Epochs in the Western World seem to have their defining diseases—mysterious, serious ailments that become nexuses of obsession. The plague, tuberculosis, malaria and polio are seared in cultural memory—as are their treatments, their inevitable effects on society, and their patron saints. We seem to be living in a cancer culture. Dozens of headlines about cancer prevention, statistics and victims beckon at every newsstand; cancer narratives (either triumphant or tragic) are standard fare for TV movies; zeitgeist-defining, bleakly funny novels like White Noise gently mock media saturation with cancer prevention while characters grapple with a terror of the illness.
My generation (X? Y? Me? ) grew up on “cancer” prose—Lurlene McDaniel’s stories (with ominous titles like Six Months to Live and Is My Sister Dying?) were best-sellers at school book fairs and at least as well loved as Little House on the Prairie or Misty of Chincoteague. Anecdotes about Ma and Pa and Mary and Laura coexist in my brain with a terror of the unexplained bruise, always the first sign of childhood leukemia in McDaniel’s plotlines. As Mary Ellen Walsh, director of the Cancer Care Program at Northampton’s Cooley Dickinson Hospital, stated simply, “Cancer is scary because of the amount of information out there.” For myself, and presumably for a large cross-section of the population, fear of cancer is supported by lots of murky and conflicting statistics and is linked to other millennial anxieties about pollution, global warming, corporatization, and a conspiratorial (or at least evasive) government. So I welcomed this opportunity to sort through the cacophonous discourse about cancer.
The Basics
The term “cancer” refers not to a single ailment but to over one hundred different conditions, often with drastically disparate symptoms, causes and treatments. Though cancer is an umbrella term for many diseases, it refers to a disruption of the normal processes of cellular reproduction. In healthy individuals, when the body needs new cells, older ones die and younger ones reproduce by dividing. In cancer patients, however, cells continue to divide although they are not needed and form a growth of unnecessary cells called a tumor. Tumor cells may eventually interfere with the function of healthy tissues and metastasize (which means they escape from the tumor and enter other organs and tissues), which is when they are termed malignant.
Generally, it takes several years for tumors to develop and metastasize—hence the much-publicized importance of early detection. The sooner a tumor is detected, the more treatment options a patient is likely to have; the less invasive these options are likely to be; and the greater the chance to control or cure the condition. In fact, the one thing sources agree on almost universally is the importance of early detection and treatment—though Lindsay Rockwell, an oncologist affiliated with Cooley Dickinson’s Cancer Care Program, noted that “screening for prostate cancer remains controversial, ” according to many publications.
Regional Statistics
Cancer statistics involve a dizzying number of variables: the type of cancer in question; the location, age, sex, racial background and lifestyle choices of the afflicted; diagnosis rates versus five- and ten- year survival rates and the proportion of patients achieving long-term remission. The multivalence of cancer variables is also, of course, one of the reasons why cancer research is such a controversial and conflicted field, and why the tone of much advice regarding the disease is so tentative.
The National Cancer Institute, however, publishes detailed and definitive national and state statistics on its webpage (seer.cancer.gov). Recent reports for Hampshire County coincided with Walsh’s approximate statistics on cancer diagnosis at Cooley Dickinson Hospital. Walsh reported that about 450 cases of cancer are diagnosed yearly at Cooley Dickinson; the NCI established that Hampshire County diagnoses are about 474 per 100,000 (a low-to-middling rate). County-wide and within Cooley Dickinson, breast cancer cases comprise the majority of diagnoses: according to Walsh, nearly a quarter of newly diagnosed cancers are breast cancer. Other prominent local varieties of the disease include, in order of frequency of detection, prostate cancers, lung cancers, and lymphomas (cancers of the lymphatic system, which produces infection-fighting white blood cells.)
Though recent news has suggested the existence in the Pioneer Valley of cancer hot spots—small areas where cancer cases are unusually frequent, and potentially closely related to a single environmental factor—Walsh claimed that to the best of her knowledge there are no obvious statistics to confirm such claims to date.
Prevention and Detection
The World Health Organization claims that one-third of cancers worldwide are preventable, and another third are curable with early detection and proper treatment.
The laundry list of clearly evident preventive measures is ubiquitous. Avoiding smoking and secondhand smoke is the number one way an individual can minimize his or her cancer risk, since, according the U.S. Department of Health and Human Services’ publication, Cancer and the Environment, “… exposure to the carcinogens in tobacco products accounts for about one-third of all cancer deaths in the United States each year… smoking (is) associated with cancers of the lung, mouth, bladder, colon, kidney, throat, nasal cavity, voice box, esophagus, lip, stomach, cervix, liver, and pancreas, and with leukemia.”
Physicians and medical organizations also universally issue advice about maintaining a healthy diet and weight to avoid cancer. Cancer and the Environment notes that “large population studies show a consistent association between obesity and certain kinds of cancer” in the U.S., especially “breast cancer in older women, and cancers of the endometrium, kidney, colon and esophagus.”
There is also fairly conclusive evidence that physical activity, especially rigorous, sustained and consistent physical activity, cuts the risk of colon and breast cancers, two especially prevalent and often aggressive cancers. According to Cancer and the Environment, inactivity and obesity together account for “25 to 30 percent of the cases of several major cancers.”
The links between specific foods and cancers remain slightly vague, although both the U.S. Department of Health and its subsidiary, the National Cancer Institute, allude to several studies indicating that excessive consumption of red and preserved meats, foods preserved in salt, and salt itself seem to heighten an individual’s susceptibility to cancer and to increase the risk of stomach and colorectal cancers. And both organizations cite evidence that consuming five or more servings of fruits and vegetables each day may decrease an individual’s cancer risk. Heavy drinking (more than two drinks per day) is also thought to increase cancer risk, as is excessive exposure to UV radiation from sunlight or artificial sources like sunlamps and tanning beds. Again, however, there is controversial recent evidence that some exposure to sunlight has beneficial health effects, boosting vitamin D levels and hence strengthening individuals’ immune systems and decreasing the risks of certain cancers, including lung cancer.
