Unlike many of the so-called ‘diseases of affluence’ that now ail modern in-
dustrialised societies, cancer has been with us for millennia. From the malignancies
of Egyptian mummies from 3000 BCE to cancerous human bone fossils that date
back over a million years, cancer is as old as humanity itself (Hartshorn & Morris,
2019; Urbano, Rodrigues, Cerveira, Ferreira, & Alpoim, 2011). In fact, cancer
predates us, as evidenced by the recent discovery of osteosarcoma in the femur
bone of a 240-million-year-old turtle-like reptile from the Triassic period (Haridy
et al., 2019). In this sense, what matters to us in cancer is not so much its distinct
features as a disease but what it means, how it feels and how we experience it as
part of the human condition – how we, as social beings, understand it, construct it,
shape it and live it. Of course, this doesn’t happen in a vacuum. How cancer is
lived depends, fundamentally, on the peculiarities of social context. Cancer is thus
both a cellular event and a historical, cultural and economic production, with our
species involved in an elaborate technological and pharmacological show-down
with one of its most enduring threats.
While cancer may have been present throughout the history of humanity (and
before), it was neither known nor experienced in ways that are remotely similar to
how we ‘do’ cancer today (Hajdu, 2004; Topi et al., 2020). We now understand (and
attempt to combat) cancer in highly specific ways, which have shaped and are shaped
by our particular modern ontology of this disease. The (eventually mummified)
Egyptian would likely have known, understood and experienced their malignancy (if
at all) in ways that bear little resemblance to ours. For the turtle – whose malignancy
was revealed via sophisticated micro-computed tomography (micro-CT) technology –
the threat of cancer lurking within its bones likely paled in significance compared with
other daily threats to its existence during the Triassic period.
As actors in the modern production of cancer, biotechnologies set the scene for
cancer to be thought of, and treated, in new and particular ways (e.g., Greenwood,
Dodelzon, & Katzen, 2018; Lirici & Hüscher, 2016). Even if it has always been with
(and within) us, cancer has only become visible in recent years with the invention of
technologies such as X-ray, magnetic resonance imaging (MRI), computed tomography
(CT) and positron emission tomography (PET). These and other modern technologies
have not merely made cancer visible. They have also transformed the very nature of
disease, its solutions and its experience. These technologies are now fundamentally
intertwined with how we understand the very make-up of our bodies (and disease).
Technologies, then, are part of the modern production of what we think we know
about cancer. Both CT and MRI, for example, use particular forms of data to represent
cancer within the human body (and in Triassic-period turtles); but they also embed
particular assumptions – about healthy bodies, acceptable margins and reasonable risk. It
is not that they are erroneous or misrepresentative; rather, they are representations and
actively contribute various elements to our current ontology of disease that may be
otherwise. And in doing so, they make particular things matter more or less than others.
What matters most, as a result, may sit in contrast to how we, as sentient and social
beings, know, live with and experience disease.
The twentieth century saw not only the development of novel ways of seeing
cancer, but new ways of treating it, too. Modern cytotoxic chemotherapy agents
emerged following the Second World War; during the 1940s, Yale pharmacol-
ogists Alfred Gilman and Louis Goodman decided to investigate whether the
observed effects of mustard gas used in the context of warfare could be directed
towards malignant tumours, specifically in mice with lymphoma. They could.
Soon, other cytotoxic compounds were deployed, including plant alkaloids de-
veloped from the rather modest-looking flower Catharanthus roseus (formerly Vinca
rosea). Although the results of such treatments in human patients were often
mixed, major successes in particular areas (for example, acute lymphoblastic leu-
kaemia in children) paved the way for cytotoxic chemotherapies to become the
norm within cancer care. While cancer has always been with us – and indeed a
part of us – we have also heavily shaped its form, impacts and experience through
our attempts to visualise it and ‘cure’ it. While chemotherapies and radiation
treatments that have centred on the destruction of cancerous cells (Herrmann,
2020) are, to a certain extent, changing with the rise of precision medicine and
immunotherapies (Iriart, 2019; Lacouture & Sibaud, 2018), which we examine in
the latter chapters of this book, the tripartite strategy of slash (surgery), burn
(radiation) and poison (chemotherapy) remains a core aspect of contemporary
cancer care. It also dominates the experience of survivorship, in that cancer sur-
vivorship is as much about living with modern cancer treatment as it is living with
disease itself, depending on the particular ‘solutions’ and medicocultural logics of
the particular moment in time (e.g., Hoffman et al., 2016; Ichim & Tait, 2016;
Ridgway et al., 2016). This is not to downplay the successes of oncological
treatments over the last hundred years or so, but rather to emphasise the particular
ways in which they have framed disease and inflected illness experiences.
While we are (perhaps unfairly) assuming that cancer means more to us now than
it did in Egyptian times, this assumption raises the question of what makes cancer so
culturally significant and interpersonally devastating. That cancer remains so stubbornly resistant to our attempts to eradicate it, and thus inspires considerable dread, seems self-evident, yet it is important. Combine the potential pain, suffering and even death that cancer is taken to foreordain, and you have an obvious mix of undesirables. Cancer is obviously something to be solved, fixed or avoided. Or is it? After fifty or so years of fighting the so-called ‘war on cancer’ (Davis, 1928; Jefferies, 1921; National Cancer Institute, n.d.), the battle is not being won. Certainly, it continues to be fought on different fronts (through genomics and vaccines, for instance), but if anything, cancer, particularly in the Global South, is actually rising, both in caseload and in significance (e.g., Broom, Kenny, & Kirby, 2018; Smith & Mallath, 2019). In fact, the ‘gains’ against cancer during the 20th century have largely been achieved through improvements in public health and living standards, and early detection via screening programs, rather than through dramatically more successful treatments (Rebbeck et al., 2018). That is, our greatest accomplishments against cancer have come through other areas of social life, which many contemporary pressures of neoliberalism, austerity, inequality, polarisation and even the current global pandemic threaten. The ‘battle’ with cancer, then, is likely to continue on this social terrain, as part of the human condition, as long as our species endures. In many respects, the struggle against cancer requires more than vanquishing biophysical malignancy. Instead, it requires an ongoing tussle with the limits of life itself, the meanings of our attachments (with others and to communities/society) and, ultimately, our own mortality.
