On 2015 Aug 10, Hilda Bastian commented:

This is an excellent overview of the research on the impact of celebrity and public figure announcements around cancer. The conceptual model proposed for studying impact on behavioral and disease outcomes is an important contribution, but I think it would benefit by being extended in several ways.

The issue of potentially deepening inequalities in cancer (Lorenc T, 2013) is so critical here, that equity needs to be considered at the outcome end of the picture: incorporating demographics and SES as a mediator/moderator isn't enough. Nor is age the only critical socioeconomic factor about the celebrity/public figure that should be taken into account. The authors point to some notable omissions among the cases that have drawn researcher interest. One of the most striking omissions, though, is the lack of study of non-Caucasian celebrities and public figures (for example Robin Roberts and Donna Summer on the timeline in this article).

Also striking is the extent to which existing stigma around some cancers is reinforced, both in which cancers are publicly discussed by celebrities, and which are studied by researchers. Are we doing, at the community level (and in the researcher community), what we do in private life as well - reinforcing stigma and poor knowledge of critical diseases in our lives (Qureshi N, 2009)? Take colorectal cancer for example. Whether it's the cases in the timeline (which included only Farrah Fawcett) or the included studies (which included only Ronald Reagan), the under-representation of such a stigmatized condition points to a critical issue for research in this field. Impact on stigma would be a valuable addition to the outcomes in the conceptual model, to emphasize the importance of this dimension of belief.

In general, it would be good if the potential for adverse effects was more explicit in the model. Critically, impact on over-diagnosis and screening/testing-related harm needs to be included - a key issue the paper discusses, for example, after Kylie Minogue's cancer (Kelaher M, 2008, Twine C, 2006). Accuracy in personal risk assessment, similarly, is an important outcome that is an important outcome to consider.

Focusing on behavioral and disease outcomes in the model leaves out the impact on resources, and ways systems can best respond to these unpredictable events. That was a major issue after Angelina Jolie's announcement (Evans DG, 2014).

It would be helpful to understand the impact of famous family members' announcements and pleas around cancer, as well: Katie Couric's public intervention (Cram P, 2003), for example, are relevant to this field.

Finally, the model of considering these events only in terms of cancer prevention as the end interest, risks missing potentially important impacts of these cultural events. They contribute in the complex ways we think about and deal with life-threatening illness, life, and death (Førde OH, 1998). The lack of studies that address these broader issues is striking, too.

Note: Rick Nolan noted in a comment on my blog that Dan Fogelberg's is wrongly attributed to pancreatic cancer in this article: he died of prostate cancer. I had discussed these issues, and the studies on Angelina Jolie that occurred after these reviewers completed their search, in this blog post.

On 2015 Aug 10, Hilda Bastian commented:

This is an excellent overview of the research on the impact of celebrity and public figure announcements around cancer. The conceptual model proposed for studying impact on behavioral and disease outcomes is an important contribution, but I think it would benefit by being extended in several ways.

The issue of potentially deepening inequalities in cancer (Lorenc T, 2013) is so critical here, that equity needs to be considered at the outcome end of the picture: incorporating demographics and SES as a mediator/moderator isn't enough. Nor is age the only critical socioeconomic factor about the celebrity/public figure that should be taken into account. The authors point to some notable omissions among the cases that have drawn researcher interest. One of the most striking omissions, though, is the lack of study of non-Caucasian celebrities and public figures (for example Robin Roberts and Donna Summer on the timeline in this article).

Also striking is the extent to which existing stigma around some cancers is reinforced, both in which cancers are publicly discussed by celebrities, and which are studied by researchers. Are we doing, at the community level (and in the researcher community), what we do in private life as well - reinforcing stigma and poor knowledge of critical diseases in our lives (Qureshi N, 2009)? Take colorectal cancer for example. Whether it's the cases in the timeline (which included only Farrah Fawcett) or the included studies (which included only Ronald Reagan), the under-representation of such a stigmatized condition points to a critical issue for research in this field. Impact on stigma would be a valuable addition to the outcomes in the conceptual model, to emphasize the importance of this dimension of belief.

In general, it would be good if the potential for adverse effects was more explicit in the model. Critically, impact on over-diagnosis and screening/testing-related harm needs to be included - a key issue the paper discusses, for example, after Kylie Minogue's cancer (Kelaher M, 2008, Twine C, 2006). Accuracy in personal risk assessment, similarly, is an important outcome that is an important outcome to consider.

Focusing on behavioral and disease outcomes in the model leaves out the impact on resources, and ways systems can best respond to these unpredictable events. That was a major issue after Angelina Jolie's announcement (Evans DG, 2014).

It would be helpful to understand the impact of famous family members' announcements and pleas around cancer, as well: Katie Couric's public intervention (Cram P, 2003), for example, are relevant to this field.

Finally, the model of considering these events only in terms of cancer prevention as the end interest, risks missing potentially important impacts of these cultural events. They contribute in the complex ways we think about and deal with life-threatening illness, life, and death (Førde OH, 1998). The lack of studies that address these broader issues is striking, too.

Note: Rick Nolan noted in a comment on my blog that Dan Fogelberg's is wrongly attributed to pancreatic cancer in this article: he died of prostate cancer. I had discussed these issues, and the studies on Angelina Jolie that occurred after these reviewers completed their search, in this blog post.