Despite the increasing incidence of cancer, and ad nauseam “reports” on the 11 o’clock news, there is a gap between published scientific data, and understanding how they fit into one’s life to reduce chances of being diagnosed with cancer.
Anyone can get cancer at any age, although more than ninety percent of cancers are diagnosed in people 50 years and older. This is because the risk for cancer increases with age. Incidence rates also vary by gender, race and ethnicity. Projections from the American Cancer Society suggest that there will be almost three new cancer diagnoses every minute, in 2017.
On December 23, 1971, President Nixon signed a $1.6 billion crusade to find a cure for cancer, leading to the establishment of the National Cancer Institute (NCI) in its current form, and the trope “war on cancer”. Forty-six years later, Cancer Moonshot notwithstanding, the budget for the NCI is $5.389 billion; or in 1971 dollars, a paltry $900 million.
By some reports, in 1975 there were 199 cancer deaths per 100,000 people, peaking in 1991 to 215; twenty-six years later, that number has gone down to 160 cancer deaths per 100,000 people in the US. This also means that we have more people who either have no evidence of disease, or are living with cancer as a chronic illness.
Astonishingly, although the incidence of cancer is not insignificant, and although many cancers like lung cancer and breast cancer have awareness months associated with them, a 2015 survey conducted by the American Institute for Cancer Research showed that almost 80% of Americans don’t know that family history accounts for a fraction of cancer diagnoses— up to 10%. Family history also accounts for a similar fraction of cases of heart disease..
Cancer happens how?
The majority of cancers, like heart disease, are much more complicated in etiology than most other diseases, such as diseases that are a consequence of viruses or bacteria. Consequently, environment and lifestyle choices play a significant role. Researchers continue to spend enormous effort in trying to tease out factors that put an individual at a higher risk of a particular cancer. However, because risk factors are unlikely to act in isolation, the public is often left to juggle sometimes conflicting results publicized in the media. Without access to the published data assigning risk, weighing the true consequences of what one hears or reads in the media can be extremely confounding and stressful, particularly for someone who has been diagnosed with cancer.
Cells are fascinating vessels of information that varies depending on where those cells exist — a skin cell carries different functional information from a cell in your intestines. This information includes guiding it’s life cycle — when to grow, when to talk to its neighbor, when to multiply, when to stop growing, when to die. Simply put, if this information is scrambled because of abuse from the environment, for example excessive exposure to sun; or from poor diet, the cell can either die prematurely as in cases of some neurological disorders in newborns; or it can multiply uncontrollably as in cancers. This ability of a cell to switch from one state to another based on its environment, is a motivation for researchers to find a “master switch”; and is there a uniform master switch across all cells? Every few years we are buoyed by tantalizing results that point to a master switch, and biotech companies are born; but the elation is often fleeting.
With increasing refinements in science and technology, we have made considerable progress in understanding cancer biology and treating the disease, even though we continue to see a rise in some cancers in previously unexpected demographics. As we continue to refine our processes, we will see increasing numbers of people who have survived treatment, and have no evidence of disease.
The “awkwardness” of knowing someone with cancer
Receiving a diagnosis of cancer is shattering for even the most composed and strong person. Maneuvering the mostly well-meaning onslaught of questions and remarks is like walking a tightrope across the Niagara Falls, and every so often you almost loose your footing. Questions and remarks run the gamut: have you considered a second opinion? Don’t worry, my (put-the-name-of-your-favorite-relationship-here) had the same diagnosis and came through absolutely fine. Have you tried (put-the-name-of-the-currently-popular-treatment-here)? There is no single guideline for anyone — not for the cancer patient, nor for the people around her — on how to navigate the future. The patient is likely as worried about you in addition to herself, as you are worried about her. Perhaps the best thing is to listen, and be as unintrusive as possible. There have been instances when people who have loved someone who is diagnosed with cancer, stay through the journey but simply need to walk away at the end of treatment. This is yet another awkwardness, but should not be judged. Cancer gets in the way of living. Cancer is hard. Cancer is awkward.
For many people who survive the treatment and the disease, there is a new moral urgency to mobilize as many resources as they can to ensure that others will not have to endure what they have; for some it will be a period that they will prefer remains in the past, never to be acknowledged again; for others, it is a reassessment of priorities. For still others, it is a combination of these and more. The point is that there is no uniform manner that people who have dealt with cancer and survived its treatment, behave. There are patterns, but the details are unique to each individual. Most will embark on the treatment journey promising to be back to normal at the end of it, but almost all will realize that is impossible. Few will be able to articulate that to those around them; and still fewer will have people around them who will be able to handle the reality that the person they knew while fundamentally the same person, has an additional dimension.
Another cancer trope is “the new normal”. This begs the question: what is normal? For most people who have experienced cancer, any certainty about the future sometimes feels like clairvoyance, and the present can feel like fake news. This does not make them Eeyores, rather, it gives them a greater appreciation of the moment.
When cells have their information scrambled and the result is cancer, the process is called “transformation” — a normal cell becomes malignant; a negative connotation to the word. Outside cancer biology, the noun “transformation” and the adjective “transformational” are often used with positive connotations, e.g., you can make a transformational gift to public television. Cancer is a consequence of transformation, and can itself be transformational: what an unusual juxtaposition.
The first report of chemotherapy as a means to control cancer appeared seventy-five years ago when on 27 August 1942 Alfred Gilman and Louis Goodman, faculty at the Yale School of Medicine, administered nitrogen mustard to a cancer patient in New Haven, Connecticut. Without that first patient’s consent to this untested treatment, it is difficult to imagine where we would be today in finding treatments for cancer, and what the worldwide burden of cancer would be. Cancer survivors and their families often become the most vociferous advocates for research funding and healthcare. Funding research for new ways to cure cancers is critical; but equally important is funding for programs to address issues that survivors deal with— neuropathy, fatigue, anxiety, and psychological and emotional challenges. Unfortunately, the “wow factor” for cancer cures and treatments is much greater than that for helping survivors — we need to transform that and give them equal importance, if we are truly committed to the Cancer Moonshot, and similar programs.