The weight of the word: not all cancer is ‘cancer’ | Health & Wellness

If you come to the CNIO you will be greeted by a sculpture by the artist Marina Vargas. Carved in Carrara marble, the sculpture represents the artist herself in life size. Marina Vargas shows her mastectomy and holds her arm in triumph. Marina’s triumph over the fear that, without a doubt, the diagnosis of her illness produced in her.

Marina has often told me about Anne Boyer’s book, The undying (Desmorir, in its Spanish translation), winner of the Pulitzer Prize for Non-Fiction in 2020. Boyer recounts her experience with her own breast cancer: the diagnosis—a complicated tumor, triple negative—, aggressive chemotherapy, her fatigue, their fears… Inevitably, Boyer invokes Susan Sontag, specifically her planned essay on the main causes of death in women, which the American philosopher wanted to write through cases such as that of Virginia Wolf and other famous women.

Sontag herself suffered from breast cancer and was cured, but decades later another cancer ended her life—preventing her from writing precisely that essay about the diseases that kill women. She did have time to publish in 1978 what is perhaps the best philosophical essay on cancer: The sickness and their metaphors (Equally recommendable is the essay that gave rise to The disease and its political metaphorspublished in 1976 in The New York Review of Books).

“Illness is NOT a metaphor, and the healthiest way to be sick is that which is most free from, most resistant to, metaphorical thought,” Sontag writes. Metaphors are the result of “ignorance”, “stereotypes”, scientific incomprehension about the origin of the disease and, therefore, its cure.

Metaphors are harmful to those who have cancer. Metaphors condition, blame and hide real problems. There is the language of war: cancer is the enemy, the murderer; Patients are victims, but also guilty. Cancer is ended with a fight, with a crusade, bombarding with chemotherapy. As in wars, aggressive solutions and collateral damage must be accepted. The National Cancer Act with which American President Richard Nixon declared the “war on cancer” in 1971 is famous.

Cancer is what invades, colonizes, grows and destroys. He is a predator, a devourer (like Saturn eating his children). The term is so powerful that it emphasizes deregulation, the anomalous, the incoherent: cancer of society, cancer of the economy…

These unhelpful metaphors have as an antidote, says Sontag, research, progress in knowledge about what cancer is. Sontag even pointed out that there was not just one cancer, but hundreds, and in fact today we could say that cancer is thousands of diseases, as many as there are cancer patients. Maybe the word cancer shouldn’t be used for all these diseases?

Research is managing to strip cancer—many types of cancer—of its lethal power. The term cancer, in more and more cases, is no longer synonymous with death, or even with serious illness. “Not everything we call cancer should be called cancer,” oncologists Laura Esserman and Scott Eggener recently wrote in The New York Times. “Despite astonishing advances in our understanding of the disease, we have not updated how we define what has become known as the emperor of all diseases. “Some cancers have an extraordinarily low risk of altering the quality or length of life, but they are lumped in with those that do.” The World Health Organization describes cancer as “a group of diseases that can originate in almost any organ or tissue in the body when abnormal cells grow uncontrollably, exceed their normal limits and invade adjacent parts of the body and/or spread.” to other organs.” The term is attributed to Hippocrates, which implies that its meaning has had more than 2,500 years to evolve and, above all, to accumulate power.

But now, thanks to research, many people who receive a diagnosis of cancer will hardly see the length and quality of their life altered, either because they will be treated promptly and effectively or because we know, due to the characteristics of that particular tumor, that the prognosis is good.

That is the way to deactivate the threat of the word cancer: move increasingly towards much more personalized and precise diagnoses and treatments. Only in this way will we deactivate fear. Let’s not use metaphors in cancer. Let’s look at it head-on, with research and science.

Maria A. Blasco She is director of the CNIO (National Cancer Research Center).

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