It’s not strange that cancer should be referred to as ‘the emperor of all maladies’, says Han van Krieken, pathologist and cancer expert. The qualification refers to the title of Siddhartha Mukherjee’s book, which Van Krieken considers excellent. “This disease is a side-effect of evolution. Everyone is confronted with it in their immediate environment, and if you’re lucky and grow old enough, you’ll meet it in person. There’s no getting around it.”
But it is precisely because of the disease’s imperial status that Van Krieken pleads for greater precision. He refers to the recently published 100 dagen kanker (100 Days of Cancer), in which journalist Rachel Franse describes her life after being diagnosed with a benign form of breast cancer. “The point is: we call it cancer, and the word is included in the diagnosis, but in fact, Franse didn’t have cancer. We’ve got to find a different name for this kind of diagnosis.”
Pessimistic estimates
According to Van Krieken, the medical world’s enthusiastic and lavish use of the ‘cancer’ label derives in part from a defensive attitude borrowed from the US. “Diagnosing something as cancer is always a safe bet. If the patient recovers, everyone is happy: the surgeon did a great job, the pathologist didn’t make any mistakes, and the patient is of course in heaven.”
In his lecture, Van Krieken invites the audience to reflect on their image of cancer: What percentage of patients are cured five years after diagnosis? What are the odds that someone who is declared cured will get cancer again? Van Krieken suspects that the general public may have a too pessimistic perspective. “The odds of getting another heart attack after you’ve survived the first one are far greater than the odds of cancer recurring. And yet, cancer survival is becoming a syndrome in its own right, while you rarely hear about anything like that after a heart attack.”
God’s punishment
Following a TV broadcast last year, one of the Netherlands’ most eminent cancer experts expressed the ambition to make cancer ‘chronic’. Van Krieken sent the man an e-mail, complimenting him on his ambition, and suggesting he might have gone a step further. “I prefer to speak of our ambition to cure cancer.” Among the hundreds of responses to the broadcast, Van Krieken was alone in offering a compliment. “In an e-mail he sent me he told me all others had admonished him for his gross optimism.”
Van Krieken pleads for more social research into the phenomenon. Why is this disease so loaded with guilt and shame? “In some parts of our country, it’s seen as God’s punishment.” Things are not as bad as when he was a student, but there’s still a tendency to refer to the disease as ‘the C word’. “And why is cancer, just like tuberculosis, a swear word in the Netherlands? It’s interesting, because that’s not how it’s used in neighbouring countries.”
Photo by Aaaarrrrgggghhhh! on Flickr.