Let’s let King Charles’ illness finally change the way we talk about cancer: it’s not about “winning” or “losing” a “war” | Simon Jenkins

King Charles has cancer. Coverage of this story in the days that followed announcement was funereal. Daily bulletins are published. The heads of state offer their condolences. The images depict the monarch with an ashen face. The world’s media are camped outside Buckingham Palace and waiting.

Will the cancer taboo never disappear? Half of Brits who have ‘had cancer’ are doing something called surviving and ‘living with it’. The flow 10-year survival rate skin, colon, prostate, breast and testicular cancers are now between 75 and 98%. Rates of pancreatic, brain and lung cancer remain lower and mortality is obviously much higher in older people. But like most illnesses, if diagnosed early Most cancers are now eliminable and/or curable. They are no longer what they once were: a death sentence.

Over the past ten days, it has been absurd that the mere breath of the word cancer has church bells ringing across the country. The same is not true for truly fatal diseases, such as multiple sclerosis, motor neurone disease or Alzheimer’s disease.

If untreated cancers can of course kill, the same goes for many other diseases, from Covid-19 to sepsis, including pneumonia and malaria. Yet cancer in Britain still has the image of a particularly powerful agent of death, as is the case in many countries in Africa and Asia, where it is still often present. unmentionable. While we treat most of our serious illnesses as familiar bodily illnesses, cancer still has the character of an alien, indestructible and incurable scourge.

The result is that this topic has only recently become moot. In his intriguing investigation into illness in high places, In Sickness and in Power, former doctor and Foreign Secretary David Owen recounts the euphemisms used by public figures. When U.S. President Grover Cleveland had a large portion of his cancerous jaw removed in 1893, it was “for a toothache.” Neville Chamberlain’s doctors never told him or anyone that he was dying of bowel cancer while he was still in office. As we have been told again and again in recent days, it was not revealed in 1952 that George VI had died of lung cancer. Royal dignity required him to die of “coronary thrombosis”.

In the 1970s, the actor John Wayne was praised for revealing he was suffering from stomach cancer. It can surely be assumed that macho Wayne could take down the feared enemy at 20 paces. Similarly, a recent advertisement for cancer research solicited donations by depicting soldiers emerging from the trenches of World War I – apparently as if cancers were Germans.

This language of violence is at the heart of the taboo. Patients do not suffer from cancer but are still “fighting” it. They are heading towards victory or defeat, towards “winning” or “losing” the fight. If they survive – rarely “cured” – the stigmata or scars remain. Survivors go into “remission.” They are haunted by its latent legacy, forever condemned to “living with cancer” as an unwanted tenant of their body.

When, a long time ago, I had “malignant” intestinal cancer removed, I noticed the surgeon’s use of the indefinite article. He insisted that we were not dealing with a disease but with a tumor. Cancer was a physical growth that had been removed and therefore no longer existed, like a burst appendix. We don’t talk about “having a tumor”, but about “a tumor”. Now it was gone. Yet for months, my friends would lower their voices and make nervous gestures when they asked about me. They sympathized with my wife and asked, “How long has he been in remission?” I could see the benefit of keeping it unmentionable.

King Charles III, right, and US President Joe Biden meet at Windsor Castle on July 10, 2023. Photograph: Andrew Matthews/AP

Later, I met a group of cancer linguists obsessed with ending the taboo. The American Psychologist David Hauser has long advocated for the end of warlike language. This simply led to reluctance among “tough guys” to take preventive measures such as staying out of the sun, he argued. Warmongering, he said, led to “overly aggressive treatment strategies and little thought about palliative care.” And this, even though these treatments are now often considered the best and most comforting way to prolong longevity.

Worse still, fighting language could seriously demoralize patients by making them feel that they are somehow responsible for their fate. If they died, was it because they did not fight hard enough against the feared enemy? Worse still, they began to view their doctors as complicit in their defeat. A 2019 survey by Macmillan Cancer Support reported that patients were extremely tired to be told that they were in a battle and that they were supposed to be “brave.” They particularly disliked being described as “losing the battle”, as if they were on the wrong side of a war.

Part of the problem is politics. In 1971, U.S. President Richard Nixon was shocked to discover that cancer was the second leading cause of death in the United States. declared a “war on cancer”. Half a billion dollars has been spent finding a cure. I am sure that part of the mystery that continues to cling to cancer is the resounding failure of half a century of this war. Although great strides have been made in diagnosis and relief, a “cure for cancer” still remains elusive, even with the advances currently being made in the most exciting area of ​​medical research, immunology.

Of course, cancers come in so many forms that the word itself loses its meaning. Those that are tumors may be relatively easy to remove, while those found in the brain, stomach, and throat are less easy. Cellular cancer, like that of the blood or bones, is a more complex disease, requiring medications that are often lengthy and disruptive. But this is just another warning against generalization. Addressing someone who has a greater than 90% chance of living a healthy, happy life as if they have less than a 5% chance is not only reckless but ridiculous. There is a strong case for the NHS publishing guidelines simply on ‘how to talk about cancer’.

Buckingham Palace has clearly decided to remain open about the king’s diagnosis. He went so far as to deny that the cancer had appeared in the prostate, on which an operation had taken place. But excluding prostate cancer only left the question open: “If not prostate, what?” Medical experts had to dance from one foot to the other. What is “cancer”? Why no operation? Why such a long work stoppage when simple cancers can be treated in a few days?

This is tricky territory. But the palace has gone to great lengths to indicate the king’s desire to set an example for people with cancer and to be open about their illness. This is why a simple overview is not enough. Interest in the monarch’s health is inevitable. There is no longer any non-specific cancer. The palace must know that in such circumstances the media will always assume the worst case scenario. The best thing would be to tell us what the problem really is.

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