J Cancer Surviv (2007) 1:298305 DOI 10.

1007/s11764-007-0033-y

Survivors on Cancer: The portrayal of survivors in print news

Elizabeth Edsall Kromm & Katherine Clegg Smith & Rachel Friedman Singer

Received: 13 June 2007 / Accepted: 30 August 2007 / Published online: 3 October 2007 # Springer Science + Business Media, LLC 2007

Abstract Introduction This study examines the types of news stories that include comments by everyday cancer survivors and the messages or information these individuals provide. Even though these non-celebrity survivors increasingly serve on the front lines of cancer prevention and advocacy efforts and often engage with media, the role they play in the media discourse on cancer has not been a focus of research. Methods We conducted a thematic content analysis of print news articles of non-celebrity cancer survivors in 15 leading national daily newspapers for four consecutive months starting in June 2005 to identify the issues or events that included a survivor perspective and the messages or information conveyed by the everyday survivors. Results Journalists included survivor commentary primarily when covering cancer fundraising events and when focusing on individual survivorship stories. In overall news coverage involving survivors, breast and prostate cancers received the greatest attention, followed by blood and lung cancers. Survivors spoke mainly about the diagnosis experience and life post-cancer. Our analysis of survivors comments revealed that discussions of the diagnosis

experience often convey fear and a lack of confidence in cancer screening practices, while cancer is portrayed as a positive life event. Discussions/Conclusions While evidence of a positive and hopeful portrayal of survivorship is an encouraging finding for continued efforts to decrease stigma associated with a cancer diagnosis and for the public understanding of the disease, it is important to consider potential negative implications of an idealized and restricted media discourse on survivorship. Implications for Cancer Survivors The increasing size and capacity of the survivor community offers opportunities for the cancer advocacy community to consider how news media portrayal of cancer and survivorship may contribute in both positive and potentially detrimental ways to public understanding of this disease, its survivors and life after cancer. Keywords News media . Survivors . Qualitative research . Cancer

Introduction The news media serve as one of the most important sources of information regarding health issues [1]. News coverage provides considerable information about disease, for everything from prevention, diagnosis and treatment, to prognosis and meaning [25], often setting the public agenda [6]. In this way, news helps to shape the social and cultural contexts within which illness and disease are both collectively understood and individually experienced [79]. News media framing of coverage of a disease such as cancer, and the portrayals of impacted individuals, presents a picture of what causes cancer, who gets it, how it can be prevented,

The first author of this manuscript is herself a cancer survivor. E. E. Kromm : R. F. Singer Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA K. C. Smith (*) Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 726, Baltimore, MD 21205-1996, USA e-mail: kasmith@jhsph.edu

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what having it is like and how it might be cured. For example, newspaper accounts of children with cancer have been found to be primarily eulogizing, with children portrayed only as heroic, stoic, and inspirational [10, 11]. In this way, news media help to define the boundaries for lay understanding of cancer. Much research has examined news media coverage of cancer within the sociological study of health in the media [12]. Researchers have explored news media accounts to understand differences in the presentation of this disease according to the type of cancer [1316], as well as between cancer and other diseases such as heart disease [17]. In addition, content and discourse analyses have revealed dominance of the medical model within news coverage [2], and have identified latent themes related to religion [18] and gender [14, 19], as well as a habitual application of certain metaphors and rhetoric [20]. Researchers have also examined how news coverage of celebrities with a cancer diagnosis influences cancer awareness and screening and treatment decisions. Coverage of a public figure or celebritys experience with cancer (such as the recent coverage of recurrences of cancer for both Elizabeth Edwards and Tony Snow) has been linked to shifts in general disease awareness, changes in medical decisions, and prevention activities among the lay public [2126]. Research studies have tended to focus on survivors as individuals with cancer from the time of initial diagnosis. Media coverage of the breast cancer diagnoses and treatment of prominent women in the 1970s and 1980s helped to remove some of the stigma, isolation and misunderstanding that were part of this disease by following the journeys of public figures turned cancer survivors, including Betty Ford, Happy Rockefeller, Nancy Reagan, Jill Ireland and Shirley Temple Black [21]. Research established a temporal association between media coverage of First Lady Nancy Reagans breast cancer and womens awareness of the disease and screening tests [22], as well as surgical treatment decisions [23]. More recently, Chapman and colleagues linked news coverage of the breast cancer diagnosis of Kylie Minogue (an Australian entertainer) to increases in mammography appointments [24]. These studies suggest that news coverage of celebrity cancer experiences are meaningful to the general public, and have the capacity (albeit perhaps short lived) to promote individual behavior change. In addition to portrayals of a public figures cancer experience, news media coverage of cancer also includes celebrity endorsement and promotion of cancer screenings. Celebrity sponsored messages are increasingly common and are typically delivered in one of two ways: (1) as a cancer survivor, the celebrity asserts that his/her life was saved by a cancer screening test (e.g. former New York Mayor Rudy Giuliani and prostate cancer); or (2) through

