Linked Comments: Larner. Int J Clin Pract 2011; 65: 631-2, Ho. Int J Clin Pract 2011; 65: 631. To the Editor: We would like to thank both Dr Ho and Dr Larner for their interest in our paper (1). Ho suggests that internet traffic pertaining to cancer is preferentially targeted to a younger, potentially more technologically ‘savvy’ generation (2). While the impact of this generation on the number of web pages linked to cancer should not be underestimated (and is likely to influence the data to a degree), other factors will greatly influence the quantity and quality of internet activity. Larner suggests that internet usage in the number of people over 70 years of age is low and only 5% new referrals use the internet to search for health information (3). The media is, perhaps, the strongest influence to us as individuals with regard to what we are exposed to (4). Almost all sources of media (print, news, televisual, etc.) will have a website linked to them. Thus, any mention of cancer by the print media, e.g. will register as a webpage. Previous studies comparing the media prevalence of cancer with actual prevalence has also noted a similar pattern, with the same cancers being over- and under-represented (5). The print media will respond to events that are ‘newsworthy’ rather than issues that are age-specific. Cancer web pages on the internet will also consist of scientific research, and official sources of health information (from both government funded institutions and charitable organisations); one could postulate that the amount of internet activity from these sources will reflect the incidence of disease. The exact nuances of what information is provided on a webpage highlighted via a search engine will almost certainly remain unknown, given the enormity of data that exists on the World Wide Web. We agree and concur with Larner’s first point: internet use does vary with age – PEW’s ‘Generations Online’ survey of all adult Americans (2006) noted that 88% of 18–29 year-olds, 84% of 30–49 year-olds, 71% of 50–64 year-olds and 32% aged 65 or older used the internet (6). However, this lower proportion of internet use in the elderly people still accounts for a large number of people. Moreover, the well documented rise in internet use by the ageing population – the so called ‘silver surfers’– should not be underestimated in how health information is provided. The PEW trust also noted that 73% of all adult Americans had access to the internet and 60% of these use it to search for health information. With regard to Larner’s second point, studies by Basche et al., noted that internet use was over 40% in cancer patients (and 60% in their companions) (7); Ferguson reports that a third of patients ask clinicians about websites during consultation (8) and Murray et al., report that these patients feel that the internet improves their consultation (9). We note that these studies have all occurred within the United States of America, which could account for the discrepancies Larner has noted as may the fact that it was the initial consultation. Patients may only perform an internet search when stimulated to do so, in chronic conditions or when a diagnosis is known (1,7). The internet should be viewed as a significant ally in the way that we involve patients in their management. It allows patients to seek information about their condition in their own environment, which they can revisit at their leisure. Moreover, personal accounts of disease and its management can help patients understand what their treatment pathway is likely to entail. The availability of on-line support groups can also help to lessen feelings of isolation commonly felt by cancer patients. The caveat that should be remembered with internet sources of information is that they are not all regulated – thus as clinicians, we should be able to provide a list of reputable websites to our patients so that they can seek health information safely. We should, perhaps, see ourselves as facilitators of acquiring health information in the same way as teachers now are facilitators of learning. None.