As of June 1, by order of Dr. Kenneth Kizer, director of the state Department of Health Services, Orange County physicians have been required to report all cases of cancer diagnosed or treated in Orange County to a designated state agency. Current state law mandates that this reporting requirement will gradually become statewide. Thus cancer, like hepatitis, syphilis and tuberculosis, will be added to the list of legally reportable diseases.
Unlike hepatitis, syphilis and tuberculosis, cancer is not an infectious disease. You cannot catch cancer from a cancer patient by touch or from a needle stick or from any bodily fluids. The family and friends and co-workers of cancer patients are not at risk of getting cancer from any contact with the patient no matter how intimate.
Nevertheless, it is widely recognized that cancer patients are the victims of serious prejudicial discrimination. Studies have shown that cancer survivors are at definite disadvantage in the workplace. Often they are unable to get jobs; advancement and promotion in a job already held is difficult. Regrettably, there is also a subtle social ostracism. Cancer patients become painfully aware that their very presence makes friends uncomfortable and that after dutiful sickroom visits the social circle often shrinks.
For these reasons, even otherwise healthy, long-term cancer survivors usually confide their diagnoses only to their physicians and the most intimate members of their families.
And now comes the state mandate to report all cancer cases to a state agency by name and address and diagnosis.
Of course, this information is intended to be confidential, but if we have so much confidence in the sanctity of the files of our state agencies, why with AIDS do we resort to a cryptographic numbering system which would give credit to the CIA? Obviously there are those who feel strongly that there are many leaks in the secrecy shield afforded by the state. Too many eyes have access to it--or why do we need a separate system when real privacy must be insured?
Mandatory reporting is required by Section 211.3 of the Health and Safety Code and was passed presumably to try to evaluate the link between cancer and environmental hazards, such as toxic dump sites. Unfortunately this good intention is unbalanced by the additional burden to the cancer victim--that his or her diagnosis will now, in effect, be public property.
If we fear that less than Draconian security will drive AIDS patients underground, have we considered how many patients who suspect that they have cancer may hesitate to seek care because they fear not only the disease but now the potential for the public exposure of their plight?
ARTHUR D. SILK, M.D.
Dr. Silk is an internist and the editor of the Orange County Medical Assn. Bulletin.