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Originally published as JCO Early Release 10.1200/JCO.2008.20.1392 on November 24 2008 © 2008 American Society of Clinical Oncology.
Trends in Cancer Coverage in Japanese Newspapers
Division of Expiratory Research, Institute of Medical Science, University of Tokyo, Tokyo, Japan
Department of Clinical Oncology, Teikyo University Hospital, Tokyo, Japan
Division of Expiratory Research, Institute of Medical Science, University of Tokyo, Tokyo, Japan
Department of Hematology and Rheumatology, JR Tokyo General Hospital, Tokyo, Japan
Division of Expiratory Research, Institute of Medical Science, University of Tokyo, Tokyo, Japan
Department of Hematology, Institute of Medical Science, University of Tokyo, Tokyo, Japan
Division of the Strategic Outcome Research Program for Cancer Control, Ministry of Health, Labour and Welfare Commission, Japan Cancer Society, Tokyo, Japan
Division of Expiratory Research, Institute of Medical Science, University of Tokyo, Tokyo, Japan To the Editor: Cancer has been the leading cause of death since 1981 in Japan,1 and the public is seeking information on cancer. Cancer information can be divided into two categories: general cancer information regarding therapies and specialized hospitals, and specific information regarding patients’ conditions. The mass media deliver the former, general information, which has a considerable influence on citizens. The estimated audience for a television program with an audience rating of 8.3% is approximately 3 million (NHK Broadcasting Culture Research Institute),2 whereas the circulation of each major newspaper is between 2.2 and 10 million. Newspapers may be effective for providing correct and easy-to-understand information on cancer to the public. Because no one has investigated the influence of cancer articles in newspapers thus far, we investigated cancer-related articles in newspapers to reveal trends in public interest in health care. In this study, we investigated the number of cancer-related articles published from 1992 to 2007 using Nikkei Telecom 21, the largest newspaper database in Japan. Of the registered newspapers, five major newspapers—Asahi, Mainichi, Yomiuri, Sankei, and Nihon Keizai (Nikkei)—were chosen, which account for 27 million official subscribers. In those newspapers, the number of cancer-related articles was counted. We used "cancer," "malignant tumor," and "malignant neoplasm" as keywords to search for cancer-related articles. We included three types of Japanese characters to express cancer, or gan (hiragana, katakana, and Chinese characters). Next, the annual change in the number of cancer-related articles in the newspapers was recorded and analyzed. This was compared with the number of times that the cancer-related keywords occurred in the newspapers in 2007. In addition, each word that was seen in more than 100 articles was traced to identify the trend from 1992 to 2007. The total number of articles in the five major newspapers targeted is shown in Figure 1A. The annual number of articles registered in the database started to increase in the early 1990s, but it remained almost constant after 2000. After 2000, the annual numbers of articles registered from Asahi, Yomiuri, and Mainichi were approximately three times the numbers of those from Nihon Keizai and Sankei. The number of cancer-related articles in the five major newspapers targeted is shown in Figure 1B. The annual number of cancer-related articles registered in the database started to increase in the early 1990s, but it remained almost constant after 2000. After 2000, the numbers of such articles registered from Asahi, Yomiuri, and Mainichi and those from Sankei were respectively about three times and two times the number of those from Nihon Keizai. The ratio of cancer-related articles to total articles remained stable during the study period (Fig 2). The ratio in Asahi and Yomiuri newspapers tended to decrease, whereas in Nihon Keizai and Sankei newspapers, it tended to increase. The ratio remained almost constant in Mainichi.
The number of cancer articles classified by cancer lesion in 2007 is shown in Figure 3. Cancer was reported by type in the following order: lung (n = 1,720), breast (n = 1,355), stomach (n = 1,246), hematologic malignancies (n = 1,129), colon and rectal (n = 865), and liver (n = 731). The number of newspaper articles per 1,000 cancer patients was larger in the following order: brain and CNS (n = 58), hematologic malignancies (n = 43), breast (n = 33), lung (n = 24), and esophageal (n = 22).
