The cancer mortality rate in my family is high. Of the half dozen relatives I have known with cancer (all from one side of my family), all but one has died. Five of the six were women. The high mortality rate is more likely due to the lack of medical care, however. They all lived in Guatemala; though not impoverished, medical care was not something my relatives had regular access to. By the time they went to see a physician, I am sure the cancer had metastasized. All of my relatives, but one (the one who survived) was over 50. (This reflects, in part, the association between cancer and aging.)
I’ve spent the last few months after my last entry trying to learn more about cancer. Aside from the impact it has had on my family (and, naturally, the worry it has instilled in members of my family), it also has grabbed my attention because of its insidious nature. Treating cancer is a brutal exercise of will and endurance, probably unlike any other disease. My friends post on their Facebook wall about hoping this year will be the year of a cure. As a friend of mine said after reading my last post, though she understood the science behind cancer, she still hoped for a cure for this dreadful disease.
Ever since a cancer researcher told me there is no cure for cancer, I have tried to understand what that exactly meant. It is a powerful statement. It is one I am sure would elicit strong emotional reactions from my friends who have overcome cancer or have a friend or relative who have died from cancer, and from many of the people who actively participate in raising funds for research. There is a great deal of emotions, politics, and money invested in cancer research.
The fact is that today many cancers can be treated very effectively, provided it is caught early and the cancer responds to the treatment (the survival rates continue to improve). With chemotherapy, radiation, and targeted therapy (some of which is delivered orally, a major advance in cancer treatment), people have been cured of their cancer or have suppressed it and lived with it. (The latter pertains to some targeted therapies that suppress certain cancers. People afflicted must take a pill for the rest of their natural lives, though the side effects are minimal compared to chemotherapy and radiation.) Cancer, as I’ve written before, is really a variety of diseases that share similar traits. Breast cancer is different from liver cancer, different from brain cancer, and so on. They are not all treated with the same chemical cocktails, and they all react to treatment very differently. Some cancers can be treated by targeting certain proteins that manage growth of the cancer cell. But cancer cells can be ingenious and mutate, becoming resistant to chemotherapy and other pharmacological treatments. Yet, there is good news coming from the front.
What this means is that there is no single, absolute path to treating cancer. In many cases, treating cancer means subjecting yourself to toxic treatments. Whether it is chemicals or radiation, the objective is to survive and endure the assault on the body long enough for the cancer to be purged from your body. As a friend of mine, who is an emergency medicine physician said, “Sometimes the treatment is worse than the disease.” There are many who eventually give up, unable to withstand the side effects of the treatments.
But the significant message is that treatments have evolved. Even when treatments are brutal, there is still the prognosis that you – me – all of us may either see long-term remission or be cured. And that is very important for us to understand. Cancer – in all its forms – may never be absolutely cured, that is, eradicated from human existence. There won’t be a vaccine or pill that purges all cancers from our bodies. It simply isn’t possible, given the origins, workings, and complexities of cancers. But more and more people are living with cancer, surviving cancer. However, in the United States, we often like to live in absolutes.
The polarization of American society manifests itself in the mentality that either you are with me or against me. And cancer is no different. For some activists, the war on cancer must be won. And that victory means eliminating it from our lives. Forever. There is no middle ground with some of the more radical elements of the movement. And that simply will never happen.
Dr. Siddhartha Mukherjee, Pulitzer winning author, concluded in his book “The Emperor of All Maladies: A Biography of Cancer”:
“Cancer, as we have discovered, is stitched into our genome. Oncogenes arise from mutations in essential genes that regulate the growth of cells. Mutations accumulate in these genes when DNA is damaged by carcinogens, but also by seemingly random errors in copying genes when cells divide. The former might be preventable, but the latter is endogenous. Cancer is a flaw in our growth, but this flaw is deeply entrenched in ourselves. We can rid ourselves of cancer, then, only as much as we can rid ourselves of the processes in our physiology that depend on growth – aging, regeneration, healing, reproduction.”
One of the most important parts of his statement is the reference to carcinogens. We are surrounded by chemicals, some of which we purposely consume. For example, although the use of cigarettes on a whole has decreased, I see many young people in New York (especially women) willingly pumping carcinogens into their lungs. And the popularity of hookah smoking among young people only adds to the problem. The Mayo Clinic states that “Hookah smoke contains high levels of toxic compounds, including tar, carbon monoxide, heavy metals and cancer-causing chemicals (carcinogens). In fact, hookah smokers are exposed to more carbon monoxide and smoke than are cigarette smokers.” Despite such warnings, the popularity of smoking or chewing tobacco remains popular.
What is also likely to affect the survival rates of cancer is the level of access to medical care. Those that I’ve known who have survived cancer have had medical insurance. And even then, their out of pocket expenses are enough to cripple them financially. As the cost of health care continues to rise and lifespans continue to expand, I wonder if cancer rates will increase and the survival rates drop.
Regardless, the fact remains that although cancer is never likely to be cured, its treatment continues to evolve and less toxic treatments will lead to less inhumane side effects and increased survival rates (for those who can afford it). That is a victory! The definition of “cure” should be re-defined. There will be some (perhaps many) who will suffer from aggressive cancers and die. But there will be some (perhaps many) who will also survive and overcome those cancers. Being diagnosed with cancer is no longer a death sentence. With early intervention, effective treatment, and with lifestyle changes, cancer incidences can be reduced and at least our individual battle with cancer can be won.
