Second Opinion: Don’t mention the war – cancer is not a battlefield

Ever since Richard Nixon declared “war on cancer” in 1971, caregivers, patients and the media have used military language to talk about this disease. Newspaper headlines refer to well-known people losing the battle with cancer.

When In Calm and Crisis, a new book about the late minister for finance Brian Lenihan, was reviewed on radio, commentators referred to his heroic fight with cancer. The word "riddled" – as in, with bullets – is often used to describe the health of someone whose tumour has spread to other parts of the body. Cancers are described as being invasive and aggressive.

No other disease is spoken about in this way. Strokes and heart attacks kill more people than cancer, yet no one refers to someone losing the battle or comments on their courage in coming to terms with circulatory problems.

Women are nearly 10 times more likely to die from heart disease than from breast cancer yet nobody talks about a woman losing the fight with her heart. Diabetes and obesity can kill but war has not yet been declared on these chronic health problems.

Battle and war analogies are no help to anyone, least of all people with cancer.

These analogies up the ante, contribute to a sense of helplessness and create more stress at an already stressful time.

Military talk is intended to be empowering and is victim-blaming because the implication is that those who die from cancer did not fight hard enough.

According to Ian Haines, an oncologist and palliative-care consultant, battlefield analogies have led to more than 40 years of overdiagnosis, overtreatment and the use of overly aggressive chemotherapy for incurable solid cancers.

Writing recently in the Lancet, Haines claims the warfare model of treatment "has deprived many patients with advanced cancer from access to early palliative-care referral for which there is strong evidence of benefit".

C

hance and luck Battlefield language does not capture the huge role that chance or luck play

in someone’s cancer journey. Finding a lump at an early stage is luck. Early diagnosis and whether screening services pick up tumours is often a matter of chance. Skills of cervical, breast and colon screeners vary. Some surgeons are better than others. Hospitals providing cancer services have different outcomes.

War analogies do not capture the success stories, the thousands of people alive today who are either cured of cancer or whose tumours are inactive, who did not have to “fight” much at all. They received treatment that, luckily, worked for them and they survived.

Cancer in Ireland 1994-2011: Annual Report of the National Cancer Registry 2014 shows survival at five years from diagnosis varies remarkably by tumour type, ranging from 86 per cent for prostate cancer to 11 per cent for lung cancer (based on figures from 2000 to 2007).

Breast and colon cancers have 79 per cent and 55 per cent five-year survival rates respectively. Irish five-year survival rates for all cancers combined is close to the European average. Switzerland has the best five-year survival rates, at 83 per cent.

Cancer incidence is expected to double in the next two decades, mainly because people are living longer.

A report from the National Cancer Registry, Cancer Projections for Ireland 2015-2040, says "the total number of new invasive cancer cases is projected to increase by 84 per cent for females and 107 per cent for males between 2010 and 2040, based only on population size and age distribution".

Fear and helplessness The total number of patients having cancer-directed surgery is expected to increase by more than 50 per cent by 2025 and the numbers having chemotherapy and radiotherapy by 35 to 48 per cent.

Statistics such as these, combined with war analogies, increase levels of fear and helplessness unnecessarily.

In fact, we are not helpless. The World Health Organisation's World Cancer Report 2014 notes "we cannot treat our way out of the cancer problem" and "half of all cancers could be avoided if current knowledge was adequately implemented".

Stopping smoking, eating healthily, being physically active and drinking less alcohol can cut cancer risk by nearly half.

The Government can help by introducing healthy public policies such as banning smoking in cars; introducing fat and sugar taxes and minimum unit prices for alcohol; and banning alcohol advertising and sports sponsorship.

We have been conditioned to use unhelpful, battlefield language about a disease that will affect almost everyone at some stage. Forty-three years after Nixon’s declaration, it is time to end the phony war and start taking prevention seriously.

drjackyjones@gmail.com Dr Jacky Jones is a former HSE regional manager of health promotion and a member of the Healthy Ireland council.