Cancerisation: How the Modern Cancer Prevention Movement Changed Women's Relationship with Their Bodies and Time

Table of Contents

• Key Points
• Background: Why a Historian Is Speaking at a Cancer Conference
• The Historian's Dilemma: Cancer and Risk Are Modern Concepts
• Oncophobia: The Manufacture of Fear
• Statistics and the Disembodied Self
• Does Cancer Treatment Actually Work? The Effectiveness Question
• Secondary Analyses: Looking at the Bigger Picture
• Illness vs. Suffering: The Limits of Biocracy
• Women, the Moon, and the Destruction of "Lived Time"
• Two Thousand Years of Tumors: From Hippocrates to Galen
• Clinical Implications: What This Means for Patients
• Limitations: What This Essay Cannot Prove
• Recommendations for Patients
• Frequently Asked Questions
• Source Information

Key Points

• Cancerisation is a social and economic construct, not a natural phenomenon.
• Risk statistics separate women from their lived, felt bodies and cause anxiety.
• Some studies define success narrowly, ignoring overall survival and quality of life.
• Ancient physicians like Hippocrates, Celsus, and Galen advised against tumor intervention.
• Patients should question numbers, seek symptom relief, and protect their sense of hope.

Background: Why a Historian Is Speaking at a Cancer Conference

When Barbara Duden, a professor of history at the University of Hannover in Germany, was invited to open a 1997 conference on "Lives of Women and Cancer: Possibilities of Prevention" hosted by the German Cancer Society, she found herself asking a simple question: Why invite an historian?

Her field of study, she admits, is a "treacherous" one—it deliberately excludes the researcher from the present. As a historian of the body, Duden studies eras so distant from our own that the very concepts we take for granted today—including "cancer" and "risk"—simply did not exist. "Consumption, syphilis, malaria were the public enemies," she notes. Cancer, as a fact that shapes society, was not among them.

This historical distance gave Duden what she calls an "embarrassing privilege." While the conference organizers wanted to inject a new "consciousness of risk" into European women, Duden's goal was fundamentally different: to question whether that very consciousness helps or harms the women it claims to serve.

The Historian's Dilemma: Cancer and Risk Are Modern Concepts

Duden makes a critical distinction at the outset: her concern is not with cancer as a biological reality, nor with the suffering of patients, nor even with the stigma that surrounds the diagnosis. Her focus is on "cancerisation"—the process by which cancer becomes a form of social control in a society organized around risk. She cites Susan Sontag's landmark 1978 book Illness as Metaphor, which brilliantly differentiated between "the suffering of being ill under treatment" and "the suffering about the metaphorical interpretation of its diagnosis."

The historian's approach requires a radical admission of incompetence. Cancer and risk, Duden explains, are concepts "alien to the past." She acknowledges that archaeologists and cytologists can—and do—diagnose cancer in ancient remains. An Egyptian papyrus from antiquity has been read by modern oncologists as a description of cancer. Medieval bones show evidence of metastatic carcinoma in studies by Anderson, Wakely, and Carte (1992). But finding tumors in old bones, Duden argues, is not the same as finding "cancerisation."

A person in ancient Egypt or medieval Europe might have had a tumor, but they did not live under the ever-present shadow of "cancer as a fact that forms society." They did not fear cancer the way we do. They were not bombarded with statistics about their personal probability of developing the disease. They did not define themselves as "at risk."

This distinction matters because, as Duden points out, the modern fear of cancer is not natural. It is cultivated. "The cultivation of oncophobia provides income for hundreds of thousands of people, scares millions more, and makes hundreds of millions of profit for hospital architects, suppliers of machines and chemicals, and insurance businessmen." Conferences like the one she addressed, she says, "cheapen the education in oncophobia"—they use media attention to mobilize women, rich or poor, to take "prescribed precautions" and prepare them for medical intervention.

Oncophobia: The Manufacture of Fear

Why does information about cancer produce panic rather than reasonable caution? Duden offers two explanations.

First, tumors are easy to visualize. They suggest "a form of horror" that grabs the imagination. Cancer is not an accident waiting to happen on the road—it is something you fear growing inside yourself.

Second, and more deeply, cancer information is built on statistics—a way of thinking that, when translated into media images, becomes "a disquieting phantom." Duden describes how a statement like "zero point two percent probability in the next thirty years" comes accompanied by a visiotype: a curve on a graph onto which "your profile is projected." When you see yourself as a point on that curve, you "put yourself in the world of risk"—and that reduction, she argues, "causes fear and panic."