discussions of the loss of a loved one and how that life might have been saved by a screening test (e.g. television anchorwoman Katie Couric and her husbands death from colon cancer) [25]. Celebrity endorsements have been shown to increase the likelihood of an individual undergoing a screening test [25] as well as rates of particular tests [26]. There is, therefore, evidence that celebrities with cancer are clearly newsworthy, and that media coverage of their illness experiences has helped to decrease the stigma associated with certain cancer types, raise awareness about this disease and even increase prevention efforts. One reason that stories about celebrities with cancer are important is because they foster human interest, which is a key communication tool in a news report, especially for coverage of health related issues. Research has found that sharing an individuals story helps make complex concepts more accessible [27, 28]. A personal cancer story, as we have seen from the coverage of celebrities experiences, can offer a strong human-interest element. While celebrities cancer experiences are a popular way for the news media to cover this disease, there are also others faces of cancer in the media. There are over 10 million people with a history of cancer the United States today, representing more than 3 percent of the population [29]; the number of survivors has more than tripled in the past 30 years [30]. The stories and experiences from ones own neighborhood or community have also been shown to be newsworthy. The role that regular (non-celebrity) survivors play in the media discourse on cancer has not, however, with the exception of research on media portrayal of children with cancer, been a focus of research. Regular cancer survivors increasingly serve on the front lines of cancer control advocacy efforts and often engage with media, and therefore also have the potential to impact public understanding of the disease. Survivors provide a face for the disease through awareness and educational activities that involve media interaction. While the field of survivorship research is growing, we still know little about whose stories are being told, what issues are supported by the inclusion of a regular survivors experience, and what information and messages these survivors impart regarding cancer. The purpose of this study is to examine the types of news stories in which regular survivors are called upon and the perspectives they provide. We conducted a thematic analysis of print news coverage of non-celebrity cancer survivors, focused on the following two research questions: (1) What issues or events (news pegs) include a survivor perspective or discussion of a particular survivors story? (2) What messages or information do everyday survivors provide in print news coverage?

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Methods Using the Lexis-Nexis Academic Universe database (LexisNexis, Dayton, OH), we searched 15 leading national U.S. dailies for cancer-related stories for four consecutive months starting in June 2005. The sample was constructed in order to provide geographic representation. For objectives beyond this analysis, the sample was augmented with the two Maryland newspapers available via Lexis-Nexis. Our sampling frame was intended to provide a diverse set of news sources that are accessible to large populations, but was not intended to be quantifiably representative of news coverage across U.S. daily newspapers. We also collated cancer-related stories appearing in major news magazines including Time, Newsweek, and US News & World Report. We utilized newspaper and magazine sources to serve as a proxy for the overall news environment. This decision was based on availability of data and research findings that other news media often base their stories on information first reported in print [6]. We piloted various search terms, and determined that cancer was essentially an omnipotent term in relevant coverage, and thus searched using this word. We filtered horoscopes and articles in which less than half of the paragraphs focused on cancer or where the cancer being discussed did not pertain to humans (e.g. stories on pets with cancer). This process yielded 517 pertinent news pieces. We conducted a qualitative textual analysis [31], iteratively developing variables of interest based on existing literature and an initial reading of the news articles. This method is frequently utilized in health and media research [32, 33] and specifically for cancer-related news coverage [2, 13, 14]. All eligible articles were coded for article type (hard news, letter to the editor, editorial, column), author, inclusion of enabling information (such as website URL, or telephone number), cancer topic, cancer type, prevention approaches, expertise or perspective included, and mention of research trial or research finding. The data provided by Lexis-Nexis precluded the coding of images. Based on the initial coding process, 101 articles (approximately 20% of overall coverage) were identified as including a quote from a cancer survivor. In this analysis, we used the definition of survivor espoused by the National Cancer Institutes Office on Cancer Survivorship and the National Coalition for Cancer Survivorship, namely that a survivor is an individual from the time of diagnosis through the balance of his or her life. [34] This subset of articles serves as the data for this analysis. In reviewing the subset of articles, 12 articles were excluded as duplicate articles in different publications. The final sample included 89 articles. Within the final sample, three articles featured quotes from both a celebrity cancer survivor (Lance Armstrong) and a non-celebrity or regular survivor. These

