7 Insights about Cancer from Kate Middleton 👑
Cancer doesn’t care if you wear a crown.
ICYMI 👉
(Note: I will return to my series on Mental Health is Health next week.)
Kate Middleton just taught a masterclass in communication about cancer. She artfully dispensed sensitive information while holding a boundary with her audience. Her tone was warm, firm, and direct. She reminded us that grief and hope can coexist, that gratitude and self-preservation aren’t mutually exclusive. Her vulnerability reminded us she’s human; her strength reassured us.
Sure, she has a comms team and a fabulous hairdresser. Nonetheless: I am unofficially crowning Kate the Queen of Delivering Difficult News.
Despite Kate’s poise under pressure, her announcement generated health anxiety for some and wild speculation by others. For me, it was a sobering reminder about the power of effective communication to squash misinformation and quell misplaced anxiety in those around us.
For royals and regular people, too, a cancer announcement can trigger a variety of reactions from others—ranging from empathy and generosity to avoidance and fear. Managing other people’s feelings can take a toll, whether or not you live in a castle.
I’m sorry for Kate that she had to deliver this message at all. Not only because she is ill, but because sharing with the world private elements of one’s life must be exquisitely painful. So, I will spare you any conjecture about her cancer type, treatment, or prognosis. For one thing, it’s pointless. Plus, speculation also detracts from the important lessons to be learned from her message.
Here are some important insights gleaned from Kate’s message last week:
1. Cancer isn’t one disease.
It is a set of diseases, each with unique risk factors, screening tests, prognoses, and treatments. As examples: lung cancer is usually caused by cigarette smoking and is usually detected from imaging. Cervical cancer is almost always a result of an infection with HPV (human papillomavirus) and is usually found through pap smears. Skin cancer is largely from sun and UV light exposure, and usually requires a skin exam. Colon cancer can be caused by a diet that is high in sugar, alcohol, and processed foods, and is most often diagnosed by a colonoscopy. Treatments vary widely. Some cancers require surgery, some radiation, some chemotherapy—or a combination of all three. And there are many new types of treatments in use or on the horizon.
The upshot?
Hearing about someone else’s cancer diagnosis can elicit fear about our own risk. For anxious and vulnerable people, it can cause wild speculation, ruminations about risk, catastrophization, and other cognitive distortions (e.g., “If Kate Middleton can get cancer, I’m assuming I will, too”).
It's crucial to recognize “cancer” as a diverse set of conditions—and not a mysterious monolith—in order to understand your particular risks and to manage anxiety about it.
2. The absence of cancer in your family doesn’t mean you can’t develop it.
Most types of cancer are not hereditary. Of course, some cancers stem entirely from genetic mutations that are passed on within families—for example, the BRCA1 and BRCA2 genes for breast cancer. However, most cancers result from sporadic mutations that accumulate over time, contributing to cellular damage and dysfunction.
The upshot?
It's important to understand the array of risk factors for different types of cancer—including age, genetics, lifestyle factors, and environmental factors—to apply that knowledge to your own risk. Talk to your doctor, educate yourself about your family history, take good care of your body and mind.
Genetic testing can be appropriate for people with a family history of known genetic mutations and/or whose family tree suggests a pattern of heritability. For example, if most women in your family have had breast or ovarian cancer, it probably is appropriate to get tested for the BRCA genes.
3. Cancer isn’t rare.
It will strike approximately 40% of us in our lifetimes. It also doesn’t discriminate. While the risk for most types of cancer increases with age and certain environmental factors, cancer can occur at any age, gender, race, and socioeconomic status.
The upshot?
Healthy habits help reduce the risk of certain cancers, but they don’t bring the risk to zero. Please don’t assume that a special diet or number of steps per day will render you immune from risk!
Pay attention to symptoms. Particularly if your symptoms persist or worsen over time, it's important to see your doctor. Early detection and treatment can significantly improve outcomes for many types of cancer.
The symptoms of cancer vary widely depending on the type of cancer, its location, and how advanced it is. However, some general symptoms that may indicate the presence of cancer include significant and unexplained weight loss without changes in diet or exercise habits; persistent fatigue, weakness, or pain in a specific area of the body that doesn't improve with typical treatments or time; changes in digestion or bowel or urinary habits; persistent cough; changes in the skin, such as new moles or growths or sores that don't heal; or the presence of a lump or swelling in any part of the body that isn't explained by something else.
4. Just because you have a risk factor for cancer doesn’t mean you will develop it.
For anyone whose cage I’ve just rattled with the above list of symptoms, please note that these symptoms can be caused by benign, non-cancerous conditions, too.
The upshot?
Common things are common. For example, a change in bowel habits is much more likely to be caused by stress or dietary factors than colon cancer. A cough is more commonly caused by postnasal drip or a respiratory virus than it is from lung cancer. A lump in the neck is much more likely to be a normal, reactive lymph node than a lymphoma. Possible doesn’t mean probable.
Cancer is not inevitable, even if you have every known risk factor for a certain type. I have cancer-free patients in their 70s and 80s who have been lifelong smokers, BRCA-gene carriers, and sun-worshippers. Some cancer risks are about luck, good and bad.
5. Many types of cancer are increasingly preventable.
Whether it’s through lifestyle changes or by getting appropriate screening tests, medical technologies are advancing our ability to prevent and detect early cancers like never before. Don’t believe every fear-based headline you read! 👀
The upshot?
Get screened. Make sure you’re up-to-date with your age-appropriate cancer screenings. For example, patients at average risk for colon cancer should have a screening colonoscopy at age 45; patients at average risk for breast cancer should get screening mammograms starting at age 40; past and present cigarette smokers should have yearly screening low-dose CT scans of the chest.
Reduce your risk. We have more control of our risk factors for cancer than we think. For example, quit smoking to reduce the risk for lung, bladder, colon, and pancreatic cancer. Practice safe sex and get vaccinated against HPV to protect against cervical cancer. Limit alcohol consumption to reduce your risk of breast and colon cancer.
6. Many types of cancer are treatable and curable.
One of the more gratifying parts of my job is telling patients they’re in full remission, or, better yet, moving a cancer diagnosis from a patient’s list of “active medical problems” to “past medical history.” Not everyone is fortunate enough to have “curable” on the menu of options—or even the type or stage of cancer that is treatable. This is why prevention and early detection is so important, to have the best shot at long term survival and quality of life.
The upshot?
Seek experts. Not every town, city or state has the right specialist for you. Sometimes cancer treatments are fairly standard. But particularly for rare and more advanced cancers, be sure to ask everyone you know where to get more opinions as needed.
Hope is healthy. As I commonly remind people, even the toughest statistics don’t predict your risk and future. Maintaining hope (when the facts allow it) is an important part of cancer care.
7. Cancer is not just about body parts.
It’s about protecting our physical and mental health in tandem. It’s about accepting things we cannot control. It’s about trusting science to have our back. It’s about knowing when and who to ask for help. It’s about surrendering to grief and mustering strength at the same time. It’s about finding a balance between self-protection and caring for those around us.
👑 👑 👑
Kate may be the future Queen of England, but in many ways she is just like all of us—mortal, human, and doing her best to communicate her needs during difficult times. She reminds us that living with cancer is more than a physical process, it’s emotional too. Let’s take a bow and respect it.
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Disclaimer: The views expressed here are entirely my own. They do not reflect those of my employer, nor are they a substitute for advice from your personal physician.
Brilliant response and summation. Thank you for using this concerning moment as the best cancer teaching moment ever.
Thank you, for the reassurance and the reminders!