Duden is careful to distinguish between fear and anxiety:

• Fear is concrete, healthy, clear, and keeps you alert. Duden says she is afraid of drunk drivers on the road, of doctors influenced by pharmaceutical sales representatives, of a stranger lurking near her office at night.
• Anxiety is dark, hurtful, and keeps you awake at night. It "is the result of feeling trapped."

Cancer consultation, she argues, produces only the second. Oncophobia—the irrational fear of cancer—is "the consequence of reducing your self-definition to being a 'case.'"

Statistics and the Disembodied Self

Duden refuses to see herself as a "case" or a "profile of probabilities." She refuses to describe her pregnant colleague as a "risky case." She does not let her actions be influenced by probabilities. Why? Because, she explains, "the use of statistics removes me from my own reality; it makes it literally un-graspable, un-sensual, pointless."

Statistics, she argues, are used to create disembodiment—a separation between a woman and her own lived, felt, sensory body. As soon as you try to see yourself as part of a population or a statistical group, "you let yourself be influenced by probabilities that you think you are influencing." The result is a new kind of helplessness: a self that is detached from its own experience and dependent on external experts to tell it what to fear and what to do.

Duden cites the work of William Ray Arney (1995), a historian of statistics, who studied how systematic thinking reduces the self to a "case"—"a profile of a fixed number of characteristics." She concludes: "I do not know any other more intense conditioning for this kind of disembodied self-organization, at least for women today, for this helplessness-in-need-of-help, than the consciousness of risk in the context of cancer and children."

This propaganda for "chance and risk, probability and fact," she argues, leads unavoidably to confusion—educating the public about something that "essentially cannot be understood." The result is a profound and irrational anxiety.

Does Cancer Treatment Actually Work? The Effectiveness Question

Duden turns to what she calls "oncological self-criticism"—the studies of effectiveness, efficiency, and cost conducted within the oncology field itself. She finds them astonishing for several reasons.

The Mirage of Success

Most evaluations of specific cancer therapies report success—but the definition of success is often remarkably narrow. Duden gives a striking example: studies may report that "much fewer of the cohorts of women without a uterus die of metastases in the five years following a hysterectomy than women who were diagnosed but not operated." That sounds like good news. But then she asks the question the study doesn't answer: Whether or how much longer they live is not included in this research.

In other words, a woman might be counted as a "success" if she survives five years without a particular kind of spread—even if her overall lifespan is unchanged, or even shortened, by the surgery and its complications. The criteria, Duden says, are "cut to size to fit successful results."

The "Final Victory" Illusion

Thousands of research reports create the impression of a "final victory over cancer." An editorial in The Lancet (February 6, 1993), titled "Breast Cancer: Have We Lost Our Way?" made this point bluntly: "If one were to believe all the media hype, the triumphalism of the profession in published research, and the almost weekly miracle breakthroughs trumpeted by the cancer charities, one might be surprised that women are dying at all from this (breast) cancer."

Duden notes that political groups meanwhile "ardently encourage the fight" for cancer research funding—a fight that "supports the credibility of so-called progress." She draws an ethnological parallel: places of pilgrimage that specialize in one particular disease demand faith in miracles. In this case, the opposite is required: "I have to believe in the miraculous survival of tumors which have long since been overcome."

The Economics of Failure

Perhaps strangest of all, Duden observes, is the financial pattern: "The more obvious the failure, the more money there is available." Why do patients keep paying constantly increasing premiums "in order to be pointlessly tormented"? She offers a Viennese joke:

There was once more a revolution. At the center of town they had built a platform with a scaffold. Bobby climbs up. He sees the executioner with his ax and turns around on the last step to his fellow-sufferer Rudi and says: "Hey, how much do you think they get tipped?"

Secondary Analyses: Looking at the Bigger Picture

If individual studies tend to overstate success, what happens when researchers step back and analyze entire bodies of evidence? These "secondary analyses" or "system analyses" are statistical investigations that examine how therapy, diagnosis, and prevention affect mortality rates across whole age groups.

The results, Duden says, are sobering. "Most of the statements about the positive effects of cancer therapy turn out to be zero-hypotheses"—meaning that, when rigorously tested, the claimed benefits often fail to materialize. She phrases it with characteristic bluntness: "Many millions of breasts are cut off in pairs in order to come up with these results."

She quotes the American National Cancer Institute (NCI), which only began analyzing the harmful side-effects of cancer treatment in the 1990s: "We must not simply question effectiveness, but ask what harm these diagnoses do, and at what cost." This quote appears in a 1997 New England Journal of Medicine article with a telling title: "Alice in Wonderland of Breast-Cancer Screening."