The numbers of articles for each keyword in 2007 are shown in Figure 4. The numbers of articles for each keyword were reported in the following order: therapy (n = 4,813, 29.8% of total cancer-related articles), obituary (n = 3,401, 21.1%), surgery (n = 2,386, 14.8%), Ministry of Health, Labour and Welfare (n = 1,145, 7.1%), litigation (n = 1,048, 6.5%), development (n = 861, 5.3%), chemotherapy (n = 826, 5.1%), and preventive examination (n = 741, 4.6%).
The peak years for the ratio of articles containing each keyword to the total number of articles are shown in Figure 5. The figure shows three peaks: the first in 1992 to 1997 (n = 8), the second in 1998 to 2003 (n = 6), and the third in 2004 to 2007 (n = 18).
The present study shows that cancer is a topic of major interest in newspapers. Approximately 1.0% to 1.5% of the total number of articles (or 30 to 45 articles per day) in the five major newspapers were related to cancer. Even when we deduct the number of obituary articles, which accounted for 21% of the total cancer articles, we see that newspapers presented cancer information to many citizens. The proportion of cancer articles to total articles remained stable from 1992 to 2007. These findings are contrary to the perception of medical professionals that public interest in cancer has increased with its morbidity because of the increase in the aging population.3 Interestingly, Nihon Keizai newspaper, which specializes in the economy, commerce, and business, published an increasing number of cancer articles. Cancer is of interest to the economic world as well as the world of medicine, and this situation in Japan is comparable to that in other developed countries.4 Analysis by each cancer lesion showed that the total number of cancer articles was higher with regard to cancers with higher morbidity and mortality, such as lung, breast, stomach, and colon and rectal (Fig 3A). The number of articles per 1,000 cancer patients was higher in the following types of cancer: brain and CNS; hematologic; breast; and lower stomach, colon, and rectal. Although obituaries occurred at almost the same frequency with any type of cancer, specific cancers, such as those of the brain and CNS and hematologic malignancies (Fig 3B), were presented to the general public with greater frequency. It is noteworthy that the number of articles on hematologic malignancies was relatively large. This is likely because there were a high number of articles on diagnosis and therapy. Cancer articles in newspapers are influenced by the development of new cancer therapy. For example, chemotherapy or new drugs (rituximab [Rituxan; Genentech Inc, South San Francisco, CA; Biogen Idec, Cambridge, MA], imatinib mesylate [Gleevec; Novartis Pharmaceuticals Corp, East Hanover, NJ], and so on) are featured in articles on hematologic malignancies,5 and therapeutic radiology, chemotherapy, and surgeries are often seen in brain and CNS malignancies. Our study did not reveal that Japanese newspapers focused on reports of celebrities with cancer, whereas the mass media in Western countries promotes interest in a particular disease, for instance, Parkinson's disease, HIV/AIDS, or spinal injury when a celebrity suffers from it.6-8 As for keyword analysis, commonly seen keywords were therapy (29.8%), obituary (21.1%), and diagnosis (9.6%). This is probably because such articles attract readers’ attention more frequently compared with articles involving areas in which medical professionals are interested, such as prevention, palliative care, medical system, and pharmaceutical administration. Articles on these areas are posted in professional journals and discussed at society meetings but do not often appear in newspapers. Our analysis suggests that there are limitations in distributing cancer-related information to the general public via newspapers. Rather, the Internet or free papers might be more effective in providing cancer-related information, as these media target particular readers’ interests.9,10 It should be noted that the phrase "the Ministry of Health, Labour and Welfare" occurred in 7.1% of the cancer articles. In Japan, major newspapers obtain most of their information from the press club of the Ministry of Health, Labour and Welfare. The dependency on the ministry may influence the distribution of cancer articles. As for trends in the appearance of each keyword, "development," "prevention," "cigarette," and "National Cancer Center" occurred frequently during the period between 1992 and 1997. This can be explained by the following facts on the era: a new policy named the Second Term Comprehensive 10-Year Strategy for Cancer Control was implemented in 199411; lung cancer came to be identified as the primary type of cancer causing deaths in Japan; and tobacco companies were penalized in relation to passive smoking. From 1998 to 2003, the keywords "gene," "new medicine," "clinical trial," "the Ministry of Health, Labour and Welfare," and "the Ministry of Education, Culture, Sports, Science and Technology" appeared frequently. The Millennium Project of 2000, which was directed by the government to confront the rapidly aging society, likely contributed to the appearance of these words. The phrase "medical incident" also occurred in this period. Multiple medical accidents, such as one involving a 16-year-old patient receiving chemotherapy who became a victim of iatrogenic overdose, were reported to the public at this time. More keywords reached a peak in the period between 2004 and 2007 than in the period between 1992 and 1997 or 1998 and 2003. Most keywords were related to cancer therapy (eg, therapy, surgery or operation, diagnosis, chemotherapy, preventive examination, palliative care, radiation therapy, positron emission tomography, and home care). The "Basic Act on Cancer Management," legislation passed in 2006, likely contributed to the appearance of these words. Our study revealed that the appearance of each keyword in the newspapers was influenced by governmental policies, courts, or medical incidents in each period. Our study showed that cancer is a major topic in newspapers. Information on cancer in newspapers is affected by contemporary politics and incidents. Physicians should be aware of the distinctive characteristics of newspapers, and use them to deliver accurate information to the public. AUTHORS’ DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The author(s) indicated no potential conflicts of interest.
