Colorectal Cancer and Screening in the Australian Print Media: A Discourse Analysis

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Colorectal Cancer and Screening in the Australian
Print MediaA Discourse Analysis

• JH Stephens MPH 1,2, M Warin PhD 3
• 1 Colorectal Unit, Department of Surgery, The
  Queen Elizabeth Hospital
• 2 Public Health, School of Population Health
  Clinical Practice, University of Adelaide
• 3 Gender, Work and Social Inquiry, School of
  Social Sciences, University of Adelaide

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Colorectal Cancer

• In 1990, 14 of cancer deaths, second only to
  lung cancer, which accounted for 20 (AIHW, 1998)
• One in 21 Australians will develop colorectal
  cancer within their lifetime (AIHW, 1998)

3
Colorectal Cancer

• One in 18 Australian men and one in 26 Australian
  women will develop colorectal cancer before the
  age of 75 years (AIHW, 1998)

4
Colorectal Cancer

• 13.9 of all new cancers in men compared to 14.9
  of all new cancers in females (AIHW, 2002)
• Risk increases with age family history (NHMRC,
  1999)
• 5-year survival highest for metropolitan areas,
  lowest for remote centres (AIHW, 2003)

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Colorectal Cancer

• If detected at an early stage, colorectal cancer
  is highly curable (NHMRC, 1999)

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Aim

• To examine the way colorectal cancer and
  colorectal cancer screening is discursively
  constructed in the Australian print media

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Previous Research

• Deborah Lupton (1994, Int J Health Serv, 24, pp.
  73-89)
• Breast cancer
• 3 year period Aug 1987 to Feb 1990
• 960 print articles
• Dominant discourses
• Femininity issues
• Medical technological dominance
• Lifestyle responsibility

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Methods

• Keywords
• colorectal cancer, colon cancer, bowel cancer,
  screening, colonoscopy
• men, male
• Australian print newspapers
• 439 newspapers (9 Fairfax, 120 Nationwide News)

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Methods

• Databases
• LexisNexis (130 newsprint sources)
• Electric Library Australasia
• (102 newsprint sources, no Fairfax)
• Australia-New Zealand Reference Centre
• (no source list available)

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Methods

• Study period
• 4 years 1 Jan 2000 to 31 Dec 2003
• 1183 newsprint articles
• (1014 Nationwide News, 147 Fairfax, 22 Canberra
  Times)

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Methods

• 115 full text newsprint articles
• Thematic analysis
• headline content
• use of language
• sources quoted

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Findings

• Rising incidence
• Importance as an Australian health issue
• Need for early detection
• Controversies about the screening methods
• Development of the BCSPP
• Risk factors lifestyle, family history

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Faecal Aversion

• Biological
• An evolutionary development to protect against
  bacteria and disease that may cause harm (Darwin,
  1899)
• Psychological
• A behaviour learnt in infancy by observing and
  being taught by our parents (Freud et al, 1953)
• Sociocultural
• Faecal dirt is offending because it disrupts
  bodily order and threatens our stable environment
  (Douglas, 1984)

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Cultural Construction

• Screening
• uncomfortable, a pain, intrusive, poked
  and prodded
• is like having a lamp post shoved up you rear to
  take photographs of your tonsils
• (Adelaide, The Advertiser, 9 July 2003)
• its very uncomfortable to get a colonoscopy
• (Sydney, The Daily Telegraph, 15 March 2003)
• violated by the black snake
• (Sydney Morning Herald, 8 November 2001)

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Cultural Construction

• BOWEL SCAN TO SPARE PATIENTS
• (Melbourne, Herald Sun, 29 March 2000)
• MEDICS HAIL NEW CAMERA PILL
• (Melbourne, Herald Sun, 16 October 2000)
• CAMERA CUT CANCER CASES
• (Adelaide, Sunday Mail, 14 April 2002)

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Cultural Construction

• 7M TRIAL TO TARGET BOWEL CANCER
• (Melbourne, The Age, 24 August 2002)
• A COLON CHECK NEED NOT BE FUNDAMENTALLY A PAIN
  (Australian Financial Review, 13 March 2003)
• NEW TEST FOR CANCER
• (Sydney, The Daily Telegraph, 15 March 2003)

