Cancer steps into limelight

In his recent book, When Illness Goes Public: Celebrity Patients and How We Look at Medicine, Barron Lerner describes how the National Enquirer "outed" actor Steve McQueen's diagnosis of terminal cancer in March 1980. McQueen didn't even want his close acquaintances and his children, ages 21 and 19, to know, let alone the public, Lerner writes.

Fast-forward to March 2007, when in a week's time two high-profile cancer patients, Elizabeth Edwards and Tony Snow, outed themselves.
"There's been an evolution in the public disclosure and very public sharing about cancer," says Richard Wender, the American Cancer Society's national volunteer president.

Sure, first ladies Betty Ford and Nancy Reagan were open about their breast cancer diagnoses in 1974 and 1987, respectively, but their cancers were curable.

On the other hand, Edwards, wife of Democratic presidential candidate John Edwards, and White House spokesman Snow have metastatic cancers, cancers that have spread beyond their original site.

Cancers that, like McQueen's, are likely to kill.

"That's something different," says Wender, chairman of family practice medicine at Thomas Jefferson University in Philadelphia. "It's hard to find a lot of examples of that" among high-profile people who have gone public about their cancer, he says.

"I'm not sure we can quite call it a sea change, but it did feel different, what Edwards did," Wender says. He noted her optimism in the face of incurable cancer, saying, in effect, "I'm probably going to die of this disease, but we're not going to change our life plans."

Even Snow, whose colon cancer has spread to his liver, talked about beating the disease.

Lerner calls their attitude "almost defiantly optimistic."

Optimism vs. denial

"I think it's adaptive," says Lerner, an associate professor of medicine and public health at Columbia University. "There's sort of a healthy denial that goes on among people who get a terminal cancer prognosis."

When his patients appear to be in denial, "I'm reluctant to call them on that," Lerner says. "You've got to let people have some optimism."

But, he says, there is a danger that celebrity patients' optimism about serious illness "is potentially giving misinformation."

For example, John Edwards described his wife's metastatic cancer as a chronic disease like diabetes, although some breast cancer experts and, Wender says, probably some patients cringed when they heard that comparison. Diabetics can live for decades with their disease — far longer than most women with breast cancer that has spread to the bone.

"The important message is the course is variable, and there are women who continue to battle breast cancer once it's metastatic for years," he says. "I hope Elizabeth Edwards is enormously successful, but that doesn't mean the next woman will have the same experience."

Edwards' and Snow's cases illustrate that, at least for some patients with metastatic disease, current therapies "have turned cancer from just being a quick fight that you win or lose into a longer battle that has setbacks and skirmishes and triumphs," Wender says.

In his book, Lerner notes that Lance Armstrong "is careful to state that beating cancer is not the same as beating opponents in a bike race." Surviving cancer "was more a matter of blind luck," Lerner quotes from Armstrong's 2001 book, It's Not About the Bike: My Journey Back to Life.

"If (Edwards) does better than average, her story will be told that she was optimistic and that she fought it," Lerner says. "And if she doesn't, she'll be lionized as someone who tried her hardest and had bad luck."

A chance to educate

Whether Edwards will become a celebrity spokeswoman for breast cancer remains to be seen. University of Michigan internist A. Mark Fendrick in 2003 co-authored a paper about the "Couric Effect" — the upswing in colonoscopies after Katie Couric had one on Today in 2000. Her husband, Jay Monahan, died of colon cancer at 42.

"We're hopeful that America's obsession with people in the media can somehow be turned in a way to improve public education and cancer prevention behaviors," Fendrick says.

Edwards has talked about mammograms on the campaign trail. At a campaign event in Davenport, Iowa, this month, an audience member asked whether Edwards had had regular mammograms, The Des Moines Register reported.

When she was diagnosed with a half-dollar-sized tumor in 2004, Edwards, then 55, said she hadn't had a screening mammogram since son Jack, then 4, was born. The cancer society recommends annual mammograms for women 40 and older.

Edwards told the Davenport audience that her cancer might not have spread if it had been detected earlier.

"The trickier thing will be if she gets worse, will she talk about hospice, advanced directives, that sort of thing?" Lerner says. "That would really be entering new ground."