Book review by Patricia Kearns

What convinced me to buy Alanna Mitchell’s book, Malignant Metaphor: Confronting Cancer Myths, was reading down the list of chapters and finding the final one, which is titled “Rewriting the Metaphor.” Recently diagnosed with breast cancer myself and long involved in the breast cancer prevention movement, I was tired of the language, images and inferences we use to talk about cancer. So often militaristic (the war on cancer, the survivors, and the ones who lost a brave battle); sometimes based on myth (early detection is your best protection, or is best for prevention: both have been proven untrue); and regularly crafted by marketing pros aiming to get us to empty our pockets for the cause—these terms did not suit me or many of the people with whom I’ve spoken. Would Malignant Metaphor offer us a guide to reshaping the current cultural mode of speaking about cancer?

Alanna Mitchell is an author who writes about science, medicine and social trends in an effort to democratize knowledge. Her most recent full-length book, Sea-Sick: The Global Ocean in Crisis, is an international, prize-winning best seller that was made into a one-woman play, which was nominated for a Dora Award. For Malignant Metaphor, her investigative skills were put to work diving unabashedly into the world of scientific studies and data in an effort to understand a few things about cancer.

The task is overwhelming. For example, take her research into what has been dubbed “the liquid biopsy,” peering into the blood to identify circulating tumour cells—cancer markers that don’t originate in the blood or lymph system. This technique holds the promise of diagnosing cancer through the use of a blood test and is regarded as one of the hottest new fields of cancer research. Furthermore, the test has been used experimentally to determine whether a person’s cancer is responding to treatments like chemotherapy. Counting the circulating tumour cells can measure whether or not the treatment is working, before it can be seen if the tumour is shrinking.

Mitchell asks, “But do the counts really have the power to predict? I began to look at the evidence. I have to confess that the science on this—while fascinating—is so confusing and unsettled that, as I write this, my brain is on fire trying to figure it out.” There is so much heated disagreement in the field that adds to the confusion, but Mitchell had a very personal reason to stay the course.  Her beloved, larger-than-life brother-in-law, John Patterson, had been diagnosed with deadly stage iiib melanoma. Because there were no traditional treatment options available to him in North America, he asked Alanna to globally navigate both the alternative and mainstream worlds of cancer and its treatments.

A good person to have on your team, Mitchell describes herself as a professional skeptic whose “antennae are finely tuned to nonsense.”  While probing for answers to John’s predicament, she tried to understand why cancer has such a hold on us—terrifying us, filling us with dread and a sense of powerlessness in ways that other potentially fatal diseases do not. Consequently, she asks if we view heart disease and stroke, the other big killers, the same way we view cancer.

Mitchell gives a brief history of illness throughout the ages, illustrating how we have long seen disease as an indictment of character, either individual or societal, leading to guilt and blame.  The bubonic plague, leprosy, tuberculosis, the Spanish flu of 1918, and HIV/AIDS were all diseases laden with meaning that dissolved when newly viewed in light of emerging scientific knowledge and understanding. The narratives we piled onto these diseases were absolutely false, time and again. Each disease had the same power to stun as cancer has today because we didn’t understand it or how to cure it. As Mitchell puts it, “Today and for the past half century, the fiend is cancer.”

Susan Sontag wrote about this in Illness as Metaphor (1978) and AIDS and Its Metaphors (1989). Mitchell picks up her lead from almost 40 years ago: “I’ve come to believe that cancer suffers from a disease bigotry that shows itself in the stories we tell each other about it, and that it intrudes into our lives in ways we may not recognize.”

By crunching a lot of numbers, reading endless studies, speaking with oncologists, and talking to cancer patients and friends, Mitchell came to understand why our society’s perception of cancer leaves people in a paralytic state of fear about getting the disease in the first place, and then experiencing profound guilt and shame if they do find themselves with a positive diagnosis.

Her examination of our cancer culture led her to conclude we fear that cancer is three things at once: inevitable, preventable, and deserved.  Of course, we know there is no logic here (How can something be inevitable and preventable at the same time?), yet these narratives persist. Mitchell takes on each of these ideas and illustrates, using clear examples, how these beliefs are deeply buried within our individual and collective psyches and are actively at play, affecting what we expect and think of ourselves as well as how our society spends its energy and money.

By laying out her evidence, Mitchell hopes to “strip away a little dread” from our current understanding of cancer. I think she accomplishes this. And in order to reshape the language we use in talking about cancer, all our efforts need to be directed toward shifting the balance from placing blame on individuals who get sick to looking at “systems that create illness,” and demanding more honesty from marketing teams working for corporations that benefit from dishonest messages.