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The British have long said, "Keep calm and carry on." But the catchphrase may need an update for health care. (Keepcalm-o-matic.co.uk)

Keep Calm And Carry On, Except When It Comes To Cancer

by Michaeleen Doucleff
Jan 29, 2013

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Britain's National Health Service has already launched TV and radio campaigns to encourage people to alert their doctors of any serious symptoms.

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Restraint and unflappability are just about as British as Big Ben and English Breakfast.

But could that national "stiff upper lip" be keeping the British from getting proper cancer care?

A survey looking at why people in different countries avoid doctors finds that stoicism may be one reason why Britain's cancer survival rates lag behind its neighbors.

In the study, published in the British Journal of Cancer, researchers interviewed 19,079 people over age 50 in the U.K., Canada, Australia and the Scandinavian countries.

By far, the Brits were the most likely to cite embarrassment and not wanting to waste the doctor's time as reasons for not calling the doctor when cancer symptoms cropped up.

"There was such a big difference between the U.K. and other countries that it's very likely to be important," says Dr. Lindsay Forbes, a psychiatrist at King's College London, who led the study. "It's speculative, but it may be because the 'stiff upper lip' is distinctly ingrained in the culture."

Despite having a health care system that's just as good, the British are less likely to survive lung, breast or ovarian cancers than their Scandinavian neighbors — especially during the first year after a diagnosis.

Previous studies had hinted at this British reluctance to see a doctor when they suspect a problem. And Lindsey thought that the tendency to "keep calm and carry on" was at play.

So she and her team decided to probe the underlying attitudes in different cultures.

About one-third of the British interviewed admitted that concerns about wasting the doctor's time could cause them to delay visiting the doctor. In contrast, only about 10 percent of the Scandinavians, Australians and Canadians voiced such worries.

"This is an older population who really support the NHS [National Health Service], and they don't want to waste its time," Forbes says. "They think, 'The NHS should be helping young children or people other than me.' "

The British also were most likely to cite both potential embarrassment and fear about what the doctor might discover as reasons for delaying medical attention for serious symptoms.

Lindsey says a stiff upper lip "is not the whole story" behind why Britain's cancer survival rates are relatively low compared to those in other wealthy nations. "But we don't want to wait before we get the whole story before we start tackle this big problem," she tells Shots.

The government has already launched a campaign with posters and TV ads that encourage people to brush aside their stoicism and see a doctor.

Interestingly, the BBC ran a special series last October looking at the history of the British stiff upper lip. With footballers and tennis stars perennially crying on TV, the comedian Ian Hislop concluded that the phenomenon may be disappearing.

"I think that the younger generation may not have such a stiff lip," Forbes agrees. "But for the population most likely to get cancer, it doesn't seem to be going away."

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