Cancer is appropriately perceived as a disease of risk: genetic or heritable risks, lifestyle risks and the unknown risks of chance. Modern medical science has begun to quantify these hazards for patients even before they get cancer.
The borders of “Cancerland”—a term the oncologist David Scadden coined with the title of his 2018 memoir—begin to feel all-encompassing. In the past, entry was reserved for those with a diagnosis of cancer. Today everyone, in one way or another, slowly becomes a citizen.
Two kinds of technology are radically altering the landscape of cancer risk and screening. The first involves genetic surveillance—the attempt to quantify an individual’s inherited predisposition for cancer. The second is physiological surveillance, which seeks to detect chemical markers of incipient cancers in blood.
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But they are not yet as precise as we might hope, and they come at a cost: By pulling increasing numbers of people into the domain of surveillance and screening, they encourage people without current cancer, but with the prospect of future cancer, to become citizens or permanent residents of Cancerland.
Settling into this domain can be life-distorting: As the shadow of future illness dilates and magnifies, so too do the shadows of anxiety and dread.