three articles remained in the final sample but only the comments of the non-celebrity survivor were analyzed. Guided by the aforementioned research questions, our analysis of this article subset required coding for both manifest and latent content pertaining to the commentary provided by non-celebrity survivors. Two coders (Authors 1 and 2) iteratively developed the coding process according to methodological protocol from previous studies [3235] and an initial review of the data. The coding framework for this study appears below in Table 1.

Results We will first report on the news pegs that included contributions by an everyday cancer survivor and the thematic content of these comments. We then focus on survivors discussions of their diagnosis and life postcancer. News events involving survivor contribution Table 2 provides an overview of the news pegs that were linked with survivor commentary, with examples of the event or issue serving as the articles focus. The primary type of news peg were fundraising events, such as the American Cancer Societys (ACS) Relay for Life and the Susan G. Komen Foundations Race for the Cure. Other fundraising events were for local organizations or hospitals
Table 1 Coding framework Description I. Cancer Type II. News Peg Fundraising Event Prevention Event Survivor Story Cancer Treatment Issues Cancer Survivorship Issues Cancer Policy/Legislation Other III. Survivor Details Gender Age Stage at Diagnosis More than 1 cancer experience IV. Content of Survivors Comments Primary Prevention Secondary Prevention Data Diagnosis Experience Treatment Details Life post-cancer

J Cancer Surviv (2007) 1:298305 Table 2 News pegs involving survivor contribution News Peg News Peg Examples No. of articles (n=89) 36

301

Fundraising Event

Prevention Event Survivor Story

Cancer Treatment Issues Cancer Screening Issues Cancer Survivorship Issues Cancer Policy/ Legislation Other

American Cancer Societys Relay for Life; Avon Walk for Breast Cancer; Swim-a-thon fundraiser to benefit the Johns Hopkins Kimmel Cancer Center; PanMass Challenge Cancer Ride to benefit Dana Farber Cancer Institute Bone marrow donor registration drive; Free prostate cancer screening Denver Nuggets basketball coachs upcoming surgery for prostate cancer; Leukemia patient and recipient of bone marrow meets donor; Clinical trials for lung cancer drug; Experimental technology to freeze and heat tumors; High cost of cancer drugs and treatments Debate over effectiveness of P.S.A. test for prostate cancer Special needs for young adult cancer survivors; Benefits of regular physical activity for survivors Announcement of city participation in pilot program Survivor reaction to specific news eventtelevision celebrity lied about breast cancer diagnosis

discussion of a fundraising event. There were a few articles (n=7) that did not mention a specific type of cancer, but talked about cancer in general terms. The leading cancer type mentioned in the fundraising event articles was breast cancer, whereas for cancer treatment lung cancer was most frequently mentioned. For the survivor story news peg, prostate cancer was the leading cancer type, although many individual articles addressed relatively rare brain tumors and unusual cancers such as Ewings sarcoma. In all but two articles, the survivor was over the age of 18. What survivors are talking about Table 3 gives an overview of the categories of information provided by survivors. The included quotations illustrate the types of points commonly made. As the survivors experience figured prominently in articles with the fundraising event or survivor story news pegs, it is possible
Table 3 Content of survivors comments Thematic Content of Survivor Comment Primary prevention message (e.g. Eat well, exercise, limit sun exposure) Secondary prevention message (e.g. Get screened, see your doctor, get tested) Data/numbers (e.g. Prevalence/incidence estimates) Diagnosis Experience (e.g. How cancer was discovered, reaction to news) Example

