Last time I spoke to you about wording and public health, and the unintentional impact that can have on people. I want to continue on that theme today, and talk about what is perhaps one of the most pervasive, and more controversial language choices that we as as a society have made: the military language we use around cancer. Often, the media (and by extension, society) describe someone with cancer as a "warrior" who "battles" cancer. This language isn't rare, and has been around since the mid-70s when Susan Sontag wrote her book "Illness as a Metaphor." Research by Seale (2001) states: "News stories commonly feature sports celebrities with cancer, as well as sporting activities by ordinary people with cancer, designed to generate a sense of (usually successful) personal struggle."
The usually successful component is what results in problems. When we take the metaphor further, we describe it as "conquering cancer" when cancer goes into remission, or describe someone as a "survivor" of cancer. This is then further complicated by how medical professionals and researchers use the term "survivor" as they will have a very specific definition in mind. Some research studies use a five-year survival window following diagnoses, (see the Coleman study referenced below), while the CDC says: "The term cancer survivor refers to a person who has been diagnosed with cancer, from the time of diagnosis throughout his or her life."
This makes all the difference. "Survivorship" for research is a very precise, very defined term. It may not be the same as what an individual defines as being a survivor, and some definitions (such as the one above) may not include anything about quality of life following diagnosis. But even when cancer goes into remission, there's still a worry that it might come back, and so the term "survivor" may be a misnomer.
On the surface, I get why we use this language. The language is meant to be positive -- it's meant to evoke support. It's a tough and trying time, and family/friends/colleagues want to provide help in an way they can. So we follow the template set for us by the media and charities to try and help, as words fail us. I should point out though that this language (i.e. "surviving" "battling" "conquering") isn't used exclusively for military metaphors; it can also be used in a religious sense, or used in conjunction with sport metaphors, and there are distinct gender differences in how cancer is reported between men and women in the language and imagery we use.
But what's the other side of that conversation? Someone who "loses" their "fight" against cancer? Someone who has "fallen"? And to take it to the extreme, would they have "made it" if they "fought harder"? Kristen Garrison writes:
How can a woman with metastatic bone lesions read Lance Armstrong's story of conquering the disease and feel anything but failure? His story may be true, but does not represent the average person, and such narratives, which get so much press attention and bookshelf space, undercut the comparably determined but unsuccessful efforts of people fighting cancer.
There's a negative side to that language that is coming out, as those diagnosed with cancer speak up. Blogs and social media give people a platform from which to voice their displeasure and connect with others who feel the same way. Heather Cleland (herself diagnosed with cancer) writes:
The language around cancer -- of "battles" fought, won, lost, and succumbed to -- fails to consider the sheer chance of it all. Sure there are cancers that we bring upon ourselves, but most are a result of the tiniest bits of bodies going rogue for reasons we've yet to understand. To speak of lost battles as though the warrior didn't want victory badly enough projects our proclivity to control outcomes onto something that cannot be controlled.
In the same vein, I recommend these two pieces written after Canadian politician Jack Layton passed away by Carly Weeks and Edward Keenan. Both discuss the outpouring of support for Jack Layton that described him as "losing his fight against cancer" and the issues around those word choices.
Similarly, other people have spoken up; some notable pieces include Beyond Breast Cancer, an open letter by Aria Jones and finally, an excellent piece by the late Julie Mason. There are a number of people who are against the current language choices we made, and I think they raise some very valid and very compelling points.
While some people may not like the metaphor, some might find strength and solace in it. For those, this language helps them, and if they want to consider themselves a warrior, all the power to them. That's their decision and their prerogative. The Canadian Cancer Society sums it up well:
You may feel like a "survivor" or have heard the term used in conversation. But what does it mean? It means different things to different people. You may not like the way the word is used, or you might feel that it doesn't apply to you. But the word "survivor" helps many people. It can be powerful, and for some, it's a positive way of looking at themselves. Using it helps them to cope with their life after cancer.
