John Diamond’s book C: Because Cowards get Cancer Too was published in 1998. Diamond was a journalist with a regular column in The Times who died of throat cancer and was married to no less of a modern icon than Nigella Lawson. Re-reading it recently, I noted how little it had dated, and his acute observations remain pertinent. We may be talking more about cancer but we are using the same language.
We have certainly failed to get away from the ‘battle’ narrative around cancer. We’ve made little progress here and any public figure with cancer will inevitably be reported using these terms at some point. Diamond:
‘I despise the set of warlike metaphors that so many apply to cancer. My antipathy ... has nothing to do with pacifism and everything to do with a hatred for the sort of morality which says that only those who fight hard against their cancer survive it or deserve to survive it — the corollary being that those who lose the fight deserved to do so.’
Colorectal cancer has seen a boost in its public profile through the work of Dame Deborah James DBE. She was a deputy headteacher who did remarkably effective journalistic and advocacy work after she was diagnosed in 2016. She died on the 28th of June 2022 aged 40. The Duke and Duchess of Cambridge described her as ‘unfalteringly brave’. Diamond, as might be guessed from the title of his book, had thoughts around this language. He was insistent on his own lack of bravery; he noted the use of the word had shifted somewhat and ‘it has become a synonym for poignant suffering and usually suffering considerately undertaken in front of the photographer’s lens’.
We are all seeking earlier diagnosis of all the various cancers. Two BJGP studies published this month have flagged that, when we look at large datasets, we can see that people are presenting in various ways for many months before they get their diagnosis. The effects are subtle, and they are not a reflection on the clinicians, but they offer the tantalising hope of a diagnostic window through which we might be able to see a brighter future for people who develop, at least in these studies, colorectal cancer and Hodgkin lymphoma.
The NHS-Galleri Trial offers a tantalising suggestion of a dramatic shift in cancer diagnosis but, more likely, we will slowly make progress, using a range of tools, to ease forward the point of diagnosis. Those might include the way people access care, algorithmic analysis of symptom patterns, novel diagnostic tests like the faecal immunochemical test, and improved public awareness. Early pick up will likely offer better survival and less punishing treatments and perhaps that will help us shift the language and narratives of cancer, as John Diamond suggested.
| Papers on non-speculum sampling for cervical screening, safety netting, following up patients who have been cured of cancer, and advance care planning will all help improve cancer diagnosis and management. Health visitors have a critical community role and an editorial fleshes this out. We have two interesting Clinical Practice articles on Cushing’s syndrome and cardiac implantable electronic devices that have been tailored to offer busy GPs and clinicians all you need to know. And make sure you flip to Life & Times to enjoy the usual eclectic range of opinion and comment, which, this month, includes an article with the Research Paper of the Year winners. |
- © British Journal of General Practice 2022
