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Where do you bury the survivors?

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Furthermore, to be "cured" of cancer usually means that you are in remission five years after diagnosis. So here's another problem: early diagnosis automatically increases the rate of so-called "cures", just as it automatically increases the rate of survival, independent of any other variable.

Personally, I think the notions of "survival" and "cures" should be abolished from public discourse, and should remain in the realm of research and treatment, where they are useful. Instead of five-year survival, patients and the public at large should be talking about mortality. "Has this treatment been shown to impede the disease's progress and delay death?" That really is the only question we should be asking, at least in the context of cancer survival (certainly there are other legitimate goals for treatments, such as palliative care, etc).

And as for "cures", this nonsense needs to be replaced with honest language as well: in the public sphere, "cured" should not be permitted to mean anything other than, "the patient died from a different cause". If you come out of your oncologist's office with a new diagnosis, and absent-mindedly step into the path of a city bus, well, that bus will cure your cancer. The fatal heart attack you have a month later will certainly cure your cancer. But, outside the context of medical research and calculating a patient's odds, it is preposterous to speak of a "cure" unless something else brings about your death.

This linguistic sloppiness makes it very difficult for us, as consumers of medical products and services, to know if early diagnosis and intervention do significantly more than enrich the medical industry. Certainly there are tumours that can be detected early, and when diagnosed at Stage I (in situ), may often be removed surgically and then legitimately called cured, because many patients with such experiences do in fact end up dead from other causes.

But there are other cancers that are extremely difficult to treat, and - if we were to dispense with the linguistic vagueness - are probably close to 100 per cent incurable, with very high (i.e., rapid) mortality rates. We might as well face the facts. But we cannot face them when journalists and interested parties fuel public debate with professional jargon that is often misinterpreted outside the medical industry.

If we in the press were to chuck "survival" and report on cancer mortality instead, and save "cure" for those who die of something other than cancer, the public might learn a few things that the industry would prefer them to remain foggy about. As patients, we might begin asking whether an expensive regimen has actually been shown to extend lives. As charitable donors, we might begin asking if our money is going into dead-end research where virtually no mortality advantage has ever been found - and whether it might be better spent on public screening programmes, or prevention initiatives, or better palliative care.

But, yes, the UK's cancer survival rates have doubled in 30 years. That certainly is true. Are cancer patients living twice as long? Certainly not. Some of the increase is due solely to the fact that early diagnosis improves survival numbers independent of mortality. Yes, some of the increase is due to improved treatment regimens, and to the fact that early treatment can improve mortality rates - at least to some degree, and at least for some patients. But how much, and for how many? Well, that is the question. So here's an idea: why don't we in the press start using language that helps people to answer it? ®

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