Why the War on Cancer is Wrong
"She battled cancer for about three and a half years and lost her fight in June, 2015." When I first heard myself say these words in response to how long my mother had been "fighting" cancer, it just didn't feel right. But throughout the entire process, from diagnosis to death, this was the metaphor surrounding her illness. Our friends, family, doctors, and researchers - literally everyone was engaged in a battle for the ages. But how did we come to think of cancer in this way? And is it possible that it's actually doing more harm than good?
1943, the War Begins
On the heals of World War II, the war on cancer escalated quickly and quietly. A self-made, powerful businesswoman by the name Mary Woodard Lasker was a rising socialite in the bustling scene of New York City. Prior to the 40s, Lasker had been a wildly successful saleswoman and entrepreneur who would eventually be described as having "legendary social and political energy."
Following the death of her mother who had brushes with both cancer and heart disease, Lasker redirected her professional efforts from the business world to public health activism. Her first step was to get a pulse on the landscape of cancer research, so she visited the American Cancer Society (then called the American Society for the Control of Cancer) in 1943, and what she found was disappointing.
"The visit left her cold. The society, a professional organization of doctors and scientists, was self-contained and moribund, an ossifying Manhattan social club. Of its small annual budget of about $250,000, it spent an even smaller smattering on research programs (Emperor of All Maladies)."
So Lasker got to work, upending the entire system in her signature way.
In four short years, she and her team transformed the fledging society by replacing the leadership, rewriting the bylaws and constitution, and fundraising an incredible twelve million dollars - a near 5000% boost to their budget.
How did she do it?
By deploying one of the most powerful metaphors that we have at our disposal: war. She shaped the public's perception of cancer from a disease that people were too frightened to talk about, to an enemy that needed ruthless and systematic eradication. She not only rallied doctors and scientists, but also celebrities and philanthropists. She took to the radio waves and magazines and newspapers to raise awareness around this silent and devious enemy. This was a war she couldn't fight alone, and her previous experience as a businesswoman gave her all the skills she needed to rally everyone to her cause.
Most people would agree that we are an innately tribalistic species, and if we detect a threat to our people, we have an extraordinary capacity to collectively neutralize that threat. And herein lies the troublesome double-edged sword of "fighting" cancer. There's no doubting the immensely positive impact that Lasker had on cancer awareness, advocacy, and research by appealing to this side of humanity. Her efforts would culminate in the signing of the 1971 National Cancer Act, which would pledge more money and resources toward cancer research and treatment than ever before. And the progress that we have made as a result is unbelievable.
But what was the tradeoff that we made when we decided to go to war? And how can we detect when the impact of this mentality is no longer beneficial?
By listening to the "soldiers" we send into battle.
The Price for Glory
Everybody loves an underdog who wins. Whether it's David toppling Goliath, or the proverbial Cinderella team dancing their way through the March Madness tournament. You see where I'm going with this - we all want to view our friends and family who are diagnosed with cancer in the same light. We want them to embody the spirit of a warrior who will fight against and beat all odds. I know, because this is how I wanted to view my mother as she went through treatment.
But it was a mistake and in hindsight, I wish I hadn't. Because the reality that we must face is that we're not all warriors. And having cancer is not a battle that we should force people to fight.
Because "fighting" cancer shifts the burden of victory, or worse, the guilt of loss, squarely on the shoulders of the patient. Consider what is implicated when the cancer is out of control and can no longer be treated. Would it have been possible to win if only the patient fought harder? And while at first the metaphor may be inspiring, it falls apart in the throes of chemotherapy, radiation, and surgery.
Today's standard for cancer therapy is a much crueler world than many of us want to acknowledge. Sure, we all have an abstract sense of its physical challenges - the nausea, the hair loss, the energy drain, etc. But what most of us lack is a fundamental understanding of how it erodes our psyche - the isolation, the depression, the bitter confrontation with one's own mortality.
In the midst of this physical and mental trial, our loved ones are urged to remain strong, to never give up, to keep fighting. Making these suggestions is a blatant, and often completely unintentional disregard for the enormity of the existential task that is surviving cancer.
So does this mean we should preach the opposite message? To give up immediately in the face of a terminal diagnosis?
A New Framework
What I am advocating for is a collective shift in how we talk about cancer. If we move past this metaphorical war and begin to understand how cancer actually impacts the human condition, not only will we be more successful in how we support our loved ones as they go through treatment, but we will be more successful in how we treat cancer itself.
Let me explain.
When we replace words like "battle" and "fight" with "diagnosis" and "treatment," we paint a more realistic picture of the disease. And it creates a more approachable environment for those having to deal with it. So rather than asking, "how long have you been battling cancer?" a better question might be, "how long ago were you diagnosed?" And if you want to show your support to a friend or a loved one, saying "I'm here for you through your treatment," might be a better option than "keep on fighting, I know you can win." Take a look at cancer survivor and writer Xeni Jardin's opinion on this.
Changing our rhetoric also forces us to understand cancer in its truest form. What does it mean to be diagnosed? For starters, cancer is the term we use to describes a set of diseases that share the common characteristic of abnormal cellular growth. Diagnosis is confirmed under a microscope when cells exhibit very distinct patterns that suggest cancerous transformation. So why do the current treatments have such devastating side effects? Cancer cells grow rapidly and have the potential to spread and invade to other parts of the body. Our classical chemotherapeutics target all rapidly dividing cells including those found in your hair follicles and digestive tract, hence the dramatic hair loss and nausea.
From here, we can ask more nuanced questions: how does the next generation of therapy promise better efficacy with fewer side effects? Right now, there is a colossal effort in the research community to find out exactly how cancer cells differ from healthy cells at the molecular level. Given that there are probably more molecules in a single cell than there are stars in the Milky Way galaxy, you can appreciate the grand scale of this challenge. But with technological advancements in areas such as immunology, big data, and even machine learning, the problem is slowly being solved. And your ability to recognize which efforts are the most promising is a direct function of your understanding of cancer. Which is why you shouldn't resort to metaphorical thinking, but stick to more accurate descriptors that force you to comprehend what this disease really is. This gives you the added benefit of knowing how to best prevent cancer in your own body.
Today marks the beginning of a new year and an opportunity for all of us to start something new. Let 2018 be the year you transform your thinking about cancer. Challenge yourself to use more accurate, non-metaphorical words when referring to this disease. And with this new framework, let us enhance our support and progress toward a world free of cancer.
Illness as Metaphor - Susan Sontag
Emperor of All Maladies - Siddhartha Mukherjee