Opinion

from: Le Monde, January 3, 2013.

CANCER NEEDS TO BE REDEFINED

by Luc Perino, medical doctor

translation: Doxa-louise

Science cannot define health, because it’s subjective character is incompatible

with the necessity for demonstration and proof. As historical anecdote, some 

practioners have tried, such as René Leriche with ‘silent organs’, and Claude 

Bernard with ‘normal activity in organic elements’. Certain philosophers have taken 

the plunge: for Friedrich Nietzsche, it was an ‘ideal state wherein each could do best 

what he did the most willingly’, for George Canguilhem, a ‘capacity to get through crisis’, 

for Alain Froment, a ‘power to be’. Last but not least, midly amusing intitutional definitions 

such as ‘equilibiumas a function of temperament’ for Diderot and d’Alembert, or the 

infamous ‘total welfare’ from the World Health Organisation (WHO).

Thus finding a scientifically acceptable general concept of illness comes down to the

same problem, as the Larousse and common sense define it as an alteration of health.

We are caught in a vicious cycle.

Illness-Objects

By way of contrast, for many pathologies experienced by patients and observed

by clinical pratitionners in a similar way, science can define ‘illness-objects’ 

with sufficient precision. Bacterial angina (tonsillitis), a fractured tibia, rheumatoid

arthritis, migraine, Type 1 insulin-dependent diabetes, schizophrenia all belong to those 

clinical entities compatible enough with the rigor of scientific terminology.

As for the word ‘cure’, it can have no precise definition without reference to

an illness-object of type acute with a pre-existing acceptable definition. Healing

in the case of a fractured tibia or tonsillitis is easily determined. For the chronic and 

cyclic illnesses of our other examples, the word cure is inappropriate; medecine, which 

here seeks to ameliorate the ‘being power’ of patients, speaks of remission, stabilisation 

or quiescence.

The current biomedical model now refers to new illness-objects, no longer experienced 

by patients, not observed clinically. Here it is a case of ‘risk factors’ or ‘anomalies’ with 

a potential for pathology.  Hypercholesterol or colorectal polyps are good examples of 

these new biomedical objects where the terms cure and remission loose all meaning, 

since they have no correspondance with the experience of patients.

Lived and non-lived illnesses

Cancerology presents a new and unheard-of situation in the history of medecine and 

medical terminology. Th word cure there possesses a very precise definition for all types 

of cancers, while the majority of illness-objects within the discipline are still without.

Cancer ‘objects’ can be found in two vatieties. On the one hand, illnesses experienced 

by patients or detectd by the clinical practitioner (ganglions, bleeding, fatigue, etc,): these 

are clinical illness-objects. On the other hand, illnesses not experienced, but discovered 

through testing: biomedical illness-objects.

The term cure, in effect, is used wihout qualification for these two types of objects.

In cancerology, a cure is a five-year period without clinical symptoms, without modification 

to the imagery or biology of tumors, without local recurrence or metastasis.

Past this five-year waiting period, the cancer is said to be cured.

Although fairly arbitrary with respect to its temporal aspect, this definition would be scientifically 

acceptable if the illness-object had first been defined with at least as much rigour.

The clinical or biomedical model

Unfortunately, it is not. Is cancer a cell considered ‘abnormal’ by an anamatopathologist? 

Is cancer a tumor that has become a symptom in the eyes of a patient or his doctor? Is cancer 

a temporary grouping of cells which spontaneously dissolves? Is cancer a latent tumor or one 

that doesn’t shorten life expectancy? Is cancer a metastatic illness that uses up the natural 

defenses of the patient and ends up killing him? Is cancer a raging illness that kills its carrier 

in a few months?

To this day, no expert can answer these questions for any one cancer or carrier (even though 

the genetic aspect of certain tumors are starting to offer timid avenues toward prognosis). Regardless, 

cure, as defined above, is the object of a large consensus among oncologists. Another 

unheard-of aspect of cancerology is what one could call the ‘secondary equivalence for experience’. 

Patients consider themselves cancerous in the same manner, whatever might have been the initial 

definition of their illness-object: clinical or biomedical, from a diagnostic or from a test procedure. 

Strangely enough, the discovery of a virtual or potential illness creates a real one.

Without initial clinical selection

With the advent of organized testing without preliminary clinical selection (in France, breast 

and colon), these terminological grey zones pose two new types of problems. For 

public health, there is an increase in lived cancer morbidity. For biomedecine and 

fundamental research, the persistence of this confusion risks becoming, in the long term, 

a source of discredit and blockage.

The generalization of mass testing means that more and more patients are declared cured of 

a tumor that would have declared itself fifteen years hence. They would thus be medically ‘cured’ 

fifteen years before being ‘clinically’ ill and their clinical illness could have appeared twenty years 

after a biomedical screening. In the case of a latent illness or one capable of spontaneous regression, 

they would be declared ‘cured’ of an illness they never had!

Cure under this definition means that 90% of cancers caught early are cured, This way of putting 

things, being neither a lie nor a misrepresentation, can be repeated without scrutiny by specialists 

and media alike. Yet, for a science that aims fo rigour, this definition and formulation are no 

longer acceptable.

The terminology of cancer must evolve to allow this discipline to operate as a science.

This need is all the more pressing as cancers are a scourge for humanity.