The following is an excerpt from Nafis Hasan’s new book, Metastasis: The Rise of the Cancer-Industrial Complex and the Horizons of Care, published by Common Notions. Listen to an interview with Hasan on the latest episode of CounterPunch Radio.

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Every major armed conflict since World War I has created significant cancer clusters among both civilians and soldiers. The atomic bombs dropped on Japan resulted in a 660 percent increase in leukemia rates among survivors living near the detonation zone, even twelve to thirteen years after the bombing. Increased risks for several types of solid cancers are also observed among the same population to this day. Women exposed to the bomb radiation during puberty showed higher risks of developing uterine and breast cancers than those exposed before or after puberty. The radioactive fallout from nuclear weapons tests in the Marshall Islands between 1946 and 1958 also eviscerated the Marshallese from within––55 percent of all cancers among the Rongelap community are attributable to the radioactive fallout.

The indiscriminate use of Agent Orange, the chemical weapon used by the US military in Vietnam, resulted in increased risks for cancers of the mouth, salivary glands, stomach, and small intestine among military personnel. Vietnamese civilians exposed to Agent Orange also showed an increased prevalence of cancers, with more cancer incidences occurring at higher dose exposures. The cancers inflicted on the enemy came with collateral damage––according to a US Centers for Disease Control (CDC) study, Vietnam veterans have an increased risk of non-Hodgkin’s lymphoma. Another study by the Australian Institute of Health and Welfare showed male Vietnam veterans had a higher risk of prostate cancer, which correlated with length of service.

The War on Terror that led to the invasion of Iraq resulted in a 2,200 percent increase in leukemia rates among children in Fallujah due to the carpet bombing of the region within five to ten years of the bombings. There was a 1260 percent increase in rates of other childhood cancers and a 740 percent increase in brain tumors. Another study showed an increase in childhood leukemia rates in Basra and patients exhibiting multiple tumors simultaneously. The US veterans did not escape either––exposure to burn pits drove up non-Hodgkin lymphoma rates in male soldiers and breast cancer rates in female soldiers. Active-duty service members in the US suffer higher rates of breast, testicular, and melanoma cancers than their age-matched civilian counterparts.

At the time of writing, the only cancer hospital in the Gaza Strip has been closed by Israel’s siege. The thousands of cancer patients in Gaza await death due to the lack of medicine, if they were not already killed in the strikes on the Al-Rantisi Hospital. The cancerous effects of the thousands of pounds of bombs—that the US has supplied and Israel has dropped on Gaza’s dense, urban areas—have yet to be observed. However, as history teaches us, there will be an upcoming surge.

Survivors

The embedding of individual responsibility within thirties-era early detection and cancer awareness campaigns by the Women’s Field Army (WFA) had far-reaching implications on the social perspectives of (women) cancer patients. In the thirties and forties, when cancer was a taboo topic, the WFA organized in military fashion to campaign aggressively on a message of hope. The WFA commander Marjorie B. Illig went on public radio to declare, “Our war . . . it is a war to save human life, a war for health and happiness. We are not using bayonets or tanks or machine guns; our weapons are leaflets and lectures. . . .This war is against one of the greatest enemies of health. It is against cancer.” The military-style campaign to raise awareness about cancer imbibed the public with the war metaphor. Following the military logic of personal sacrifice and responsibility, a woman sacrificed her cancerous breast to the surgeon who would perform a radical mastectomy––creating a survivor and a hero, respectively. While cancer was ultimately situated as an individual responsibility without political or social dimensions, the question of who gets to be a survivor was and remains a political one.

During World War II, the ACS and WFA doubled down on the military metaphor, creating a map highlighting where its “cancer defense” forces were active. Commander Illig declared the month of April, originally commemorated as the Cancer Control month, as “[WFA’s] battle month.” The WFA also partnered with the Cured Cancer Clubs, first established by Dr. Anna Palmer, a retired physician and a breast cancer patient who had remained cancer-free for eighteen years and wanted to show the world that cancer was curable. These clubs informed the WFA’s optimist messaging, a predecessor to the now ubiquitous slogan that early detection saves lives. The bombing of Pearl Harbor forced the WFA to step back from their aggressive war of words; by 1944, Mary Lasker successfully wrested control of the ACS in a bloodless coup and the WFA’s activities came to an end.

Early detection was at the core of WFA’s messaging; the organization firmly believed that if more women consulted doctors earlier about their breast cancers, more lives would be saved. While no one could point to a definite cause of cancer, the narrative remained that cancer caught early could be surgically removed, resulting in a cure. The WFA’s aggressive campaign was not welcomed by all––many physicians and their colleagues were suspicious of the WFA trespassing on their territory. The doctors alleged that the WFA was providing medical information to patients, an act outside their expertise, and a violation of social gender norms. The predominantly male doctors did not take kindly to a host of women, mostly housewives, talking to their patients. To assuage their fears, the WFA stressed the responsibility of the individual in maintaining their own health; the WFA New York commander wrote to the medical societies, “individual responsibility has been the keynote of the movement . . . as it is the keynote of democracy.”

Before survivor became a term of empowerment, cancer patients were seen as victims at best and complicit in their own demise at worst. A 1947 Journal of American Medicine paper reflecting on the failure to stem cancer mortality squarely blamed the cancer patients themselves for failing to seek earlier treatment. By the fifties, early detection had become synonymous with cancer control and prevention. The ACS’ relentless campaign presented a “sanitized” version of the disease, one that solely hinged on individual responsibility and lacked any political or social dimensions. In the Cured Cancer Clubs and public media, cancer patients and doctors described their personal experiences without speculating on the cause of rising cancer incidence and mortality.

