The War Metaphor

I often start talks I give on cancer research with a discussion of the war on cancer. To be honest, I have a very mixed relationship with this metaphor.

The concept of the war on cancer was first popularized in 1971 by President Richard Nixon and used in a more nuanced manner more recently by Vice President Biden. This metaphor emphasizes how working together against a formidable foe will improve our lives and those of future generations. It speaks to the need for immense dedication, focus, sacrifice and persistence to achieve a noble goal. The war on cancer implies a need for teamwork by multiple sectors of society, including civilly minded citizens, government, academia and the private sector. It also implies there is an identifiable enemy, and that total victory is possible. This last point is where the metaphor of the war on cancer starts to break down. In 1971 our knowledge of cancer was quite primitive. We thought of cancer as a single disease where a single approach to victory was possible. We now know that cancer is not a single disease but multiple diseases. Indeed, every cancer is unique and personalized approaches are required for success. In other words, in the war on cancer, there is no single and simple way to target and defeat the enemy.

Let’s start with cancer prevention. Effective cancer prevention results in more people living longer and healthier lives. Based on current scientific understanding, we could prevent 40-45% of cancers if we apply what we know related to healthy living, vaccination against cancer-causing viruses (e.g. HPV) and appropriate screening. However not every cancer can be prevented. Going back to the war on cancer metaphor, our foe is less of standing army and more of an insurgency that will keep popping up irrespective of our diligence.

From the point of view of therapy, cancer is not a single disease, but multiple diseases with multiple different underlying mechanisms. Each cancer is unique, and optimal treatment requires individualization. In addition, cancer is more common as we age. Paradoxically, improved approaches to cancer therapy and other health care advances that extend life span are actually leading to an increase in cancer incidence. Patients, including cancer survivors, are living long enough to develop second, third or even more cancers. This is reflected in cancer statistics, where overall age adjusted cancer rates are dropping, while overall cancer rates in the entire population are not changing as rapidly.

Given these facts, when I am asked if we can win the war on cancer, I respond “yes.” However, I add the caveat that by winning, I mean successfully reducing the pain and suffering caused by cancer and thereby helping members of this and future generations live longer and happier lives.  I don’t see achieving “total victory” in the war on cancer as analogous to what we were able to achieve in World War II, or in the medical field, in totally eliminating smallpox from the face of the earth.

So, our usual mental image of a war involves epic interactions between two forces aligned along a battle line where one will emerge victorious. The war on cancer is different but no less imperative. Great progress is achievable. What we already know about healthy living and following guidelines on screening could result in a significant reduction in cancer deaths. With continued research, improved individualized approaches to cancer therapy will emerge and result in more cancer survivors who are able to live longer, more productive, happy lives.

The enemy is vicious. Over 600,000 Americans die each year from cancer, and many more cancer survivors and loved ones of those with cancer experience pain and suffering. Progress in reducing this is within our grasp. The war on cancer is undoubtedly worthwhile even if declaring total victory may not be feasible. Success in this war will be measured by the impact we have on the lives of those we serve, and that is noble goal indeed.

One thought on “The War Metaphor

  1. Lisa Sotelo, RN , BSN

    Interesting metaphor and thoughtful analogy on how the battle against cancer is changing and quickly as well

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