Why cancer prevention is never as sexy as raising funds in pursuit of a cure

What is it about breast cancer that attracts prominent glitterati into fund-raising but sees most of them comfortable with ignoring - or sometimes even helping promote - lung cancer?

The leading couturier Peter Morrissey is featuring in full-page ads for the National Breast Cancer Foundation. Yet Morrissey assisted Philip Morris with a fashion parade at an illegal "Wavesnet" [Wavesnet website unavailable at time of publishing] promotional event successfully prosecuted by the Health Department in November last year. These events were built around Alpine cigarette promotions targetting young women.

The model Sarah O'Hare is another whose views on cancer prevention are hard to read. A new book just out by Kathy Buchanan, Quit for Chicks, has a foreword by O'Hare where she spoons it on about how she'll never smoke again. So what then should we all make of a full-page photo showing her miming a deep, unmistakably ecstatic pull on a lung buster in Who magazine's October 20 issue, "100 years of glamour"? Only doing her job? I guess she needs the cash. O'Hare is patron of the National Breast Cancer Foundation.

Nicole Kidman has also thrown her stick-figure weight behind fighting breast cancer. Meanwhile millions of young women note her unabashed public smoking.

Breast cancer bad. Lung cancer OK. Mixed messages indeed.

There are a bewildering number of breast cancer charities, foundations and support groups, often fronted by high-profile women. While men occasionally get breast cancer, it is overwhelmingly a women's disease.

In NSW in 2001 there were 4067 new cases and 871 deaths. Screening and better treatment have reduced the death rate by 22 per cent in the past decade, and 85 per cent of newly diagnosed women will still be alive in five years. Fund-raising is helping save and extend lives.

But compare this with lung cancer, where in the same year there were 2326 deaths - nearly three times more than breast cancer. Only 15 per cent of people diagnosed with lung cancer will be alive five years later, giving it one of the worst prognosis profiles of all cancers. When we add all the heart disease, other smoking-caused cancers and emphysema, smoking-caused diseases leave breast cancer well in the shade.

Unlike breast cancer, lung cancer is almost entirely preventable. In 1919 the famous surgeon Alton Ochsner was summoned as a young intern to see a lung cancer operation, something he was told he may never see again. He didn't see another case for 19 years. Today lung cancer is the leading cause of cancer death in Australia, with 85 per cent occurring in smokers.

If we knew what caused breast cancer, the thought of celebrities promoting it would be unimaginable. However, music stars like Craig David, Alanis Morissette, Savage Garden and Jewel have all appeared in tobacco-sponsored concerts in developing countries. The Deveaux promotions agency in Sydney is supplying young hunks and babes to act as Marlboro salespeople in nightclubs and World Cup events. So where are the celebrities lining up to criticise all this and demand the government fund the pathetically emaciated Quit campaign?

Breast cancer authorities have no evidence-based advice on preventing the disease, so the mission becomes one of promoting early detection and treatment. For all the apple pie of prevention being better than cure, the promise of curing disease beats prevention every time as a wallet opener and headline grabber. Resurrecting the dying provides endless life dramas of despair, hope and redemption. This is why there are no medical soaps about prevention, despite it saving more lives than cures ever dreamed of.

This is where lung cancer loses out. By contrast, lung cancer offers little hope for cure or survival and its victims labour under the spectre of self-blame.

It's argued that smokers choose to smoke. But with 85 per cent of smokers starting when children, and tobacco company chemists working into the night to fine-tune nicotine addiction, shrugging off lung cancer with indifference is victim-blaming. Thanks to prevention, male lung cancer rates have been falling by an average of nearly two per cent a year since 1984, with rates for females remaining steady. These trends mirror the avalanche of men who've quit, and hold the line in preventing women's smoking rates from rising.

Today it is fashionable to work to help breast cancer, and many are reaping the benefits. Yet an article in this month's Journal of the National Cancer Institute on lessons for cancer control states: "Tobacco is the big gorilla in all of cancer control. Just a few percentage points' shift in tobacco use makes a huge difference [in total cancer death rates] compared to, for instance, mammography." The new NSW Cancer Institute will add important weight to the fight against all cancers and the early death they can bring. Let us hope it remembers the gorilla.