Duden also recalls a concrete policy reversal: in 1993, the National Cancer Institute "took back its recommendation that all women over 40 years of age should start screening for breast cancer." When the NCI's own council produced evidence that screening was less useful than previously claimed, "attempts were made to prevent these obviously negative results from being officially publicized."

The institutional effort to evaluate cancer diagnosis and therapy dates back to at least 1926, when an International Symposium on Cancer Control was held under the auspices of the American Society for the Control of Cancer. Yet nearly a century later, the fundamental questions remain unanswered.

Illness vs. Suffering: The Limits of Biocracy

Duden draws a historical distinction between two concepts of medicine. Before the late eighteenth century, the doctor's aim was "to refresh, encourage, and yes, even heal the suffering patient." After that point, the doctor's role shifted: medicine now diagnoses a patient's "illness" whether the patient is aware of it or not.

This "biocracy"—the rule of medicine over life—is most visible, Duden argues, in the field of oncological algology, or cancer pain treatment. The paradox is striking:

• Painkillers are given more generously to cancer patients who have undergone therapy and are willing to die under medical control than to patients with any other illness.
• Yet strong analgesics have been criminalized for all patients who cannot afford a hospital deathbed, "under the pressure of the US drug paranoia."
• A poor woman in Mexico "has to buy her opiates on the black market because she couldn't afford to be operated," while only hospital patients can access doctors allowed to prescribe painkillers.

The new pain medicine, Duden concludes, "de facto serves to secure the further acceptance of aggressive and expensive therapies, even if they are mainly without success." It is not about relieving suffering—it is about guaranteeing that patients comply with treatment.

Women, the Moon, and the Destruction of "Lived Time"

Duden's central argument, reserved for her conclusion, is about time. She quotes the poet's image of women as "spinners of time"—connected to the moon, to cycles, to pregnancy as "a sign for an invisible presence and coming reality." This was a woman's sense of time: open, cyclical, oriented toward what has "not yet" happened.

Cancer prevention, she argues, destroys this "liveliness rooted in the woman's body." The constant awareness of risk—the checkups, the screenings, the statistical probabilities—replaces natural hope with what she calls the tyranny of the "NOT YET":

What used to be called 'Good Hope' in my childhood at Schliersee, now becomes, in the shadow of risk, a source of insecurity, gnawing fear and suffering because of something which has 'NOT YET' happened.

This is the deepest harm of cancerisation. It is not just about false statistics or questionable treatments. It is about "rape by a type of time that doesn't fit her body." The future becomes a threat rather than a promise. The woman's own body is detached from lived time, and she is left suspended in a permanent state of anxious anticipation.

Two Thousand Years of Tumors: From Hippocrates to Galen

Duden closes her historical survey by examining how ancient doctors actually understood tumors—and their conclusions may surprise modern patients who assume aggressive treatment has always been the norm.

The Hippocratics (c. 400 BC)

On the island of Kos, the so-called Hippocratic doctors differentiated among tumors, growths, and swellings of the breast, stomach, and uterus. They distinguished oidemata (soft cysts, mostly hot) from hard karkinoi (the root of our word "cancer"). And what was their therapeutic advice? They advised against therapy. This marks "the start of two thousand years of therapeutic nihilism."

Celsus (1st century AD)

The Roman medical writer Celsus shared this cautious view, believing that therapy "irritates tumors." In other words, the ancient consensus was that treating tumors could make them worse.

Galen (2nd century AD)

About a century after Celsus, Galen—perhaps the most influential physician in Western history—wrote De tumoribus praeter naturam ("On Tumors Beyond Nature"), distinguishing more than a dozen types of swelling:

• Phlegmone: throbbing, hot, and red swellings
• Polysarkia: "watery boils"
• Kolpai: swellings that fester
• Karkinoi: hard swellings that only become painful when they break through the skin, after which they become festering phagedaina (eating sores)
• Aneury smata: swellings in which blood has built up
• Elephas: swellings of lepers
• Myrmekia: warts
• Psydrakes: pimples
• Epiknyktides: swellings produced by insect bites
• Kirsoi: what we would now call varicose veins

Most of these swellings, Galen believed, were caused by a blocked gallbladder—and he too strongly advised against intervention. (The original manuscript ends mid-sentence at this point, cutting off Galen's final recommendation.)

