Why I Hope to Die of Cancer

I am currently reading my way through a prepublication version of Jarle Breivik’s book “Making Sense of Cancer,” which will be published in English in October 2023. Jarle, whom I have not met, is a professor of medicine at the University of Oslo and a cancer researcher. His book points out that although we have for a long time had a huge industry fighting “a war on cancer,” we have and will have more cancer than ever. Some people with cancer are kept alive for much longer than used to be the case, but most people in the world don’t have access to even the simplest treatments, including opiates for pain. We need, he argues, to think about the meaning of cancer.

Jarle has kindly given me permission to publish this English language version of an article he published in a Norwegian newspaper in May. I haven’t seen much of the discussion he calls for in English, but we need it badly.

Everybody hates cancer. It is the evil enemy we aim to eliminate at all costs. Yet, dying from cancer can also be a good thing.

JARLE BREIVIK (MD, PhD, EdD)

Professor of Medicine, University of Oslo and author of “Making Sense of Cancer,” to be released October 2023.

Adated from an op-ed published in the Norwegian newspaper VG (May 2, 2023).

https://www.vg.no/nyheter/meninger/i/on8Qna/derfor-haaper-jeg-aa-doe-av-kreft

This may sound absurd and insensitive, but let me complete my reasoning. I do not wish for anyone to get cancer. I do not underestimate the pain and grief many people experience as cancer patients or their loved ones. And if I get cancer, I will suffer just like everybody else. Cancer can be horrible – but it is also very common.

About one in three of us will be diagnosed with cancer during our lifetime. Most receive effective treatment and survive the disease – at least in the first round. But for many, cancer will eventually be the end of life. Cancer is a leading cause of death, second only to heart disease, and it is completely normal to die of cancer.

More people get, live with, and die of cancer than ever before. It is a great paradox, but this development is actually an exceptional success story. It is the story of why people live longer and longer. We generally have better working and living conditions, a healthier diet, and a health service that offers vaccines, antibiotics, and regular check-ups. We no longer die from measles or tuberculosis, while doctors are getting better at repairing clogged blood vessels and worn-out heart valves.

Cancer in children and young adults is tragic but fortunately rare, and the vast majority are cured due to advances in research and treatment. Getting cancer at a young age is often due to an unfortunate combination of heredity and environmental factors and can generally be ascribed to bad luck. Something goes wrong in a cell that runs wild in an otherwise healthy body.

Getting cancer as we get older, however, is neither bad luck nor unusual. The probability of developing cancer increases markedly from the age of 50. Getting cancer after 70 is quite normal. A 90-year-old who has not been diagnosed with cancer cells in the body has just not been thoroughly examined – and that is probably the best for all parties.

The reason why cancer increases with age is, in principle, simple. The cells in the body are genetically programmed to collaborate. But when the job is done, and the genes are passed on to the next generation, the program says it is time to die. The aging cells, which have accumulated an increasing number of genetic mutations, are told to commit suicide. They wither like flowers in autumn, and we grow old.

The alternative is that the genetic mutations deactivate the suicide mechanism. The cells do not listen to the control signals and continue to reproduce even if they have passed their expiration date. The most stubborn and rebellious cells always survive and multiply, eventually developing into cancerous tumors.

Our cells either wither away or develop into cancer. And for us, it is the end of life. We can delay cancer development by living as healthily as possible. And we can kill cancer cells with advanced biotechnology. But sooner or later, we have to die of something, and the longer we live, the greater the probability of even more cells running astray. Anyone hoping for a long life should therefore be prepared to die of cancer.

Nevertheless, most people hope to die of something completely different. But what is the best way of dying? The former editor of the British Medical Journal (BMJ), Richard Smith, says that to die of cancer is better than its reputation. He argues that there are, in principle, four ways to die:

One alternative is that we die suddenly, for example, from a heart attack or an accident, and many will probably say that is their preferred death. Smith advises us to reconsider. To die by surprise may be good for you, but what about your loved ones? Wouldn’t it be better to have time to plan and say a proper goodbye?

Another possibility is to die slowly of dementia. Your memory and personality are gradually erased, and in the end, only the body is alive. Death itself can be mild, but the years before are often difficult for both the patients and their caretakers. Smith believes that this may be the worst way to die.

The third option is to die of organ failure, like heart failure or chronic lung disease. Such illnesses can be a great burden over many years, while life is shaped by medication and hospitalization. Living is difficult, and death is unpredictable.

The last alternative is to die of cancer, and for most people, that is probably also the last choice. Death by cancer is often perceived as the worst thing imaginable, but according to Smith, cancer can be the best way to die. The disease often comes with a few years or months of notice, and when it first sets in, death is relatively quick.

Smith describes dying of cancer as a natural process where the physical and psychological pain can be numbed with morphine and whisky. That is true, but as may be expected, some have interpreted his argument as belittling the pain and suffering that so many have experienced due to cancer. We should be careful about rating other people’s experiences of illness and death. In the end, our inner strength and caring surroundings are probably more important than the underlying diagnosis for how we perceive the end of life.

Nevertheless, there is little reason to fear cancer more than other causes of death. Getting cancer as we grow older is a natural consequence of being human. So, when my time comes, I won’t mind if I die of cancer.