s private health information and holds information within his or her own privacy boundary, such as worrying whether he or she diagnosed the symptoms correctly. Thus, there are a number of circumstances that can lead to health risks where privacy management and decisions to reveal or conceal health information are concerned. CPM theory has been applied in eleven countries and in numerous contexts where privacy management occurs, such as health, families, organizations, interpersonal relationships, and social media. This theory is unique in offering a comprehensive way to understand the relationship between the notion of disclosure and that of privacy. The landscape of health-related risks where privacy management plays a significant role is both large and complex. The situations of HIV/AIDS, cancer care, and managing patient and provider disclosure of private information help to elucidate the ways decisions of privacy potentially lead to health risks.

Article

Christian von Wagner, Wouter Verstraete, and Sandro Stoffel

Cancer screening aims to detect cancer before the appearance of symptoms. Applying a proactive and systematic approach, cancer screening programs invite every person in the target population automatically. Many countries have established guidelines that define criteria and principles on whether to implement screening programs for specific conditions. Despite the universal coverage of these programs, inequalities have been observed in their uptake based on various sociodemographic factors: gender, age, ethnicity, socioeconomic status (SES), educational level, and marital status. Behavioral science provides key performance indicators of these programs. Psychological factors such as perceived benefits (e.g., ability of the program to diagnose early or even prevent cancer) and barriers (e.g., opportunity costs relating to test attendance or completion), as well as people’s cancer and screening-related beliefs and perceptions of their own susceptibility to cancer, play a crucial role in cancer screening uptake. Furthermore, there is increasing awareness among professional bodies for the need to balance the public health benefits against individual costs, including financial and opportunity costs associated with participation and potential longer-term harms, such as receiving a cancer diagnosis that would never have caused any symptoms or problems). These recent developments have led to stronger emphasis on monitoring patient-reported experiences and ensuring that participation is based on informed choice. In addition, some of these issues have also been addressed by more fundamental changes to the screening paradigm such as more personalized approaches (using additional genetic and epigenetic information) to establishing eligibility criteria. The acceptability of using this information and its implication to offer more or less intensive screening and developing effective ways to understand the ability of the program to communicate this information are key challenges for the clinical, research and policy making community.

Article

Janice L. Krieger and Jordan M. Neil

Strategic communication is an essential component in the science and practice of recruiting participants to clinical research studies. Unfortunately, many clinical research studies do not consider the role of communication in the recruitment process until efforts to enroll patients in a timely manner have failed. The field of communication is rich with theory and research that can inform the development of an effective recruitment plan from the inception of a clinical research study through informed consent. The recruitment context is distinct from many other health contexts in that there is often not a behavioral response that can be universally promoted to patients. The appropriateness of a clinical research study for an individual is based on a number of medical, psychological, and contextual factors, making it impossible to recommend that everyone who is eligible for a clinical research study enroll. Instead, clinical research study recruitment efforts must utilize strategic communication principles to ensure that messages promote awareness of clinical research, maximize personal relevance, minimize information overload, and facilitate informed choice. This can be accomplished through careful consideration of various aspects of the communication context described in this chapter, including audience segmentation, message content, message channels, and formative, process, and outcome evaluation, as well as the enrollment encounter.