Comparing Cancer Risks and Screening Rates between Racial Groups in Public Health Messages May Have Unintended Consequences

In a recent study published in Human Communication Research, Jiawei Liu and Jeff Niederdeppe examined the effects of public health messages that feature cancer risk comparisons and screening rate comparisons between Black Americans and White Americans.

Communicating health disparities in media typically employs social comparison framing, which involves contrasting disease prevalence or risks between groups with an emphasis on one group’s disadvantage. However, prior research had suggested that this type of communication runs the risks of demoralization and message resistance among members of the disadvantaged group due to its focus on group deficits, particularly in the absence of mentioning other strengths of that group.

While the lifetime risks of dying from colorectal and breast cancers are higher among Black Americans than White Americans, Black Americans have similar colorectal cancer screening rates and higher breast cancer screening rates compared to White Americans. It raises the question how adding screening rates (which highlight the strengths of Black Americans in engaging in recommended screening behaviors) in messages that feature cancer risk comparisons may affect intentions to engage in screening behaviors and to support public policies that advance health equity.

Liu and Niederdeppe conducted two experiments using similar designs in the context of breast cancer and colorectal cancer, respectively. Participants were Black and White U.S. adult respondents within the age range for recommended colorectal/breast cancer screening. Findings showed that comparing the lifetime risks of dying from breast cancer between Black and White Americans lowered screening intention among Black respondents while also reducing perceived cancer risks and fear among White respondents.

Adding comparisons of screening behavior to the messages describing risk comparisons heightened awareness of the higher breast cancer screening rate among Black Americans but did not significantly shift screening intention among Black respondents. Moreover, messages describing behavioral comparisons reduced support for policies to address cancer risk disparity gaps among Black respondents when Black Americans have higher cancer screening rates than White Americans (in the context of breast cancer screening). Some evidence suggested that it increased policy support when the screening rates between Black and White Americans are similar (in the context of colorectal cancer screening).

Taken together, the authors concluded that communicating cancer risk and screening rate comparisons between racial groups may not be an effective way of promoting cancer screening and racial health equity and may incur unintended consequences in some cases.

Read related work from the COMM team:

• Misperceptions about the prevalence of health problems and behaviors published in Journal of Health Communication
• Effects of communicating about health and racial disparities published in Health Communication and The Milbank Quarterly.

This study was supported by the Cornell Center for Social Sciences (Grant No. U32800) and Robert Wood Johnson Foundation (Grant No. 79754).