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While composing a prior post, I found myself likening the experience of cancer to an “assault” in deference to the challenging nature of what cancer patients undergo when diagnosed and treated for the disease. At another point, I wanted to use the word “tackling” in describing the coping process. Metaphors are prominent in our discourse regarding cancer. Battle metaphors resonate with the War on Cancer initiated by President Nixon with the signing of the National Cancer Act in 1974, which launched an intense effort to find a cure for cancer.
Metaphors are prominent in the public discourse about cancer and may also be present in practitioner-patient interactions. We know that our appraisal of events colors our emotions, so, do the metaphors we use to speak about cancer, whether related to battle, sport, or journey, make a difference in how we feel about the disease? Authors Reisfield and Wilson1 note that metaphors are useful in depicting complex or unfamiliar concepts in more familiar terms, and can provide a common language between clinicians and patients, but have downsides as well. Military metaphors may be appropriate in evoking the seriousness of a life threatening illness but may provoke feelings of inadequacy for patients who are uncomfortable with the combative stance of fighting a disease. Sport metaphors may fit well for many, but perhaps best for those who see cancer as a competition. Journey metaphors may mesh well with way that cancer is now viewed to be more of a chronic than an acute condition and may be more universally applicable. Individuals may develop their own metaphors for coping with the disease such as playing a chess game or scaling a mountain. Accordingly, other authors2 note that listening to patients’ own imagery and language can promote shared understanding and meaning, thus fostering an effective therapeutic relationship.
Relatedly, a term that is pervasive in cancer discourse is the term “survivor.” Some bodies, such as the National Coalition for Cancer Survivorship (NCCS), the National Cancer Institute (NCI), the American Cancer Society (ACS), use the term to refer to any person with cancer from the time of diagnosis forward. Such a term is appealing because of its optimistic and powerful connotations, but it is not universally embraced and may be problematic for those who are actively in the process of dying.
Some research has considered how the medical terminology used to describe certain types of cancer might affect emotional reactions and treatment decisions. One example is the condition ductal carcinoma in situ, or DCIS, a type of pre-invasive breast malignancy. Increases in mammography screening have led to it being increasingly identified and there is concern that it is over-treated. Some have called for describing this condition as a breast lesion or abnormal cells rather than as a pre-invasive cancer (which also holds somewhat militaristic connotations) as a means to reducing distress and perhaps the desire for active treatment as opposed to watchful waiting. One study asked women to consider a hypothetical diagnosis that alternated the use of the terms abnormal cells and pre-invasive breast cancer cells.3 Participants were told that, if left untreated, two-thirds of women with such a diagnosis would not develop invasive cancer over 10 years and one-third would. Given the choice of treatment with surgery, radiation, or drugs vs. watchful waiting with close monitoring by doctors, the two groups did not significantly differ in what they would choose or their level of concern about the diagnoses. However, when those who were initially told that they had abnormal cells were asked to consider what they would do if they were instead told they had pre-invasive cancer cells, their likelihood of choosing treatment increased. Similarly, this group had more concern about pre-invasive cancer cells than those who were initially told they had pre-invasive cancer cells who were then told to consider how they would feel if they had abnormal cells. Thus, even minor alterations in terminology can change the way we feel or behave in the face of cancer.
The use of metaphors and specific terminology gain more importance as our discourse regarding cancer has evolved. Whereas in prior decades conversing about cancer was more taboo and a diagnosis was sometimes revealed only to a patient’s family to preserve a patient’s sense of hope, today awareness about cancer is a public health focus and patients advocate for informed decision making. Euphemisms such as “the big C” and “illness” may also be heard less often. As we have begun to talk more frankly, openly, and individually about cancer, the richness of the language, imagery, and concepts that can be used as tools for comprehending the experience expands. However, we must also be aware that accurate medical terms can constitute jargon that can be misunderstood by patients and metaphors should be used mindfully and sensitively.
1Reisfield, G. M. & Wilson, G. R. (2004). Use of metaphor in the discourse on cancer. Journal of Clinical Oncology, 22, 4024-4027. doi: 10.1200/JCO.2004.03.136
2Harrington, K.J. (2012). The use of metaphor in discourse about cancer: A review of the literature. Clinical Journal of Oncology Nursing, 16, 408-412.doi: 10.1188/12.CJON.408-412
3McCaffery, K., Nickel, B., Moynihan, R., Hersch, J., Teixeira-Pinto, A., Irwig, L., & Barratt, A. (2015). How different terminology for ductal carcinoma in situ impacts women's concern and treatment preferences: a randomised comparison within a national community survey. BMJ Open 11 e008094 doi:10.1136/bmjopen-2015-008094