ACKNOWLEDGMENTS This study was supported by Health and Labour Sciences Research Grant No. H18-general-011 for Third Term Comprehensive 10-Year Strategy for Cancer Control. NOTES published online ahead of print at www.jco.org on November 17, 2008. REFERENCES
1. Yamaguchi K: Overview of cancer control programs in Japan. Jpn J Clin Oncol 32:S22-S31, 2002 (suppl) 2. Matsumura T, Yuji K, Nakamura T, et al: Possible impact of the NHK special questioning cancer treatment in Japan on clinicians’ prescriptions of oxaliplatin. Jpn J Clin Oncol 38:78-83, 2008 3. Yancik R, Ries LA: Cancer in older persons: An international issue in an aging world. Semin Oncol 31:128-136, 2004[CrossRef][Medline] 4. Eckhouse S, Sullivan R: A survey of public funding of cancer research in the European Union. PLoS Med 3:e267, 2006[CrossRef][Medline] 5. Chizuka A, Suda M, Shibata T, et al: Difference between hematological malignancy and solid tumor research articles published in four major medical journals. Leukemia 20:1655-1657, 2006[CrossRef][Medline] 6. Casey MK, Allen M, Emmers-Sommer T, et al: When a celebrity contracts a disease: The example of Earvin "Magic" Johnson's announcement that he was HIV positive. J Health Commun 8:249-265, 2003[CrossRef][Medline] 7. Kempster PA: Michael J. Fox and his Parkinson's disease. Mov Disord 19:105-106, 2004[CrossRef][Medline] 8. Reeve C: Man and superman: Interview by Lynn Eaton. BMJ 326:1287-1290, 2003 9. Hong T: Information control in time of crisis: The framing of SARS in China-based newspapers and Internet sources. Cyberpsychol Behav 10:696-699, 2007[CrossRef][Medline] 10. Morita T, Narimatsu H, Matsumura T, et al: A study of cancer information for cancer patients on the internet. Int J Clin Oncol 12:440-447, 2007[CrossRef][Medline] 11. Koh HK, Joossens LX, Connolly GN: Making smoking history worldwide. N Engl J Med 356:1496-1498, 2007
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Copyright © 2008 by the American Society of Clinical Oncology, Online ISSN: 1527-7755. Print ISSN: 0732-183X
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Diagnosis-related words; 
therapy-related words; 
prevention-related words; * policy-related words; 
words related to medical societies; 
words related to drug development; x research-related words; + patient-related words; • litigation-related words; 
other cancer-related words. 1, diagnosis; 4, positron emission tomography; 5, therapy; 7, radiation therapy; 8, chemotherapy; 9, new drug; 11, surgery or operation; 12, palliative care; 13, home care; 14, end of life or hospice; 15, side effect; 16, complication; 18, cigarette, tobacco, or smoking; 19, prevention; 20, preventive examination; 21, policy; 22, disparity; 24, Basic Act on Cancer Management; 31, medical society; 35, board certified physician; 37, development; 38, clinical trial; 46, genetics; 48, epidemiology; 50, patient's wish; 54, advocacy; 55, litigation or lawsuits; 56, court case; 57, medical accident or medical error; 59, National Cancer Center; 60, Ministry of Health, Labour and Welfare; 61, Ministry of Education, Culture, Sports, Science and Technology.
