Let King Charles’s illness finally change how we speak about cancer: it’s not about ‘winning’ or ‘losing’ a ‘war’
King Charles has cancer. Coverage of this story in the days since the announcement has been funereal. Daily bulletins are issued. Heads of state send condolences. Pictures portray the monarch ashen-faced. The global media pitch camp outside Buckingham Palace, and wait.
Will the cancer taboo never vanish? Half of Britons who have “had cancer” do something called survive, and “live with it”. The current 10-year survival rates of skin, prostate, breast and testicular cancer are now running at 75-98%. Rates for pancreatic, brain and lung cancers remain lower, and mortality is obviously much higher for older people. But like most illnesses, if diagnosed early most cancers are now removable and/or curable. They are no longer as they once were: a death sentence.
This past 10 days, it has been absurd that the mere breathing of the word cancer should set the nation’s church bells tolling. It is not so for many other serious diseases, such as motor neurone disease or Alzheimer’s.
While untreated cancers can, of course, kill, the same applies to many other illnesses, from Covid-19 to sepsis and pneumonia to malaria. Yet cancer in Britain still has the image of a uniquely potent agent of death, as it does in many African and Asian countries, where it is still often unmentionable. While we treat most of our serious illnesses as bodily familiars, cancer still has the character of an alien plague, indestructible and resistant to cure.
The result is that this subject has only lately become discussable. In his intriguing survey of illness in high places, In Sickness and in Power, the former doctor and foreign secretary David Owen recounts the euphemisms used by public figures. When the American president Grover Cleveland had a large part of his cancerous jaw removed in 1893, it was “for toothache”. Neville Chamberlain’s doctors never told him, or anyone, he was dying of bowel cancer when still in office. As we have been told incessantly in recent days, it was not revealed in 1952 that George VI died of lung cancer. Royal dignity required him to die of “coronary thrombosis”.
In the 1970s the actor John Wayne was praised for revealing that he had stomach cancer. Surely, it might be safely assumed, the macho Wayne could gun down the dreaded foe at 20 paces. Likewise, a recent advertisement for cancer research sought donations by depicting soldiers charging forward out of first world war trenches – apparently as if cancers were Germans.
This language of violence lies at the heart of the taboo. Patients are not suffering cancer but always “fighting” it. They go on to victory or defeat, to “winning” or “losing” the fight. If they survive – rarely “cured” – the stigma or the scars remain. Survivors go into “remission”. They are haunted by its dormant legacy, doomed for ever to “live with cancer” as an unwelcome tenant of their body.
When, long ago, I had “a” malignant bowel cancer removed, I noted the surgeon’s use of the indefinite article. He was emphatic that we were dealing not with a disease but with a tumour. The cancer was a physical growth that was removed and therefore was no more, like a burst appendix. We do not talk of “having tumour”, but “a tumour”. Now it was gone. Yet for months afterwards, friends would lower their voices and gesture nervously when asking after me. They would commiserate with my wife and ask: “How long is he in remission?” I could see the virtue in keeping it unmentionable.
I later met a group of cancer linguists obsessed with ending the taboo. The American psychologist David Hauser has long pleaded for an end to the warlike language. It merely induces “tough guy” reluctance to take preventive measures such as staying out of the sun, he argues. Bellicosity, he says, may “overly favour aggressive treatment strategies and give little thought to palliative care”. This is despite such care being now considered often the best and most comforting way to prolong longevity.
Worse, the language of fighting can severely demoralise patients by making them feel they are somehow at fault for their fate. If they die, is it because they have not fought hard enough against the dreaded enemy? Worse, they become inclined to treat their doctors as somehow complicit in their defeat.
A 2019 poll by Macmillan Cancer Support reported that sufferers were overwhelmingly tired of being told they were in a battle and were expected to be “brave”. They particularly disliked being described as “losing the battle”, as if on the wrong side in a war.
Part of the trouble lies in politics. In 1971 the American president Richard Nixon was shocked to discover that cancer was the second leading cause of death in the US, and declared a “war on cancer”. Half a billion dollars was assigned to finding a cure. I am sure part of the mystique that continued to attach to cancer lay in the signal failure of half a century of that war. While great strides have been in made in diagnosis and relief, a “cure for cancer” remains persistently elusive, even with the advances now being made in the most exciting area of medical research, immunology.
Cancers, of course, come in so many forms that the word itself is losing meaning. Those that are tumours can be relatively easy to remove, while those in the brain, stomach and throat are less easy. Cellular cancer, as of the blood or bone, is a more challenging illness, requiring often lengthy and disruptive medication. But that is merely another warning against generalisation. To address someone with a more than 90% chance of living a healthy and happy life as if they had a less than 5% chance is not just tactless but ridiculous. There is a strong case for the NHS issuing guidelines simply on “how to talk cancer”.
Buckingham Palace clearly decided to be open about the king’s diagnosis. It went so far as to deny the cancer arose in the prostate, on which an operation had taken place. But to rule out prostate cancer merely left the question open: “If not prostate, what?” Medical pundits were left dancing from one foot to the other. What is “the” cancer? Why no operation? Why so long off work when simple cancers can be dealt with in a matter of days?
This is delicate territory. But the palace has gone to lengths to indicate the king’s desire to set an example to cancer sufferers, to be open about the condition. That is why a glimpse is not enough. Interest in the monarch’s health is inevitable. There is no longer such a condition as nonspecific cancer. The palace must know that in such circumstances the media will always assume the worst-case scenario. It would be best to tell us what really is the matter.
Simon Jenkins is a Guardian columnist