Cancer and Metaphors

When the US created the National Cancer Institute in 1937, the headline for the Washington Post boasted, "'Conquer Cancer' Adopted as Battle Cry of the Public Health Service." In 1971, President Nixon launched the "War on Cancer" by signing the National Cancer Act, framed as an "intensive campaign" to find a cure and referred to as the "Act to Conquer Cancer".

Thus the world of cancer has always been mired in a single over-arching metaphor: War. Combatants, cancer and patient. Cancer is hostile and aggressive. The cancer patient is armed with Western medicine. As was noted so well by the New York Times' Jan Hoffman in an article that should be required reading for friends and caregivers of cancer patients, we expect cancer patients to adopt this metaphor, to be conscripted and to take up arms against their cancer.

This makes sense, especially in the US. With one of the largest and best-equipped standing armies in the world, we're accustomed to viewing conflict in this manner. We're also accustomed to winning.

Unfortunately, most cancers don't play according to the rules of warfare. They bear more resemblance to pockets of insurgents and guerrilla fighters than they do to a highly organized military under disciplined leadership, and here's at least one place where the metaphor stumbles. During the Vietnam War, US leaders unleashed the massive firepower of the military, killing an estimated one million enemy combatants while losing only a fraction of that. By any previous measure, this would have meant a sure victory for US and South Vietnamese forces.

We all know it didn't work out that way. Discerning friend from enemy proved nearly impossible for a military better equipped to bomb the shit out everyone and everything than it was equipped to adapt to the unknown and make changes on the fly.

Western anti-cancer treatments and therapies are astonishingly powerful, equipped to bomb the shit out of every cell in the body. But, much like the US military strategy in Vietnam, they fail to demonstrate a true understanding of their enemy. They lack the flexibility necessary to adapt. Non-targeted chemotherapy regimens try to bomb cancer into submission by attending to the particulars of mitosis, or cell division—the 'how' of a growing cancer. They don't, they can't, attend to the 'why', leaving a gaping hole in our philosophical approach to this disease.

Critics of the 'War on Cancer' contend, rightly, that this approach is flawed because we don't understand cancer well enough to wage a 'win or lose' war. We present these treatments as being plausible offensives against cancer despite not really understanding cancer in the first place.

CONSCIENTIOUS OBJECTION

In Use of Metaphor in the Discourse of Cancer, Dr. Gary Reisfeld makes the point that despite its ubiquity, the war metaphor doesn't work for everyone, and that each person needs to frame their relationship with cancer in terms they can understand: athletes might envision a competition, managers might see an extended project.

The war metaphor is too cold, too short-sighted, black and white, and two-dimensional, to cover cancer for everyone. This is especially true in light of the many aspects of treatment — scans, biopsies, radiation, chemotherapy cycles — which amount to ups and downs, peaks and valleys, that better fall in line, as metaphor and in reality, with the flexibility of a journey than the martial rigidity of a war.

It's not as trivial as it sounds; using a metaphor they're comfortable with allows a patient to better express their experiences within the full cancer spectrum—to doctors, loved ones, and to themselves.

Sources:
- Reisfield GM, Wilson GR. Use of Metaphor in the Discourse of Cancer. Journal of Clinical Oncology, Vol 22, No 19 (October 1), 2004: pp. 4024-4027.

- When Thumbs Up Is No Comfort, by Jan Hoffman (The New York Times, June 1, 2008)

- Camus, W. Metaphors of cancer in scientific popularization articles in the British press. Discourse Studies. 2009; 11: 465-495

- "The Cancer Contrarian" (Andrew Grant interviews the Dartmouth Institute's H. Gilbert Welch), Discover Presents the New Science of Health, Summer 2009.