Is Ignorance Bliss, When Knowledge Is Not Actionable?

(p. C1) . . . even in today’s pandemic world, cancer holds a special place in the anxious imagination. Its advance is often stealthy, its prognosis potentially frightening and its treatments damaging and life-altering. Once its shadow falls on us, we fear it will never go away—that there will always be another relapse and a return to harsh therapies that subsume our lives.

. . .

(p. C2) The borders of “Cancerland”—a term the oncologist David Scadden coined with the title of his 2018 memoir—begin to feel all-encompassing. In the past, entry was reserved for those with a diagnosis of cancer. Today everyone, in one way or another, slowly becomes a citizen.

. . .

The promise of detecting cancer in its earliest stages, together with that of identifying those at genetic risk for future cancer, is powerfully alluring. And yet the prospect of farther-reaching surveillance for this elusive long-term illness also warrants caution. In the 1950s, the sociologist Erving Goffman coined the term “total institution” for a community in which “a great number of similarly situated people, cut off from the wider community for a considerable time, together lead an enclosed, formally administered round of life.”

Total institutions, such as mental hospitals, prisons and even boarding schools, have rituals of entry and exit. They inculcate belonging. They invent their own vocabulary and codes of behavior; they have an internal logic, impenetrable to others. They encourage surveillance and create anxiety: Members are united by a common sense of purpose, by the feeling of being chosen or marked. Those who are expelled may feel a sense of betrayal, while those who remain can be consumed by the guilt of survivorship.

In this new era of cancer treatment, I wonder whether we unwittingly, but insidiously, intensify the totality of the “cancer institution” for patients. When I once asked a woman with a rare sarcoma about her life outside the hospital, she observed, “I am in the hospital even when I am outside the hospital.”

For the full commentary, see:

Siddhartha Mukherjee. “Will We All Soon Live in Cancerland?” The Wall Street Journal (Saturday, Dec. 18, 2021): C1-C2.

(Note: ellipsis, and bracketed year, added.)

(Note: the online version of the commentary was updated Dec. 17, 2021, and has the same title as the print version.)

Muckherjee’s commentary is adapted from his chapter in The New Deal for Cancer book:

Mukherjee, Siddhartha. “The New Borders of Cancerland.” In A New Deal for Cancer: Lessons from a 50 Year War, edited by Abbe R. Gluck and Charles S. Fuchs. New York: PublicAffairs, 2021, pp. 27-42.

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