25

12

1 4

and were not tied to a national advocacy organization. For articles in which the new peg was a fundraiser, survivors were prominent in the coverage. The portrayal of a survivors story was itself a frequent news peg. Many times articles with this peg were identified as a profile, biography, or spotlight on piece, and almost half of such articles appeared in a newspapers sports section. Articles in which the focus was on cancer treatment issues such as clinical trials and procedures, survivors comments were not found as frequently. In treatment pieces, survivors were mentioned as examples of patients for whom the drug or new procedure worked, but rarely was their cancer story discussed. Certain cancer types appeared with greater frequency in the coverage. Overall, breast (n=27) and prostate (n=16) cancers received the greatest attention, followed by blood (n=10) and lung (n=6) cancers. In many cases, more than one cancer was discussed, often in the context of a

Treatment process details (e.g. Experience with clinical trial/drug/ procedure or other treatment) Life post-cancer, Part 1 (e.g. Importance of giving back, volunteering, getting involved in cancer advocacy) Life post-cancer, Part 2 (e.g. Experience changes outlook on life, new priorities and purpose)

My goal has been to educate others, especially girls, who think tans are beautiful and that sort of thing [36]. I try to tell people that Im living proof that you really should start getting tested early [37]. There is a one in a million chance that Asians will find a bone marrow match if they need one [38]. I thought it was probably just a bacterial infection, no big deal, further testing uncovered prostate cancer. I was lucky, because of the running I had the PSA test [37]. Ive had amazing response to it. They predicted Id be dead now. Instead I just got back from 3 weeks in Italy [39]. After a week of recovery, I started volunteering at ACS. Were trying to help women go through the journey so they dont have to be alone [40]. This happened for a reason, to make me a better, stronger person [41].

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that journalists and editors prioritized the inclusion of certain comments over others to construct a particular story. Our analysis revealed a tendency for the quotes from survivors to focus on diagnosis experience and life postcancer. Survivors offered perspectives on two distinct components of life post-cancer: (1) that survivorship involves a commitment to battling the greater war on cancer; and (2) that the cancer experience brings a new outlook on life. Survivors talk about the diagnosis experience One theme to emerge from examination of survivors discussion of diagnosis was the idea that the discovery of cancer was essentially a stroke of luck. The text surrounding survivors quotations also conveyed this sense of finding cancer as if by accident. In the following extract, the survivor explicitly challenges the idea that anyone is safe from cancer simply on the basis of age. This survivor offers himself as evidence that anyone and everyone is at risk. I try to tell people that Im living proof that you really should start getting tested early, at least to get a baseline, it can hit you at any time. Just because youre 41 doesnt mean youre safe [37]. Cancer survivors gave accounts of being well one day, and cancer appearing the next. The latent message here is that this disease may be just around the corner for anyone. The lump seemingly popped up from nowhere. Just months earlier a mammogram had shown no sign of the mass [42]. Survivors also provided insight into how seemingly minor and innocuous symptoms can sometimes indicate cancer in an otherwise healthy individual. Such messages may contribute to a generalized discourse of fear of cancer lurking in the seemingly healthy. During a physical exam in preparation for his iron man competition, he offhandedly mentioned he had trouble swallowing vitamins. Despite Shaffers apparently excellent health, the doctored ordered an endoscopic exam and found a 5 centimeter tumor at the junction of his esophagus and stomach. I went from thinking I was an Iron Man to thinking this was the end [43]. Many survivors explained they were simply lucky that the cancer was found, potentially conveying a message that there is no rhyme or reason to such a discovery. In fact, from several of the survivors diagnosis details, cancer was shown to be discovered at a time of peak physical condition. Though he was fit 41 yr old runner, he nevertheless decided to get a physical when he started training for

