Background: Few studies exist that examine a potential relationship between coverage of cancer in the popular press and subsequent public health/economic outcomes. In a novel 1990 study published by Brown and Potosky, ''The Presidential Effect: The Public Health response to Media Coverage About Ronald Reagan's Colon Cancer Episode'' the authors identified and used three nonreactive measures to evaluate the impact of this July 1985 event. The authors suggest a temporal relationship between this cancer episode and public interest, screening behavior, and incidence of disease. Unfortunately, the authors' analysis was in part limited due to the lack of mortality data and the unavailability of long term public interest, screening, and incidence data. By using long term data now available, we extend this study by evaluating the sustained impact and significance of this episode. We also use mortality data unavailable to Brown and Potosky to develop cost per life year saved estimates. Methods: Phone calls from the general public to the U.S. National Cancer Institute (NCI) through its Cancer Information Service (CIS) CONCERNED with colon or rectal cancer from 1984 to 1994 are used to measure public interest. Rates of screening utilization obtained from the U.S. Health Care Finance Administration (HCFA) from 1983 to 1994 are used to measure changes in screening. Surveillance data from NCI are used to measure shifts in incidence of early and advanced colorectal cancer from 1980 to 1993. NCI mortality data from 1973 to 1993 are used to determine if the event can be associated with a real public health benefit. Regression analysis including Chow tests are used to evaluate the potential impact of this public health event. Estimates are made of the cost per life year saved suggested by a change in the public's interest in colorectal cancer. Results: We found a sustained and statistically significant increase in the colorectal cancer related phone calls to NCI coincident with the Reagan episode. The analysis also shows a sustained increase in the utilization of screening and an unexpected statistically significant increase in of early and advanced colorectal cancer incidence rates. In addition, colorectal cancer mortality rates decline at a faster rate subsequent to event. Cost per life year saved associated with this event are estimated for the years 1986-1996 and approach $29,000 in 1996. Discussion: New evidence suggests that this discrete public health event contributed to a sustained and beneficial impact on public health. Reduced colorectal cancer mortality rates and increased life years saved, appear to be correlated with President Reagan's colon cancer episode.
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