Tumori, 79: 297-300, 1993 THE ROLE OF MEDICAL COUNSELING IN SECONDARY PRBVENTION OF CANCER IN THE ELDERLY Sergio Giunta,' Lucio Piantanelli,' Andrea Basso,' Angelo Morresi,' Riccardo Lanza,' Giuseppe Groppa,' Umberto Caruso,2 and Leo Fiori ' (' l.N.R.C.A., Italian National Research Centers on Aging, Ancona, and 2 Department of Surgery II, Rome University, Tor Vergata, Roma) In western countries the elderly are those who experience the major impact of cancer, as epidemlologlc data clearly show. Thus, secondary prevention of cancer (SPC) in older persons deserves more attention than it has received until now. Target subjects, however, are often reluctant to enter SPC plans. The reasons range from the lack of knowledge about the importance of SPC to the underevaluation of the risk of cancer, or, even more often, to the anxiety and fear that may stem from such a clinical investigation. In this context, the lnterven- Key words: Medical counseling, cancer in elderly. The intervention known as counseling (CSL) is the voluntary and conscious approach of the physician to the patient's decisional process about health problems, with the shared aim of improving his well-being (physi- cal, psychologic and social) (3, 4). The process develops through exchanges of communication-information, being respectful of the patient's will, and paying attention to physiologic, social and cultural conditions. The relevance of CSL is not restricted to particular diagnostic or therapeutic intervention: it should also be very useful in promoting patients' participation in preventive stra- tegies. CSL assumes paramount importance when the sub- jects face situations related to cancer, be it diagnosis, treatment or prevention. In such situations, the physician should take into account anxiety and fear stemming from the patient's involvement in problems related to cancer which might entail consequences for his future health. When considering the elderly, CSL is very likely to be more than just a help: it is an actual need. All problems that may affect adults are usually amplified; thus, even decisions on the application of early diagnostic procedures may be biased by social, cultural, and fear- induced attitudes (5, 23). Moreover, the high inter- individual variability of these attitudes among elderly people hardly allows generalizations about the psycho- social issue for cancer risk in elderly subjects (14). In the present paper the different aspects of medical CSL are addressed with particular emphasis on the tion known as couseling fJnds Its natural and essential role. In the paper some general considerations on the significance of medical counseling Is given, with particular emphasis on Its role in SPC in the elderly. The analysis herein reported points out the specific skills and methods that physicians can adopt to cope with the eventually adverse influences that may affect the participation of the elderly in SPC initiatives. However, such action should avoid any paternalistic approach and respect the patient's will and autonomy. strategies regarding why and how it should be proposed to the elderly in order to stimulate their involvement in plans for secondary prevention of cancer (SPC). In fact, despite an almost generalized lack of interest in this field until recently, it is now clearly emerging that the elderly should be considered the most important target for any SPC strategy (24, 25). Secondary prevention of cancer {SPC) Cancer is going to assume the characteristic of a healthy emergency problem in Italy as well as inter- nationally. Although relevant progress has been achieved in the field of clinical and therapeutic research, preven- tion, both primary and secondary, remains the main tool to counteract cancer. SPC, in particular, is one of the issues on which any health system has to be judged regarding intervention efficiency. The SPC goal is to screen an apparently healthy population for signs of early disease or precancerous damage. Most cancers are more successfully treated if caught early: the estimates of deaths which could be avoided through early detec- tion might reach 1/3. SPC requires a complex strategy, made up of different steps. Thus, it is not merely re- stricted to screening: it consists of a preclinical step of communication-information, followed by a phase, when data are collected in asymptomatic subjects; then the clinical phase, diagnostic procedures and, if necessary, treatment will take place. Acknowledgments: This work has been supported by the Ministero della Sanita, Progetto finalizzato « Prevenzione secondaria dei tumori nell'anziano ». We thank Ms Monica Glebocki for kindly reading the manuscript. To whom correspondence should be addressed: Dr. Sergio Giunta, Centro Radioimmunologia, INRCA, Via della Montagnola 164, 60100 Ancona, Italy. Received August 7, 1993. 297