his first half marathon. Tests revealed an elevated PSA [prostate-specific antigen] level, but he felt fine. I thought it was probably just a bacterial infection, no big deal, further testing uncovered prostate cancer, I was lucky, because of the running I had the PSA test. If I wouldnt have had that testing, it might have had a different outcome, it definitely saved my life [37]. Survivors accounts show cancer to be capable of outsmarting screening tests and health care providers. People are therefore encouraged to be vigilant in monitoring bodily signs and symptoms. Moreover, survivors encourage others to be proactive in advocating for screening and investigation of possible indications of cancer. It would have probably gone undetected had she not insisted the mole on her arm be removed, even though two free cancer screenings indicated all was well. I had a gut feeling something was not right with it [36]. My big message is really being aware of your body. If you feel somethings not right or has changed, be proactive [40]. Survivors talk about life post-cancer Accounts of life post-cancer were a major component of the coverage. Survivors repeatedly described how the disease experience provided the opportunity to devote time to helping others with cancer. In addition, cancer was portrayed as giving new meaning to life in general. Survivors frequently described giving back as being part of surviving cancer. The survivors contributions served to define volunteer work and cancer advocacy as both appropriate and expected behavior. In addition, these efforts were presented as beginning as soon as possible, with several survivors talking about leading volunteer activities before treatment was even completed. After a week of recovery, I started volunteering at ACS. Were trying to help women go through the journey so they dont have to be alone [40]. It has been a goal of mine to be an advocate for cancer research and clinical trials, this is my best chance to make good on that promise. My goal and my responsibility is to make sure that we dont forget how devastating cancer has been. I can help change that [44]. Many survivors provided personal accounts of how the illness experience forced introspection and re-evaluation of lifes priorities, describing how cancer changes life for the better.

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This happened for a reason, to make me a better and stronger person [41]. It really makes you think. All the stuff you take for grantedyour kids, your wife, you can make money but time is the one thing you cant get back [45]. Cancer makes people grow up, a lot of people are pretty materialistic, theyre trying to achieve, achieve, achieve. You get evened out when cancer comes along. Its letting some of that go. I actually think cancer brings maturity to people [46]. Cancer gave me today, every day, in a way Id never known before. Since I no longer take much of anything for granted, everything has an added element of happy surpriseI made it to see this, do this, stay here and go there. Even unpleasant times are less painful, for they are proof that Im still here [47]. These quotes illustrate how the discussions of the survivorship experience go far beyond simply describing diagnosis, treatment and living with cancer in isolated terms. Rather, the survivors personal accounts set cancer within a life perspective framework. Cancer is presented as much more than simply a negative experience to be handled within ones life experience.

Discussions/Conclusions We found that discussions of the diagnosis experience convey fear and a lack of confidence in cancer screening practices, whereas cancer survivorship is positively defined by survivors perspectives on life post-cancer. Research on media coverage of cancer issues has argued that fear of the disease is exacerbated in the media accounts [2]. In our survivor data, fear is a latent theme in discussions related to each part of the cancer continuum, from prevention and screening to treatment and survivorship. Frequent references are made to contradictions and uncertainty about medical information, diagnosis and treatment details. Clarke and Everest delineated seven ways in which fear is heightened; three of which were evident in our analysis: (1) description of cancer as growing silently and secretly; (2) the portrayal of the disease as inevitable; and (3) a link between fear and cancer screening [2]. The comments provided by survivors, especially those offering messages on prevention and the diagnosis experience, support this connection between fear and cancer. Fear was heightened by the way in which several survivors explained the discovery of cancer as a stroke of luck. There were also accounts of accidental findings of cancer in routine care, again contributing to the image of cancer as a silent stalker [2].

Survivors repeatedly provided illustrations of the limitations of the health care system in initial detections of their cancer. This finding largely confirms the uncertainty and contradictions found by Clarke and EverestImplicit in this is that doctors upon whom people are to rely for diagnosis, treatment, and prevention make errors and thus cannot be entirely trusted [2]. However, in our study, survivors focused primarily on the limitations of the screening tests and guidelines that are currently relied upon to detect cancer. Survivors offered their experiences as evidence that a persons intuition can, and sometimes should, trump medical practice and screening guidelines. Thus, a strong message is conveyed about medical versus personal authority when it comes to ones own health; knowing ones own body is prioritized over the medical model. This was especially evident in messages provided by breast cancer survivors. The survivors comments may also be considered examples of a societal emphasis on socalled lay powers [12] or the empowerment of patients to play an active role in medical decision-making. From their perspectives on life post-cancer, survivors in these news media accounts provide critical information regarding the meaning of cancer survivorship. They help to construct for us an image of a survivor, the expectations of what it means to be a cancer survivor, and what life as a survivor both should and will entail. All survivors who addressed the issue of life post-cancer presented the disease experience as overwhelmingly positive terms. Given that one of every two men and one of every three women in this country will develop some form of cancer at some point during their lifetime [29], such a positive and hopeful portrayal of survivorship is important not only for continued efforts to decrease stigma associated with a cancer diagnosis but also for the public understanding of the disease. At the same time, however, it is important to consider potential negative implications of an idealized portrayal of a cancer survivor. This is similar in many ways to the idealized portrayal of childhood cancer survivors in news media [10, 11, 48]. Researchers have found that the discourse around children with cancer in newspaper articles is primarily eulogizing, constructing children as courageous, stoical and inspirational [10]. While an individual is technically considered a cancer survivor from the time of diagnosis, it cannot be assumed that the response to this news is immediately positive or that ones life post-cancer is drastically different from life prior to diagnosis. Due to both personal intentions and variations in socio-economic resources, many cancer survivors will not become full-time volunteers, which is the primary portrayal given in these accounts. A narrow portrayal of survivors may have unintended consequencesperhaps serving to exclude or stigmatize individuals who do not fit the description of an

