Scientific findings take time to land on the street. About 17 years old, the researchers calculate. And when the evidence does come into practice, it does not always penetrate satisfactorily. “The impact of an intervention depends on the effectiveness of the intervention and the reach of the population,” explains María Fernández, director of the Center for Health Prevention at the University of Texas School of Public Health, during a scientific seminar organized by the Catalan Institute of Oncology, in Barcelona. The researcher (Washington DC, 56 years old), an expert in the development and evaluation of health promotion interventions, spoke to EL PAÍS after recounting, in front of a room full of young researchers, the challenges of implementing science in prevention of cancer.
Ask. In his conference, he talked about the gap between what they know and what it costs to put it into practice. Regarding cancer, what example is there of something that you know works, but it hasn’t made it to the street?
Answer. In the United States, for example, we know that the use of physician reminders works to increase colorectal cancer screening, but it is not being used in clinics and many physicians may not remember. And patient reminders work too. We also know that there are interventions that increase children’s physical activity, such as active learning, in which those interventions teach teachers to teach while moving the children around. Another example is that we know that if the doctor recommends the papilloma vaccine while he is recommending the other vaccines, it works better than giving a separate recommendation.
Q. In his conference, he also mentioned fear as a factor that can play a double role: it can be used to get citizens to participate in some strategies, such as screening, but if you go too far, they can reject these measures. How is balance achieved?
R. With this example I was hitting the key point that it is very important to work with expert patients because people identify with other patients. But it is also important to work with people who know about health psychology because there are different things that influence whether or not a person listens to a message and whether or not the message motivates them. One way to handle it is to be realistic with the risk there is, but give hints about what they can do: never just give a message of fear.
Q. Is the population being scared too much with cancer?
R. I don’t know… I think it’s important that people know they’re at risk, but that they know there are things they can do. A person is not going to make an effort to do something if they think that “it will not happen to me” or that “if it happens to me, there is nothing I can do, I cannot survive”.
Q. What barriers are there to improve prevention?
R. In cancer, there are several things that can reduce your risk and others that you can do to detect it early. People perhaps do not pay attention to the recommendations or do not believe them and think that it does not matter what they do because it will not happen to them or it will happen to them anyway: that determinism, that fatalism, can be a barrier. But the most important thing, without a doubt, is tobacco: if a person does not smoke, eats well, and takes the tests that are due, it is the best way to prevent cancer.
Q. It has long been known that smoking is very bad for health and causes cancer. Why hasn’t tobacco been removed from the equation?
R. One of the problems is that there are programs that work, but they are not integrated as much as possible and that means that people do not have access to them. The programs have to be powerful, they have to work; it is not worth giving pamphlets. In the United States we have a telephone line to help people quit smoking: they give advice and access to medicines.
In lifestyles it is something in which we are failing: people eat worse and worse, exercise less and continue to smoke”
Q. Precisely in tobacco consumption there is a gradient of social inequality: people with fewer resources smoke more. How much does social inequality weigh in the fight against cancer?
R. It weighs a lot. In Spain you have it much better in terms of access, there are not as many inequalities as in the United States, but they still exist. Sometimes it is inequality in the sense that educated people understand more about the risks or where they have to go to access it. [al sistema]; this, for a migrant or person with less education or resources, is very difficult. And then the day-to-day influences: if a person is thinking about how to pay for food this week, it is much more difficult, because of that day-to-day struggle, for them to say: ‘I’m going to take care of myself, I’m going to the doctor or I’m going to to participate in this community program’.
Q. It is more difficult for them to worry about their health.
R. Clear. But what frustrates me, sometimes, when we talk about inequality, is that the controversy always goes to the person, to what they care about or to their motivation. And this seems super unfair to me. It is not that the person does not care about their health, it is that what they have to solve that day is more urgent.
Q. Regarding tobacco and other risk factors, the scientific community says that around 40% of tumors could be prevented. What is wrong with citizenship?
R. In lifestyles it is something in which we are failing: people eat worse and worse, exercise less and continue to smoke. But there are also screenings that can prevent cancer and we have to use them. Accessibility and motivation must be increased.
Q. How is he motivated?
R. This depends on what are the reasons or determinants of that behavior. And there are different. Some may not feel susceptible; others may think that the tests are not effective or that they do not want to know if they have cancer… The knowledge and beliefs in each population must be understood to focus education on the barriers they have.
Q. About the importance of the information that is given, how much do the fake news to prevention strategies?
R. It affects us a lot. She went through a lot with the covid. In the United States they say ridiculous things, like that vaccines are made with aborted fetuses or that vaccines cause autism. The fake news they create fear and a certain fear of vaccines and that is very worrying: the vaccine against the papilloma virus, for example, is incredible technology and that we have a vaccine that prevents cancer is something we dreamed of. But that people don’t like it because they say it’s very new, worries us.
Q. What is the great enemy for you, who are dedicated to cancer prevention? What is the most difficult for you to fight?
R. The enemies in this are misinformation and marketing of the tobacco industry. It is very difficult to combat this and public health does not have the resources to do so.
The ‘fake news’ creates fear and a certain fear of vaccines and that worries a lot”
Q. Does the tobacco industry put a lot of pressure on you?
R. Yes, but I think it is much worse in other countries than in the United States because in the United States there are more rules: you cannot have signs, for example, near schools, although this is different in each state.
Q. Even if it is more regulated, how far does its power reach?
R. They still have quite a bit of power. What the tobacco companies have done is diversify and sometimes you don’t know who you’re dealing with. I think they still have a lot of influence and although certain things are regulated, the marketing is strong. What seems worst to me is the approach [que están haciendo] in developing countries, which have fewer resources, to get people hooked and also expanding the types of products they use.
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