COMMENTARY

Stopping the Cancer Shame Game

Mark A. Lewis, MD

Disclosures

March 02, 2020

This transcript has been edited for clarity.

This is Mark Lewis. I am a gastrointestinal medical oncologist at Intermountain Healthcare in Utah and a contributor to Medscape.

I'm recording this video in mid-January, and as we start this new year, I've been thinking a lot about luck. T.S. Eliot may have been wrong about which month is the cruelest. He said it was April, but for me it is January, when our bright hopes for better health can be dashed by the harsh realities of our broken bodies. New Year's resolutions are wonderful things, but it's no secret that they tend to be short-lived and often not by choice.

After a prolonged illness at the end of 2019, I started 2020 intending to be healthier. I believed that through sheer willpower, more sleep, more exercise, more conscientious eating, and better self-care overall, I could avoid illness. And then on January 3, I awoke with a knife-like pain in my chest. It was hard to breathe, and I felt a sense of impending doom. This is a phenomenon I had read about in medical textbooks, but as with every other symptom, it meant something entirely different to feel it for myself. Indeed, one swift visit to the emergency room later, I was diagnosed with a pulmonary embolism.

But here is where my fortunes began to look up. I was started on the proper treatment immediately and almost as quickly started to feel better. It's now 2 weeks later and I feel back to normal, just anticoagulated. Now if you prick me, I will definitely bleed.

The whole episode got me thinking again about luck. We tend to be our own worst critics when it comes to our health. So many of the patients I see in my oncology practice assume that they did something wrong, almost as if they deserve their malignancy. A lot of the well-meaning advice dispensed to patients after diagnosis, often by friends or family, makes them feel culpable for their lifestyle choices before diagnosis. All of the admonitions to avoid sugar, alkalinize their pH, take supratherapeutic doses of vitamins—these don't just fly in the face of our physiology and our homeostasis; they also imply that all of those things were lacking beforehand.

No one wills themselves to have cancer. And it's equally impossible to will yourself out of it. We need to stop the stigmatization of people who are simply deeply unfortunate. Patients with lung cancer have long been aware of the toxic twinning of their diagnosis with tobacco use. Does smoking increase your risk? Yes. But we know all too well that nonsmokers can get lung cancer too. So let's get rid of the shame.

In his book The Gene, Siddhartha Mukherjee spells out the formula for our phenotype—any phenotype—as our genes plus environment, plus triggers, plus chance. I believe that the influence of that last component, chance, is the most disturbing because it's also the most unpredictable. It's what Shakespeare so eloquently called "the slings and arrows of outrageous fortune." And that's what good intentions and resolutions in the best-laid plans cannot protect against. As we start 2020, let's take care of our wounded.

Mark A. Lewis, MD, is director of gastrointestinal oncology at Intermountain Healthcare in Salt Lake City, Utah. He has an interest in neuroendocrine tumors, hereditary cancer syndromes, and patient-physician communication.

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