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. Reporting on this story in the days since the announcement funeral has taken place. Bulletins are issued daily. Heads of state express their condolences. Photos show the monarch with an ashen face. The global media sets up camp outside Buckingham Palace and waits.

Will the taboo on cancer never disappear? Half of Brits who have ‘had cancer’ do something called ‘surviving’ and ‘living with it’. The current Survival rates after 10 years of skin, colon, prostate, breast and testicular cancer now stands at 75-98%. The rates for pancreatic, brain and lung cancer remain lower, and mortality among the elderly is of course much higher. But like most diseases if the diagnosis is made early most cancers are now removable and/or curable. They are no longer what they once were: a death sentence.

For the past ten days, it has been absurd that just saying the word cancer would ring the country’s church bells. This does not apply to diseases that are truly terminal, such as multiple sclerosis, motor neurone diseases or Alzheimer’s disease.

While untreated cancers can obviously be fatal, the same is true of many other diseases, from Covid-19 to sepsis and pneumonia to malaria. Yet cancer still has the image of a unique, powerful cause of death in Britain, as it does in many African and Asian countries, where cancer remains common. untold. Although we treat most of our serious illnesses as physical illnesses, cancer still has the character of an alien plague, indestructible and resistant to cure.

The result is that this topic has only recently become open to discussion. In his intriguing overview of illness in high places, In Sickness and in Power, former doctor and Foreign Secretary David Owen recounts the euphemisms used by public figures. When US President Grover Cleveland had a large part of his cancerous jaw removed in 1893, it was ‘because of toothache’. Neville Chamberlain’s doctors never told him, or anyone else, that he was dying of bowel cancer while he was 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. His royal dignity required him to die of ‘coronary thrombosis’.

In the seventies the actor John Wayne was praised for revealing he had stomach cancer. It can certainly be assumed that the macho Wayne could shoot the feared enemy from twenty paces away. Similarly, a recent ad for cancer research solicited donations by depicting soldiers charging forward from the trenches of World War I – apparently as if the cancers were Germans.

This language of violence is at the heart of the taboo. Patients do not suffer from cancer, but are always ‘fighting’ with it. They move on to victory or defeat, to ‘winning’ or ‘losing’ the battle. If they survive – rarely ‘cured’ – the stigma and scars remain. Survivors go into ‘remission’. They are haunted by its dormant legacy, forever doomed to “live with cancer” as an unwanted tenant of their bodies.

Long ago, when I had a malignant colon cancer removed, I noticed that the surgeon used the indefinite article. He emphasized that we were not dealing with a disease, but with a tumor. The cancer was a physical growth that had been removed and therefore no longer existed, like a burst appendix. We do not speak of “having a tumor”, but of “a tumor”. Now it was gone. But for months afterward, friends continued to lower their voices and gesture nervously when they asked about me. They felt sorry for my wife and asked, “How long has he been in remission?” I saw the virtue in keeping it out of the question.

Later I met a group of cancer linguists who were obsessed with breaking the taboo. The American psychologist David Hauser has long advocated an end to bellicose language. It only led to the “tough guy’s” reluctance to take preventative measures such as staying out of the sun, he argued. Warmongering, he said, led to “overly aggressive treatment strategies and little attention to palliative care.” This is despite the fact that such care is now often considered the best and most reassuring way to extend life.

Worse still, the language of fighting could seriously demoralize patients, making them feel like they are somehow to blame for their fate. If they died, was it because they had not fought hard enough against the dreaded enemy? Worse, they became inclined to treat their doctors as somehow complicit in their defeat. A 2019 poll by Macmillan Cancer Support reported that The patients were overwhelmingly tired that they were told that they were in a fight and that they were expected to be ‘brave’. They especially hated being described as “losing the battle,” as if they were on the wrong side of a war.

Part of the problems lies in politics. In 1971, US President Richard Nixon was shocked to discover that cancer was the second leading cause of death in the US. declared a ‘war on cancer’. Half a billion dollars was allocated to finding a cure. I’m sure some of the mystique that clung to cancer was due to the signaling failure of half a century of war. Although great advances have been made in diagnosis and relief, a ‘cure for cancer’ remains continually elusive, even with the advances now being made in the most exciting field of medical research, immunology.

Of course, cancers come in so many forms that the word itself loses its meaning. Those that are tumors can be removed relatively easily, while those in the brain, stomach and throat are less easy. Cell cancer, like blood or bone cancer, is a more challenging disease, often requiring long-term and disruptive medication. But that’s just a warning against generalization. Addressing someone with a more than 90% chance of a healthy and happy life as if he has less than a 5% chance is not only tactless, but also ridiculous. There is a strong case for the NHS issuing guidance simply on ‘how to talk about cancer’.

Buckingham Palace clearly decided to be open about the king’s diagnosis. It even went so far as to deny that the cancer had originated in the prostate, which had undergone surgery. But to rule out prostate cancer, the question remained open: “If it’s not prostate, then what?” Medical experts continued to dance from one foot to the other. What is ‘the’ cancer? Why not surgery? Why not work for so long when simple cancers can be treated in a few days?

This is a vulnerable area. But the palace has gone to great lengths to signal the king’s desire to set an example for cancer patients, to be open about the condition. Therefore, a glimpse is not enough. Interest in the monarch’s health is inevitable. There is no longer such a condition as non-specific cancer. The palace must know that under such circumstances the media will always assume the worst-case scenario. It would be best to tell us what’s really going on.