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Cultural Construction

• NEW COLON SCAN HAILED
• (Melbourne, Herald Sun, 13 December 2003)
• NEW TEST FOR BOWEL CANCER IMMINENT
• (Newcastle Herald, 23 December 2003)

18
Cultural Construction

• VIRTUAL TEST FALSE HOPE
• (Sydney, The Daily Telegraph, 21 October 2003)
• PATIENTS WARNED OF SCANS THAT GIVE FALSE HOPE
  (Sydney Morning Herald, 21 October 2003)

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Cultural Construction

• BOTTOM LINE (Sydney Morning Herald, 8 November
  2001)
• POSTIES SAY SMEAR CAMPAIGN STINKS
• (Melbourne, Sunday Herald Sun, 18 June 2003)
• GIVE YOUR BOWEL A CLEAR RUN (Gold Coast
  Bulletin, 18 June 2003)
• ITS THE YEAR TO PEER AT OUR REAR
• (Melbourne, Herald Sun, 8 July 2003)

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Cultural Construction

• COLONOSCOPY CAPITAL, PLEASE TAKE A BOWEL
• (Adelaide, The Advertiser, 9 July 2003)
• POOPER SCOOPER (Manly Daily, 31 July 2003)

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Cultural Construction

• You can picture it, cant you? The oversized
  mascot, Colin the colon, shaking peoples hands
  in shopping malls. T-shirts with a snappy slogan
  you never scowl with a happy bowel (Adelaide,
  The Advertiser, 9 July 2003)

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Cultural Construction

• Dinner party conversations are like life The
  early ones were fiery affairs where the political
  rows were matched by the curries. Then came more
  comfortable chairs, blander food and talk about
  mortgages and schools. But now, scratch a dinner
  party guest and beneath a thin veneer is likely
  to be someone whos just dying to share their
  colonoscopy and dissect the ins and out of bowel
  preparation (Sydney Morning Herald, 8 November
  2001)

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Gendered Representation

• Individuals providing medical information
• male health care professionals
• such as dieticians, gastroenterologists, or
  surgeons
• American Cancer Society
• Australian Medical Association
• Rotary BowelScan
• Cancer Council of Australia

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Gendered Representation

• Individuals who had undergone procedures
• United States president George W Bush
• former Australian Prime Minister Paul Keating
• Senator Bob Carr
• numerous sporting and radio personalities
• several laypersons

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Gendered Representation

• BOWEL CANCER THERAPY OF LESS BENEFIT TO
  MEN (Melbourne, The Age, 17 August 2000)
• ACT MEN TOP CANCER DEATH RATE REPORT
• (Canberra Times, 25 November 2000)
• ONLINE HELP FOR BLOKES
• (Sydney, the Daily Telegraph, 19 June 2003)

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Gendered Representation

• HOW FAR HAVE MEN COME?
• (Melbourne, Herald Sun, 30 June 2003)
• DIY CANCER-TEST KIT GIVES MEN EARLY WARNING
• (Sydney Morning Herald, 24 August 2003)

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Masculinity

• mid-18th century
• defined by bodily criteria
• end-18th century
• vigour, competitiveness, strength, assertiveness
• 19th century
• blue collar workers, physical toughness,
  invulnerability, bread winner, heterosexual

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Masculinity

• mid-20th century
• Fearless, confident, dependable, successful
• Ability to look after oneself and other
• Ability to be a leader
• 21st-century
• White, middle-class, heterosexual, successful

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Construction of Masculinity

• DIY
• blokes
• beer and scotch
• His Royal Hairiness
• self-sufficient

• workaholic
• talk about mortgages and schools
• dinner party
• political rows

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Construction of Masculinity

• a strong preoccupation with health iswacky
• (Sydney, The Daily Telegraph, 10 May 2003)

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Conclusions

• Colorectal cancer incidence higher in men
• Colorectal cancer screening is unpleasant
• Body barriers should not be crossed
• Australian man is a bloke

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Implications

• Newsprint
• Constructs colorectal cancer and screening
• Plays a role in how colorectal cancer is
  portrayed and what information is received by the
  population