It also ignores the economic potential and quality of available healthcare issues which may be even more significant factors in cancer outcomes in this demographic than a spiral of silence. Finally, I believe that the existence of the spiral of silence is best determined indirectly in studies not associated with the spiral of silence, as respondents may be inclined to alter their responses if the typically subconscious spiral of silence is discussed openly. Even surveys based on individuals' beliefs about community opinions may not fully address the problem, as the belief that one's views are a minority opinion does not necessarily equate to a deterrent effect. Sociological study of cultural customs and taboos can better articulate the existence of a spiral of silence in a given culture. Analysis by a professional