Life After Cancer

Living With Risk

Krista L. Wilkins, PhD, RN; Roberta L. Woodgate, PhD, RN

Disclosures

Cancer Nurs. 2011;34(6):487-494. 

In This Article

Discussion

For the cancer survivors who took part in this study, a second cancer diagnosis was undoubtedly a real-life danger. Cancer survivors became refined by and lived with their risk of developing a second cancer. As found in previous studies of being at risk, living with second cancer risk was experiential and evolved over time.[7] Study participants explained that their heightened bodily awareness and monitoring of their second cancer risk eventually gave way. Once they had learned to integrate their risk of a second cancer diagnosis into their sense of self, participants rarely translated their awareness of their second cancer risk into actions to take care of that risk (see follow-up article in Cancer Nursing).

Giving voice to cancer survivors' understanding of second cancer risk shows that there is a plethora of risk discourses that coexist and compete. What is evident from this study is that second cancer risk does not exist merely as an epidemiological calculation. Second cancer risk, from the perspective of cancer survivors, is shaped by more intuitive conceptual models than statistical models of risk. Cancer survivors' understanding of second cancer risk involves "lay epidemiology," which incorporates personal meanings, familial experiences, and social conditions in the construction of knowledge about risk and health behaviors.[18]

Processes that cancer survivors go through in constructing their perceptions of second cancer risk can be best explained using the concept of heuristics.[9] Cancer survivors used the anchoring and adjustment (saliency), representativeness (similarity to a stereotype), and affective heuristics (positive affect) while faced with complex and fragmented information about second cancer risk.

The anchoring and adjustment heuristic was used when cancer survivors relied on their cancer experience and cancer experiences of others as an initial reference point through which they interpreted their second cancer risk. Consistent with previous studies,[7] participants in this study explained second cancer risk in terms of concrete risk factors for cancer, some of which are well known, and others were based on personal theories of cancer causation.

Cancer survivors used the representativeness heuristic in that they assessed their second cancer risk based on their perception of how similar (or different) they were to the typical person who gets cancer in the general population and within their own family. For example, a common perception was that cancer survivors' risk for developing cancer is equal to that of anyone else because their risk reverts back to their precancer level. Cancer survivors' perception that everyone is at risk of developing cancer implies a leveling of one's personal risk for cancer and a desire to avoid recognizing that one's actions, such as smoking, may place them at greater risk than the general population.

As a proxy for genetics and heredity, family history of cancer served to provide the social context for individual interpretations of second cancer risk.[7] Through the affective heuristic, cancer survivors with a strong affective reaction to thinking about their second cancer risk demonstrated that experiences of cancer in the family overshadowed the possibility that their epidemiological risk was relatively low. Several study participants stated that they would most certainly develop a cancer that was present in their family history. However, others denied the possibility of developing a second cancer despite a family history of cancer. These cancer survivors explained their cancer risk is a guessing game because it is unknowable and that it is impossible to predict what will happen in the future. This sense of security would seem to be misplaced given the ongoing research demonstrating an association between family history of cancer and development of second cancers.[3,4]

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