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energized, dynamic survivor warrior. Our analysis led us to ask whether this might contribute to the creation of a hierarchy of survivorship. If media accounts shape public understanding of survivorship, do we run the risk that those who do not fit the very positive image being displayed are then viewed as survivors in name only? Previous research posited similar suggestions regarding the idealized and heroic portrayal of children cancer in the news media as a source of stigma [11]. The survivors in our news accounts did not discuss health or work issues related to their cancer experience. One explanation for this absence is that journalists and editors prioritize the inclusion of certain comments over others. Previous research on the news media portrayal of childhood cancer indicates that certain accounts are privilegedit becomes unseemly, to report a child with cancer as being anything other than brave and uncomplaining [10]. Another explanation might be that survivors are compelled to self-censor [10]. Survivors experience problems such as late effects of treatment, second cancers, and even difficulty in maintaining or obtaining insurance coverage [30]. Most cancer survivors return to work after treatment, and one in five individuals will experience work limitations related to their cancer for as many as five years [30]. These survivorship issues were not themes that were represented in the news media accounts that we reviewed. It is also interesting to note that the perspective of cancer as a positive life event was often coupled with comments regarding the unpredictable nature of the disease. As a result, a single article presents the audience with competing perspectives on cancer. At first, cancer is a silent stalker; in the end, the survivor has a better life due to that unexpected diagnosis. The duality in the message is perhaps worthy of further consideration. Limitations This study was conducted using only four months of coverage from fifteen newspapers and three news magazines, which may have differed from coverage during other time periods or from other sources. Moreover, although print news is an important proxy for the overall news environment, both the content and the audience may differ in meaningful ways from other sources of news, such as television or the Internet. Of particular concern would be regularly scheduled cancer events that occur outside of the months captured in this study (e.g. Breast Cancer Awareness Month in October, Skin Cancer Detection and Prevention Month in May), which may skew the image of the survivors being called upon with regard to the fundraising events. Our time period did, however, include both National Cancer Survivors Day (June 3rd) and the prime summertime months for outdoor fundraising efforts.

Implications for survivors There are over 10 million cancer survivors in the U.S. today, and more than 1.4 million people will receive a cancer diagnosis this year [29]. Rates for cancer screening and testing are increasing, and overall cancer mortality rates have declined for the second year in a row [29]. At the same time, however, a recent poll by the American Cancer Society found that 36% of Americans believe they have little or no control over reducing their risk of getting cancer [49]. News media play a pivotal role in shaping public understanding of cancer, oftentimes utilizing everyday survivors stories and perspectives. Survivors increasingly serve on the front lines of cancer prevention and control efforts and cancer advocacy groups rely on survivors to provide a face for the disease through awareness and educational activities that involve media interaction. When survivors appear in the news media, the information conveyed and perspectives provided contribute to our understanding of the cancer experience and what it means to be a cancer survivor. This study suggests that news media engagement with cancer survivors provided insight into the experience of diagnosis, treatment and life after cancer. We suggest that the media discourse on survivorship is, however, fairly constrained, and raise questions as to the potential impact of a narrow perspective regarding diagnosis, treatment and living with cancer. The increasing size and capacity of the survivor community offers opportunities for the cancer advocacy community to consider how news media portrayal of cancer and survivorship may contribute in both positive and potentially detrimental ways to public understanding of this disease, its survivors and life after cancer.
Acknowledgment This research was supported by funding from the American Cancer Society (RSGHP-04-206-01) and by Dr. Smiths Richard L. Gelb Fellowship for Cancer Prevention. We thank Samantha Cogar Farrell for her initial coding of the news data.

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