This historical record matters because it shows how radically our approach has shifted. For two thousand years, the most respected physicians in Western medicine counseled restraint. The modern oncology enterprise, by contrast, is built on aggressive early intervention—an approach that Duden suggests may be based more on institutional and economic imperatives than on solid evidence of benefit.

Clinical Implications: What This Means for Patients

Duden's critique has direct relevance for anyone facing cancer screening or treatment decisions today:

1. Question the numbers. When you are told you have a "0.2% probability" of developing cancer, remember that statistics describe populations, not individuals. Your body is not a point on a graph. Duden argues that statistical thinking "removes you from your own reality" and replaces lived experience with abstract risk.

2. Ask about the definition of success. As Duden's hysterectomy example shows, a study may report that fewer women died of metastases within five years—while remaining silent about whether they actually lived longer or better. Before agreeing to any intervention, ask: "What does success mean in this study? How is my overall survival and quality of life affected?"

3. Distinguish fear from anxiety. Fear is concrete and alerts you to real dangers. Anxiety—especially the kind generated by risk messaging—is dark, diffuse, and paralyzing. If a screening recommendation is making you anxious rather than informed, that is a problem with the messaging, not with you.

4. Seek relief from suffering. Duden's critique of cancer pain treatment is a reminder that symptom relief should be a fundamental right. If you are in pain, you should not have to "earn" painkillers by submitting to aggressive therapy. Palliative care is not a reward for compliance.

5. Protect your sense of time. One of Duden's most poignant points: prevention messaging can transform the future from a place of hope into a source of dread. Living in constant anticipation of the "NOT YET" is a form of suffering in itself. It is legitimate to make health decisions that preserve your capacity for hope and your connection to your own lived time.

Limitations: What This Essay Cannot Prove

Duden is remarkably candid about the limits of her own argument. As an historian, she denies any competence to judge whether modern cancer treatment "works" in a biological sense. She cannot say whether the biological confusion called "cancer" refers to a real similarity in physical changes, or whether the concept was "melting-pot" created so that therapeutic attempts could deal with different incurable illnesses.

She also notes that the fundamental questions remain open:

• Was the entity called "cancer" invented as a focal point in order to finance the oncological complex?
• Is the symbolic enemy of cancer—"as diffused as communism used to be"—an ideology for gender-specific discipline?
• Or is oncology "the seed of an enterprise" that will, after the Human Genome Project, supply "follow-up projects of the Malthusians and Eugenics"?

These are questions, not conclusions. Duden states explicitly: "If I observe the present time from the perspective of cancer-economy, I am not able to come to any kind of conclusion, not even to an assumption of a conclusion."

It is also important to note that this essay was written in 1997. Some specific policy details have changed since then. However, the deeper arguments about risk consciousness, statistical thinking, and the experience of time remain relevant—indeed, they have only intensified in the decades since.

Recommendations for Patients

Based on Duden's analysis, patients can take several practical steps:

1. Educate yourself about the statistics behind screening recommendations. Look beyond headlines to understand what "success" actually means in clinical trials—including how overall survival, quality of life, and harms are measured.
2. Ask pointed questions: "What are the chances this test or treatment will extend my life? What are the chances it will harm me? What do the number of needed screenings versus lives saved actually look like?"
3. Remember that "watchful waiting" is a legitimate option. For two thousand years, from Hippocrates to Galen, the most respected physicians in history advised against aggressive tumor intervention. Modern medicine has swung toward early intervention—but that shift was driven by tools, institutions, and economics, not solely by evidence.
4. Notice how risk messaging makes you feel. If a screening campaign is producing anxiety, sleeplessness, or a sense of dread about the future, that is a real harm. Your emotional and temporal wellbeing are part of your health.
5. Advocate for pain relief. Do not accept that strong pain medication should be reserved for patients who undergo aggressive therapy. Your suffering deserves treatment on its own terms.
6. Protect your sense of hope. Duden's central message is that the "NOT YET" should be a source of openness and possibility, not of gnawing fear. Whatever medical decisions you make, guard your capacity to live in the present and to look forward to the future.

This essay does not tell patients what to do. It tells them something more valuable: that the choices they face are framed by a system with its own institutional interests, that the language of risk is not neutral, and that their own bodily experience and sense of time are legitimate sources of knowledge. As Duden says of herself: "I do not see myself as a 'case.'"

Frequently Asked Questions

What is “cancerisation” and how is it different from cancer?

Cancerisation is the process by which cancer becomes a social and economic construct, creating anxiety and social control around risk. It is distinct from cancer as a biological reality. According to the essay, it changes women's relationship with their bodies and time, replacing natural hope with fear of a “NOT YET” disease.

