Cancer: Maybe It's Not What You Think

By Heather Millar

We need to rethink cancer.

Once upon a time, researchers thought that if we could just find the magic key to the disease, then we could cure cancer. In those days, most people thought that a cancer diagnosis was an automatic death sentence.

Today, we live in a world in which scientists are finding that cancer is more dizzyingly complicated than we could have imagined a generation ago: There are many, many subtypes of lung cancer and breast cancer and that seems to be true of most malignancies. The genetics of a tumor can vary within the same lesion. Cancer changes and evolves within the same patient. A study out this week finds that breast cancer, for instance, is not one disease but many, involving dozens of genetic mutations and involving as many as 50 different genes.

Buh-bye, simple "cure" for cancer.

And yet, even as the problem seems to get more and more complex, more and more people are surviving cancer. A first-ever report by the American Cancer Society and the National Institutes of Health, published late last week, estimates that 13.7 million Americans are cancer survivors. That number is expected to grow to 18 million by 2020. Stop and appreciate that for a moment: 18 million survivors.

Buh-bye, automatic death sentence.

So what does this mean for us, as cancer patients and survivors? These developments have many, many implications, but let's start with just a couple:

First, let's rethink the nature of the problem cancer poses.

As you're talking with your doctor and making decisions about treatment or prevention, try to appreciate the shifting sands that your medical team treads upon. Cancer is not simple, and our understanding of it seems to change almost daily. Doctors don't have all the answers. You've got to try to keep abreast of the developing knowledge about your particular disease. You've got to remember that the doctors can't give you any guarantees. Try to remember that, scientifically, this is both a scary (wow, cancer's wicked complex!) and exciting (wow, better understanding leads to better treatments!) time.

Second, let's rethink the scope of cancer. It's not necessarily a one-time crisis, but may, in fact, create chronic problems that go on for a lifetime. Survivors don't necessarily survive unscathed.

As I've written in a previous post, maybe we need to start thinking of cancer beyond the initial treatments of surgery, chemo, and radiation. We need to spend more time thinking about survivorship, about the "chronic" aspects of cancer. For instance, a study released this week in the Journal of Cancer Survivorship showed that, even five years after diagnosis, cancer survivors take more sick leave than their disease-free colleagues. Even if they're able to work, this suggests many cancer survivors still struggle. As a society, we need to talk more about the long-term challenges of cancer survivors.

What do you think? As patients, how does re-thinking cancer change our treatment? As survivors, how does re-thinking cancer change the kinds of services and programs we need?