11 December 2015
This past week, two well known public figures made announcements regarding their cancer. The actress Rita Wilson, who underwent a bilateral mastectomy in March, stated that “I am cancer free” and “100% healthy”. Former President Jimmy Carter, who is being treated for melanoma with metastasis to his liver and brain, announced that on a recent scan, “they didn’t find any cancer at all”. Note that he did not say he was cured.
“Am I cancer free?” is a question commonly asked by those treated for cancer. The reality is, we often don’t know. We used to think that there was some sort of magic in passing the 5 year or 10 year mark, indicating that the cancer was truly gone, never to return. While the likelihood of cancer returning decreases with time, the reality is that cancer can return at any time, even years after apparently successful treatment. As pointed out in a Health News Review post regarding the coverage of President Carter’s announcement, “cure” as defined by the National Cancer Institute “means that there are no traces of your cancer after treatment and the cancer will never come back”. “Remission means that the signs and symptoms of your cancer are reduced. Remission can be partial or complete. In a complete remission, all signs and symptoms of cancer have disappeared.” We commonly use the phrase “no evidence of disease” (NED) instead of remission. While NED doesn’t sound as hopeful as “cure”, it is more accurate.
President Carter appeared to be very careful in his announcement – it was the media coverage that turned his words into something more. Ms. Wilson – not so much. While patients want to hear that they are “cured” (and physicians would love to utter those words), it is important to be accurate in our statements. Cancer is incredibly complex, and a true cure is years away. Media coverage and celebrity statements that imply otherwise make it more challenging for patients to cope with the uncertainty that is NED.
NPR – Why Cancer Is Gone’ Discourse Doesn’t Help Cancer Patients
TIME – What it means that Jimmy Carter is ‘Cancer Free’
Dr. David Gorski – Why Haven’t We Cured Cancer Yet?
But Doctor I Hate Pink – Stable vs Remission vs NED vs Cure