The correlation between environmental toxins and cancer remains one of the most hotly contested aspects of the disease. The NCI and the National Board of Health confirm that exposure to radiation, either from radioactive fallout or from medical procedures like X-rays, increases an individual’s risk of cancer. Various medications, pesticides, industrial solvents (particularly benzene) and dioxins are also directly correlated with certain types of cancer.
To minimize risk, national organizations offer common-sense advice: read labels, use potentially harmful products in well-ventilated areas, and familiarize yourself with Occupational Safety and Health Administration and Environmental Protection Agency regulations. Consumer groups and investigative publications suggest that there are many ingredients in popular household products and health and beauty aids, as well as pesticide residues on factory-farmed food, that are potentially carcinogenic and ill-researched; they encourage savvy, skeptical consumption.
What potential symptoms of cancer should not be ignored? Local cancer specialists Walsh and Rockwell both mentioned lingering coughs (especially coughs accompanied by blood) and breast lumps. Decreased appetite and weight loss are symptoms common to virtually all cancers, Rockwell said. Fevers, chills, and night sweats often denote leukemias and lymphomas, while increased abdominal girth may be a sign of ovarian cancer. Walsh also mentioned large and irregular moles as a cause for concern. Additional common cancer symptoms listed in Cancer and the Environment include “a sore that does not heal; changes in bowel or bladder habits; indigestion or difficulty swallowing,” and “unusual bleeding or discharge.” Walsh tempered this garden variety list of cancer symptoms with the caveat that they are common to many diseases and ailments and that the existence of a cancer-like symptom does not necessarily mean that cancer is present. Walsh also emphasized the importance of “body awareness” and intuition in early cancer detection, pointing out that in general, people should be alert to changes in their own bodies.
Walsh reiterated what all health publications say about the importance of regular screening for breast, cervical, colon and rectal cancers. She explained that colonoscopy itself is often a preventive measure, as the procedure may remove cancerous or precancerous polyps.
Six Months to Live?
Today the title of my favorite maudlin cancer narrative is, fortunately, no longer so pertinent. Though cancer rates have remained fairly steady in the U.S. since the ‘70s, mortality rates have dropped drastically, a fall that is largely attributable to increased awareness and early detection, ground-breaking medical research and improved treatments.
Walsh emphasized that cancer is now “chronic, not necessarily terminal.” She noted that patients now have “first-line, second-line, third- and sometimes even fourth-line treatment options,” whereas a single round of chemotherapy might have been their sole choice ten or twenty years ago. Cooley Dickinson’s team of oncologists appreciates patients’ active involvement in their own treatments. The oncologists encourage patients’ “self-advocacy” and the adoption of proactive attitudes in the face of cancer, she said.
Rockwell amplified the ABCs of cancer prevention by noting that stress management also helps maintain health. Walsh, too, did not overlook the mind-body connection and expressed her conviction that although a positive outlook may not necessarily improve a patient’s initial prognosis, it will invariably improve his or her quality of life after diagnosis. She also described the availability of local resources to unite and support cancer patients emotionally, such as Cancer Connection in Florence and several programs at Cooley Dickinson. One department at the hospital focuses on complementary and alternative treatments, including reiki, therapeutic massage and guided imagery, to promote comfort and decrease stress and anxiety for all patients, especially those coping with cancer.
When I asked Walsh about her opinion of the slightly “pulpier” cancer narratives on newsstands or on TV, she said that she had been ambivalent about the usefulness of such stories. Yet she added that in her experience, patients often have strong emotional responses to first-person narratives about cancer regardless of the brow-elevation level of such pieces or the quality of research they include. She acknowledged that many patients identify with or are inspired by first-person testimonials or figureheads’ struggles with cancer, and that the “humanization” of cancer either by the media or within a medical environment is crucial to a patient’s comfort and positive outlook.
Rockwell, on the other hand, perceived many media accounts as slightly sensationalistic and potentially pernicious. In her view, “the mainstream media often caters to the drama of a cancer diagnosis. This is often counterproductive for those struggling with a diagnosis of cancer and wanting to lead as ‘normal’ a life as possible. Though it is crucial the media play its role as informant, [media sources] often dangerously oversimplify and therefore the representation of data is misleading.”
Though Walsh and Rockwell both stress the need to tailor all aspects of cancer treatment—including cancer information, complementary therapies and mental and emotional supports—for individual patients, their divergent opinions of media representation of the illness underscore what a controversial disease cancer is. Discourse on the subject is often subtly politicized; causes and cures differ from patient to patient; statistics and medical research are always accompanied by dozens of footnotes, variables and exceptions. The primary certainty of cancer is still uncertainty.
However, survival rates are on the rise and treatment options are ever more sophisticated. And cancer narratives—whether exhaustively factual or more impressionistic and personal—seem to reflect this trend. The tone of much media coverage is less Six Months To Live and more in the vein of “The Cancer Diaries” in Mademoiselle ( a twenty-something diagnosed with an often-fatal cancer tries a controversial new treatment and establishes remission), or Crazy Sexy Cancer, a documentary about a young woman, who, when faced with an alarming diagnosis, goes on a defiant, exhaustive search for a cure. These narratives may be exceptional or sensational, but at the same time they are life-affirming and inspirational. And while their subjects may not ever be fully “cured,” they may raise awareness, result in increased prevention and early detection, and, finally, influence other cancer patients to be similarly motivated and positive in their searches for a cure.
