Under the headline “Cancer: A Day in the Life,” Shelby Gagne’s portrait covered almost the entire front page of the Globe and Mail on Saturday, November 18, 2006. The Globe was launching an ambitious series of articles about cancer, and Shelby was its star: As the articles rolled out in the days and weeks that followed, the little girl’s painfully beautiful portrait appeared at the start of each one. In effect, the newspaper made Shelby the face of cancer.
And that was odd because the face of cancer looks nothing like Shelby’s. “Cancer is primarily a disease of the elderly,” the Canadian Cancer Society says in its compilation of cancer statistics. In 2006, the society notes, 60 percent of all those who lost their lives to cancer were seventy or older. A further 21 percent were in their sixties. “In contrast, less than one percent of new cases and of deaths occur prior to age 20.” The precise figures vary from country to country and year to year, but everywhere the basic story is the same: The risk of cancer falls heavily on older people, and a story like Shelby’s is vanishingly rare.
The Globe’s profile of Shelby, especially that stunning photograph, is journalism at its best. It is urgent and moving. But the decision to put the little girl at the center of a series about cancer is journalism at its worst. It was obvious that this “one-in-a-million case” was fantastically unrepresentative, but the newspaper chose story over statistics, emotion over accuracy, and in doing so it risked giving readers a very false impression about a very important issue.
This sort of mismatch between tragic tale and cold numbers is routine in the media, particularly in stories about cancer. In 2001, researchers led by Wylie Burke of the University of Washington published an analysis of articles about breast cancer that appeared in major U.S. magazines between 1993 and 1997. Among the women that appeared in these stories, 84 percent were younger than fifty years old when they were first diagnosed with breast cancer; almost half were under forty. But as the researchers noted, the statistics tell a very different story: Only 16 percent of women diagnosed with breast cancer were younger than fifty at the time of diagnosis, and 3.6 percent were under forty. As for the older women who are most at risk of breast cancer, they were almost invisible in the articles: Only 2.3 percent of the profiles featured women in their sixties and not one article out of 172 profiled a woman in her seventies—even though two-thirds of women diagnosed with breast cancer are sixty or older. In effect, the media turned the reality of breast cancer on its head. Surveys in Australia and the United Kingdom made the same discovery.
This is troubling because it has a predictable effect on women’s perceptions of the risk of breast cancer. Profiles of victims are personal, vivid, and emotional—precisely the qualities that produce strong memories—so when a woman exposed to them later thinks about the risk of breast cancer she will quickly and easily recall examples of young women with breast cancer, while finding it a struggle (assuming she does not have personal experience) to come up with examples of old women with breast cancer. The woman’s Gut will use the Example Rule to conclude that the risk of breast cancer is slight for old women and substantial for young women. Even if she reads the statistics that reveal the truth—the older a woman is, the greater the risk—these numbers may not make a difference because statistics do not sway Gut, and Gut often has the final word in people’s judgments.
And that is precisely what research has found in several countries. A 2007 survey of British women by Oxford University researchers, for example, asked at what age a woman is “most likely to get breast cancer”: 56.2 percent said, “Age doesn’t matter”; 9.3 percent said the risk was greatest in the forties; 21.3 percent said it was in the fifties; 6.9 said in the sixties; 1.3 percent said the risk was highest in the seventies. The correct answer— “80 or older”—was chosen by a minuscule 0.7 percent.
“Exaggerated and inaccurate perceptions of breast cancer risk could have a variety of adverse effects on patients,” noted Wylie Burke. Older women may not bother getting screened if they believe breast cancer is a disease of the young, while younger women may worry unreasonably, “which in itself might be considered a morbid condition.”
These distortions can result from words alone, but on television and in print, words are rarely alone. In the news, we are presented with words and images together, and researchers have found that our memories tend to blend the two—so if the sentence “A bird was perched atop the tree” is accompanied with a photograph of an eagle in a tree, it will likely be remembered as “an eagle was perched atop the tree.” Rhonda Gibson, a professor of journalism at Texas Tech University, and Dolf Zillman, a communications professor at the University of Alabama, took this research one step further and applied it to risk perception.
To ensure they were starting with a clean slate, Gibson and Zillman used a fictitious threat—“Blowing Rock Disease”—which was said to be a newly identified illness spread by ticks in the American Southeast. Children were deemed particularly vulnerable to this new danger.
Gibson and Zillman asked 135 people, mainly university students, to read two articles—the first about wetlands and another about Blowing Rock Disease—taken from national news magazines, with questions about facts and opinions asked after each. The first article really did come from a national news magazine. The second was fictitious, but made to look like a typical piece from the magazine U.S. News & World Report, with a headline that read, “Ticks Cutting a Mean Path: Areas in the Southeast Hardest Hit by Deadly New Disease.” Participants were presented with one of several versions of the article. One was text only. The second also had photos of ticks, seen in creepy close-up. The third had the ticks plus photos of children who were said to be infected. The text of the article was the same in every case—it informed the reader that children were at more risk than adults, and it had profiles of children who had contracted the disease.
If factual information and logic were all there were to risk perception, the estimates of the danger posed by “Blowing Rock Disease” would have been the same no matter which version of the article they read. But those who read the version that had no pictures gave a lower estimate of the risk than all the others. Those who got the second version of the story—with photos of ticks—believed the risk was significantly higher, while those who saw photos of ticks and children pegged the risk higher still. This is the Good-Bad Rule in action. No picture means no charged emotion and no reason for Gut to inflate its hunch about the risk; a close-up of a diseased tick is disturbing and Gut uses that emotion to conclude the risk is higher; images of ticks and sad children are even worse, and so Gut again ratchets up its estimate. The result is a series of risk estimates that have nothing to do with factual information and everything to do with how images make people feel.
The power of images to drive risk perceptions is particularly important in light of the media’s proven bias in covering causes of death. As Paul Slovic was among the first to demonstrate, the media give disproportionate coverage to dramatic, violent, and catastrophic causes of death—precisely the sort of risks that lend themselves to vivid, disturbing images—while paying far less attention to slow, quiet killers like diabetes. A 1997 study in the American Journal of Public Health that examined how leading American magazines covered a list of killers found “impressively disproportionate” attention given to murder, car crashes, and illicit drugs, while tobacco, stroke, and heart disease got nowhere near the coverage proportionate to their death toll. A 2001 study by David McArthur and other researchers at the University of California that compared local television news in Los Angeles County with the reality of injuries and deaths from traumatic causes got much the same results: Deaths caused by fire, murder, car crashes, and police shootings were widely reported; deaths caused by falls, poisonings, or other accidents got little notice. Injuries were also much less likely to be reported, although injuries caused by fires or assaults were actually better represented than accidental deaths. Overall, the picture of traumatic injury and death presented by the news is “grossly” distorted, the authors concluded, with too much attention paid to “events with high visual intrigue” and too little for those that didn’t offer striking images. The other consistent factor, they noted, was crime—the news heavily tilted toward injuries or deaths caused by one person hurting another at the expense of injuries and deaths where no one was to blame.