The language of cancer. A language of exclusion

I’ve recently had to think quite a bit about inequality, old age and cancer care. As a result I have been considering the language we use around cancer.

I’ve coined a phrase - lingua cancer – to name it. It’s like a lingua franca but consists of the shared, familiar, everyday language of cancer. There are two dialects – professional and lay. I’m talking about the lay version here. ‘Cancer in public’, as it were. I mean words like survival, cure, fighting, all clear, tragedy, survivor, victim, sufferers, young, screening, lives saved, lives cut short, early detection, tumour, mass, tests, suspected and smoking. There’s some overlap with professional lingua cancer as the public also use some medical cancer terms quite happily e.g. chemo, radiotherapy, nausea, prognosis and diagnosis.

Like any language meaning and their understanding aren’t always as shared as one might believe. Commonly, cancer drugs are described as ‘increasing survival’ meaning survival can be extended from n months to, say, n+3 months. That’s survival as a length of time. However, the public is also confronted by forms of words such as ‘increasing the number of people surviving cancer’ which is a reference to lives saved – people – not lengths of time. Not the same thing as length of survival. The same kind of flabby lack of clarity for the general public occurs with risk explanations. Double the risk sounds bad. It can be. But if the risk doubles from 1 in a million to 2 in a million – it’s still most unlikely. Absolute v relative risks. I like the absolute ones…. The one lingua cancer likes is usually a relative one.       

There’s a tonal or accented element to the language. For instance there is a usually shared assumption that there are some people with some cancers who are deserving of particular concern - women with breast cancer, for instance – and, conversely, other people who are deserving of considerably less concern, typically with e.g. lung cancer, as they ‘brought it on themselves’ though this is not always expressed – just tacitly acknowledged. Fighting and bravery often feature. There is some ‘within cancer’ debate on this martial imagery and concern about the implied opposite of loser or surrender but the wider public and media love it. Either way, moral judgements are integral to the lingua cancer with e.g. much discussion on who do or don’t – mostly don’t, luckily – deserve their cancer.

Lay lingua cancer also includes the visual clues and ‘usual’ imagery of cancer – such as headscarves or wigs, waiting rooms, scanners, fun runs and hospices. There’s also considerable convention in newspaper photographs – a family on a sofa, a person in a hospital bed. Cancer charity newsletters are equally bound by convention. Groups of people in not usually very well ordered ‘team’ photo poses, finishers’ medals and some scientific reports of research progress.

What interests me though are the things are totally missing from lay lingua cancer. Most obviously these are people of colour and people of age - anyone from any of the ‘inequalities’ groups, basically. If we burrowed down into the detail I think we’d also find some subtleties. I think the image of a ‘cancer victim’ is more often a woman than it is a man. And then, that woman is far more likely to be a parent. Childless women, single women and quite a lot of men are more unlikely parts of the public vocabulary of cancer.

I find the absence of old people the most remarkable. Cancer is a disease of ageing and however the language has developed and whatever the modern day influences shaping its usage - it does seem to be highly conventional and dangerously conservative in omitting any mention of them.   

Thus, I arrive at the rather unnerving idea that the public ‘lingua cancer’, shaped by society and cancer charities’ awareness raising activities and mediated by the media, has an exceptionally narrow, blunted and regressive range - the entire opposite of the reality of cancer.

The lingua cancer is a language of exclusion.

I imagine (until I have worked it out better) that this, some of the time, is a side effect of so many charities for site specific cancers. Their bottom line demands a USP – and the need for a Selling Point inevitably means following the path of least resistance, gathering up the low hanging fruit and being far more likely to work with the mores of society rather than challenging them. Then the Law of Unexpected Consequences applies because considerable disadvantage accrues elsewhere, amongst the less favoured unequal populations with cancer.

Charities have to create and use tropes for their profile raising and PR but these have to be complicit with the wider world’s ageist stereotypes. For example, women with breast cancer aren’t post menopausal in charity world. But 80% are, in the real world. And if anyone ever sees older men [the over 75’s] even mentioned as the most in need of the efforts of Movember, I’ll eat all my hats.

Lingua cancer excludes all complexity and quite a lot of reality – for instance, the care and hope provided by support and information offered to the relatively small group of ‘people with’,  is entirely contradicted by the lingua cancer of fundraising which targets millions of ‘the public’. It relies on reinforcing and even amplifying the stereotype of cancer as a dread disease.

Old people have the longest relationship with this ‘lingua cancer’ and how do they handle reorganising their understanding from the ‘public’ and the dread disease imagery to ‘people with’ and the hope of information and support?  It may be hard for them inside their own psyche but we also know that all stories of institutionalised service failings (Mid-Staffordshire) brutal disregard (any abuse in care homes) and murderous rage (Shipman) always a have old people at the end of them.

I want a new lingua cancer. We either alter what is there so it includes old people – and all the other inequalities groups or, alternatively, we build an entirely new one. As old people are my ‘thing’ my preferred lingua cancer has to include imagery and words that encapsulates the cancer experience of aged men and women, includes co-morbidities, the syndromes of older age and within a variety of social contexts and without discrimination.  

All I have to work out now is whether the innovation in the language I require would lead, or follow, the revolution in cancer care in the over 75’s which is badly needed.

On a personal note, as the lingua cancer is a language of exclusion, I’d like to stop using it - modifying it right out of existence.