Does cancer screening actually save lives according to this article?

The article questions screening effectiveness. It cites that in 1993 the U.S. National Cancer Institute took back its recommendation that all women over 40 start breast cancer screening, after evidence showed screening was less useful than claimed. Secondary analyses often show that positive effects of cancer therapy turn out to be zero-hypotheses.

Why does risk information about cancer cause anxiety rather than caution?

The essay says cancer information is built on statistics, which translate into a “disquieting phantom” when your profile is projected onto a graph. This reduces a woman to a statistical “case,” separating her from her lived body and causing anxiety—dark, hurtful, and paralysing—rather than healthy, concrete fear.

What did ancient physicians recommend for tumors?

According to the article, Hippocratic doctors around 400 BC advised against therapy for tumors, starting two thousand years of therapeutic nihilism. Celsus in the 1st century AD believed therapy irritates tumors, and Galen in the 2nd century AD also strongly advised against intervention for most swellings.

How is “success” often defined in cancer treatment studies?

The article says success criteria are often narrow. For example, a study may report fewer women died of metastases within five years after hysterectomy, but whether they lived longer or better overall is not included. Thus, a woman could be a “success” even if her lifespan is unchanged or shortened.

Is watchful waiting a legitimate option for cancer?

Yes, the article emphasizes this. For two thousand years, from Hippocrates to Galen, respected physicians advised against aggressive tumor intervention. Modern medicine shifted to early intervention, but that shift was driven by tools, institutions, and economics, not solely by evidence. Watchful waiting remains a legitimate option.

What can patients do to protect themselves from the anxiety of risk messaging?

The article recommends questioning the numbers, asking what success means in studies, distinguishing fear from anxiety, advocating for pain relief, and protecting your sense of hope. Patients should remember that statistics describe populations, not individuals, and their own bodily experience and sense of time are legitimate sources of knowledge.

When should a woman with a cancer diagnosis or facing screening decisions seek a second opinion, given concerns about risk statistics and treatment effectiveness?

A second opinion is valuable when you feel reduced to a statistical 'case' or when risk messaging causes anxiety rather than clarity. The article highlights that success in studies is often narrowly defined, such as fewer deaths from metastases within five years, without addressing overall survival or quality of life. If a recommended treatment or screening feels driven by institutional interests rather than your lived experience, seek independent review. Protect your sense of hope and time. Diagnostic Detectives Network provides independent expert second opinions.

Source Information

This patient-friendly article is based on peer-reviewed research. The original work is an invited contribution presented at the international conference of the German Society for Cancer, titled "Lives of Women and Cancer: Possibilities of Prevention," held in Frankfurt, Germany, on October 29–30, 1997.

• Original title: "Cancerisation: The Historian of the Experienced Body Faces the Contemporary Phenomenon of Cancer Prevention"
• Author: Prof. Dr. Barbara Duden, Universität Hannover, Kreftingstr. 16, D-28203 Bremen, Germany
• Translation: Nasha Abadian; corrected by Mother Jerome
• Status: The German manuscript is not published; translation distributed among friends only
• Contact: Silja Samerski, Kreftingstr. 16, D-28203 Bremen (as listed in the original)

Key scholarly sources cited in the original essay include:

• Sontag, S. (1978). Illness as Metaphor. New York: Farrar, Strauss and Giroux.
• Luthi, F. (1996). "Le cancer est-il une maladie nouvelle?" Gesnerus 53(3-4): 175-182.
• Pahl, W.M. (1986). "Tumors of bone and soft tissue in ancient Egypt and Nubia." International Journal of Anthropology 1(3).
• Anderson, T., Wakely, J., & Carter, A. (1992). "Medieval examples of metastatic carcinoma." American Journal of Physical Anthropology 89(3): 309-332.
• Hartunian, N.S. (1981). The Incidence and Economic Costs of Major Health Impairments. Lexington Books.
• Editorial (1993). "Breast Cancer: Have We Lost Our Way?" The Lancet 341: 343-344.
• Proctor, R.N. (1995). Cancer Wars: How Politics Shapes What We Know and Don't Know About Cancer. New York: Basic Books.
• Fletcher, S.W., et al. (1997). "Wither Scientific Deliberation in Health Policy Recommendations? Alice in the Wonderland of Breast-Cancer Screening." New England Journal of Medicine, April 17, 1997.

Note: This essay reflects the author's critical perspective on cancer prevention as a cultural and historical phenomenon. It is not medical advice, and patients should make treatment decisions in consultation with qualified healthcare professionals.