*This blog originally appeared on "Public Health Perspectives" on plos.org
Results of a massive gene analysis, published last month in the journal <em>Nature</em>, shows that there are <a href="http://www.huffingtonpost.com/2012/09/24/four-breast-cancer-types-genetics-genes_n_1909116.html">four major classes</a> of breast cancer, the Associated Press reported. "With this study, we're one giant step closer to understanding the genetic origins of the <a href="http://www.siteman.wustl.edu/ContentPage.aspx?id=6431">four major subtypes of breast cancer</a>," study researcher Matthew Ellis, M.B., B.Chir., Ph.D., of the Washington University School of Medicine and the Siteman Cancer Center, said in a statement. "Now, we can investigate which drugs work best for patients based on the genetic profiles of their tumors," he added in the statement. "For basal-like breast tumors, it's clear they are genetically more similar to ovarian tumors than to other breast cancers. Whether they can be treated the same way is an intriguing possibility that needs to be explored."
Men are less likely to get breast cancer than women -- but when they do, it's <a href="http://www.huffingtonpost.com/2012/05/04/breast-cancer-men_n_1479739.html">often deadlier</a>, according to a study presented earlier this year at the American Society of Breast Surgeons meeting. The Associated Press reported that <a href="http://www.huffingtonpost.com/2012/05/04/breast-cancer-men_n_1479739.html">men diagnosed with breast cancer</a> live, on average, two fewer years than women who are diagnosed with breast cancer, and are also more likely to have the breast cancer spread, have larger tumors when the cancer is discovered, and be diagnosed later.
Cadmium -- a toxic metal that can be present in foods like shellfish, root vegetables, offal and cereals -- may <a href="http://www.huffingtonpost.com/2012/03/15/cadmium-breast-cancer-intake_n_1347523.html">raise risk of breast cancer</a>, according to a March 2012 study in the journal <em>Cancer Research</em>. The research included 56,000 women. Researchers were able to analyze about how much cadmium each woman was consuming based on the cadmium-rich foods in her diet. They found that those who <a href="http://www.huffingtonpost.com/2012/03/15/cadmium-breast-cancer-intake_n_1347523.html">consumed the most cadmium</a> had a 21 percent higher breast cancer risk, compared with those who consumed the least cadmium, HuffPost's Catherine Pearson reported.
Getting six or fewer hours of sleep <a href="http://www.huffingtonpost.com/2012/09/06/sleep-breast-cancer-aggressive-deprivation_n_1854658.html">may raise the risk of recurrent breast cancer</a> among post-menopausal breast cancer patients, according to a study in the journal <em>Breast Cancer Research and Treatment</em>. However, this same link was not observed for pre-menopausal breast cancer patients. The findings suggest "that <a href="http://www.uhhospitals.org/about/media-news-room/current-news/2012/08/lack-of-sleep-found-to-be-a-new-risk-factor-for-aggressive-breast-cancers">lack of sufficient sleep</a> may cause more aggressive tumors, but more research will need to be done to verify this finding and understand the causes of this association," study researcher Cheryl Thompson, Ph.D. said in the statement.
A <a href="http://www.eurekalert.org/pub_releases/2012-10/acos-afo092712.php">smallpox virus</a> seems to be promising against a hard-to-treat form of breast cancer, called triple-negative breast cancer, according to a study in mice presented at the 2012 Annual Clinical Congress of the American College of Surgeons. "Based upon pathology, we could see that at least 60 percent of the <a href="http://www.eurekalert.org/pub_releases/2012-10/acos-afo092712.php">tumors were completely regressed</a> and the other 40 percent had very little areas of tumor cells present with a lot of necrosis, which is a sign that the tumor was responding to therapy," study researcher Dr. Sepideh Gholami, M.D., of Stanford University Medical Center, said in a statement. ABC News pointed out that this <a href="http://abcnews.go.com/blogs/health/2012/10/01/smallpox-virus-may-help-treat-deadly-form-of-breast-cancer/">kind of breast cancer is notoriously hard to treat</a> because it doesn't respond to other hormonal or immune treatments.