In the eighties and nineties, cancer activists took cues from feminist movements against sexual abuse and domestic violence. Cancer patients were now seen as cancer survivors and cancer warriors, not hapless victims. Reflecting on her personal experience with breast cancer and mastectomy, Audre Lorde wrote in 1980, “[W]omen with breast cancer are warriors, also. I have been to war, and still am. So has every woman who had had one or both breasts amputated because of the cancer.” In rejecting the label of victim and embracing her body with battle scars, Lorde reclaimed her agency as a woman, and not just a patient at the mercy of a disease, the healthcare system, or the environment. The notion of cancer survivors received official legitimacy with the formation of the National Coalition of Cancer Survivorship (NCCS), which advocated for survivors’ rights by lobbying for increased research funding, educational programs, and access to quality care. The NCI established the Office of Cancer Survivorship to study the aftereffects of cancer treatment and quality of life among cancer survivors; the private nonprofit sector followed suit in 1998.

By the early 2000s, survivorship had become the mainstay for cancer narratives and public discourse around cancer. Samantha King writes that Lorde’s vision was finally realized––women with cancer were no longer seen as victims or patients and were free of shame and self-harm. However, the meteoric rise of “survivor” as an identity drowned out any alternative experiences, cancer’s long-term effects, and the political and economic context of the disease and its treatments. Barbara Ehrenreich scathingly repudiated the uncritical celebration of survival––the “tyranny of cheerfulness” (as King dubbed it) ––“in the overwhelmingly Darwinian culture that has grown up around breast cancer, martyrs count for little; it is the ‘survivors’ who merit constant honor and acclaim. They, after all, offer living proof that expensive and painful treatments may in some cases actually work.” Some harrowing accounts of breast cancer notwithstanding, mainstream narratives remain focused on the “triumphalism of survivorship” in which the disease helped the survivors celebrate life and find true happiness. Ehrenreich exposed the hidden assumptions that have driven cancer treatment strategies and clinical trials.

The survivor identity that arose from the embedded kernel of personal responsibility within cancer awareness campaigns became a distorted version of Lorde’s wish that fighting cancer and fighting for one’s self would mean “recognizing the enemy outside and the enemy within” without “ignoring the strength and the barbarity of the forces aligned against.”

Race and Class Wars

There are “wide persistent cancer disparities” between social groups. Black people have twice the mortality rate for prostate, stomach, and uterine cancers as white people; Native Americans have twice the mortality rate for liver, stomach, and kidney cancers as white people. Racial disparities in cancer outcomes have been reported since the eighties––African Americans consistently have the highest mortality rates and disproportionately higher incidence rates for lung, breast, prostate, colorectal, and cervical cancers. Hispanics, Latinos, Asians, Pacific Islanders, and Native Americans suffer from higher stomach cancer incidence and mortality rates. Native Hawaiians have the highest breast cancer mortality rates of all racial and ethnic groups.

The Institute of Medicine has shown that these disparities arise from a combination of economic, social, and cultural factors. Epidemiological studies have shown that outcome disparities do not improve over time, despite aggressive mammography screening programs in nonwhite populations and after adjusting for stage of cancer at diagnosis. In fact, the disparity in death rates from all cancers combined is worse for Black men and women than their white counterparts. However, there is no inherent biological factor behind these outcome disparities; racial gaps in outcomes remain when Black and white patients have the same breast cancer type.

The reasons behind the persistence of such disparities are partly explained by socioeconomic status (SES): factors such as poverty, lack of education, health insurance or access to it. In 2022, 54.5 percent of the US population had employment-based health insurance coverage; 61 percent had private insurance. Without a universal healthcare plan, these US cancer patients are left at the mercy of their employers or the private healthcare industry, the latter of which saddles Americans with debt while siphoning off taxpayer money. In 2021, a Stanford study estimated that Americans faced $140 billion in medical debt, making medical debt the top source of debt collection. Those enrolled in Medicare are at the mercy of the pharma companies as patients, or healthcare and pharma companies as taxpayers.

Income certainly dictates the quality of care a cancer patient receives. It is also true that income inequality is an indicator of poor prognosis––US counties with persistent poverty have higher mortality rates for all cancer types; high-income counties have lower cancer death rates than middle- or low-income counties. However, SES cannot explain all racial disparities. M.N. Oliver, a prominent scholar on racial inequalities in health, notes that while substantial research between 1960 and 1990 revealed that class relations determined health outcomes, such a framework fell out of favor for the more politically accommodating framework of SES. In Oliver’s view, racialized class relations relegate African Americans to the working class and, therefore, form part of the “causal pathway by which race affects health.” The categories that make up SES––occupation, income, education––are all related to the production process, the relationship between workers and bosses. Thus, any disparities arising from such social relations can be explained by the social structure of power differentials. In other words, disparities in cancer outcomes are due to racial capitalism.

Military vernacular pervades every aspect of cancer research and treatment because it is interwoven within society at large to promote a revanchist idea of conquest against an invisible enemy lurking within oneself. The history of battle is written by the victors, who frame cancer as an enemy. Only survivors get to write the history of progress, and they often gloss over the casualties. The framework of war and individualizing of the disease erase who or what is truly responsible for cancer and its casualties. A sprawling non-profit ecosystem also provides a social grifting gateway for war profiteers and cancer-causing corporations. The real War on Cancer should be waged against capitalist relations.

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