Working the night shift is linked to an increased risk of breast cancer, according to two different studies that came out this year. One of them, published in the journal <em>Occupational and Environmental Medicine</em>, showed that <a href="http://www.huffingtonpost.com/2012/05/30/shift-work-breast-cancer-risk_n_1553058.html">breast cancer risk went up </a>among women who worked the night shift more than twice a week, with the risk being the highest among those who said that they are "morning people" instead of "night people." <em>The Toronto Sun</em> reported that the results of this study confirm the findings of the International Agency for Research on Cancer, which has a list of items and <a href="http://www.torontosun.com/2012/05/29/night-shift-work-linked-to-breast-cancer-risk">habits that may cause cancer</a>. The IARC considers shift work "possibly carcinogenic." The other study, published in the <em>International Journal of Cancer</em>, showed that breast cancer risk is 30 percent higher for <a href="http://www.huffingtonpost.com/2012/07/01/shift-work-breast-cancer-night-sleep_n_1612486.html">women who work the night shift</a>, with the risk being especially clear among those working night-time jobs for four years, or those who worked the night shift for three or fewer nights a week.
The genes that help determine a <a href="http://www.huffingtonpost.com/2012/07/05/breast-cancer-risk-breast-size-study_n_1652292.html">woman's breast size</a> may also be linked with her breast cancer risk, according to a study published earlier this year in the journal <em>BMC Medical Genetics</em>. Researchers examined the genetic data of 16,000 women to find that seven DNA variations, called single nucleotide polymorphisms (SNPs), seem to be <a href="http://www.huffingtonpost.com/2012/07/05/breast-cancer-risk-breast-size-study_n_1652292.html">linked with breast size</a> -- and three of those SNPs are known to be associated with a person's risk of breast cancer, HuffPost's Catherine Pearson reported.
Just a little bit of exercise may help to <a href="http://www.huffingtonpost.com/2012/06/25/exercise-breast-cancer-risk-moderate_n_1619175.html">reduce your risk of breast cancer</a>, though the more you move, the better, according to a study in the journal <em>CANCER</em>. Researchers at the University of North Carolina in Chapel Hill found that postmenopausal or reproductive-age women in their study who exercised the most -- from 10 to 19 hours each week -- had a 30 percent <a href="http://www.huffingtonpost.com/2012/06/25/exercise-breast-cancer-risk-moderate_n_1619175.html">lower risk of breast cancer</a>, though exercising less than that was still linked with some protective benefits. "The observation of a reduced risk of breast cancer for women who <a href="http://www.eurekalert.org/pub_releases/2012-06/w-eem062012.php">engaged in exercise after menopause</a> is particularly encouraging given the late age of onset for breast cancer," study researcher Lauren McCullough said in a statement.
For post-menopausal women, <a href="http://www.telegraph.co.uk/health/healthnews/9541796/Breast-cancer-risk-raised-by-Type-2-diabetes.html">having Type 2 diabetes</a> may raise the risk of breast cancer, according to a review conducted by the International Prevention Research Institute. "On the one hand, it's thought that being overweight, often <a href="http://www.telegraph.co.uk/health/healthnews/9541796/Breast-cancer-risk-raised-by-Type-2-diabetes.html">associated with Type 2 diabetes</a>, and the effect this has on hormone activity may be partly responsible for the processes that lead to cancer growth," study researcher Peter Boyle, the president of the International Prevention Research Institute, told <em>The Telegraph</em>. "But it's also impossible to rule out that some factors related to diabetes may be involved in the process."
Being overweight could lead to worse outcomes from breast cancer, according to a study published August in the journal <em>Cancer</em>. Specifically, the study showed that overweight women who have been treated for breast cancer have a <a href="http://www.msnbc.msn.com/id/48800019/ns/health-cancer/t/being-overweight-tied-breast-cancer-return-death/#.UGxtN_mfGPI">higher risk of recurrence and death</a>, NBC News reported. "Obesity seemed to carry a <a href="http://www.msnbc.msn.com/id/48800019/ns/health-cancer/t/being-overweight-tied-breast-cancer-return-death/#.UGxtN_mfGPI">higher risk of breast cancer</a> recurrence and death -- even in women who were healthy at the time that they were diagnosed, and despite the fact that they received the best available chemotherapy and hormone therapy," study researcher Dr. Joseph Sparano, associate chairman of medical oncology at the Montefiore Einstein Center for Cancer Care, told NBC News.
Marisa Weiss, MD, of breast cancer.org, explains the different breast cancer stages and what they mean.