Their words stun, even sting, years later. “I wish I had breast cancer,” Penny said on the video. “I wish I had testicular cancer,” Andy added. Both had been diagnosed with metastatic pancreatic cancer, a disease with an extremely low survival rate.
And that was the point of their public service announcement: While 89 percent of breast cancer patients and 95 percent of testicular cancer patients are alive five years after diagnosis, Penny and Andy didn’t expect to see that milestone. In fact, Andy died months after taping that 2014 video. He was 42.
But the campaign riled many cancer patients. Some called it insensitive because it suggested other cancers are more preferable. Some called it divisive because it stoked a strange competition that exists among people with certain malignancies, a phenomenon dubbed “cancer envy” by some and “the cancer hierarchy” by others.
Cancer survivors like Wendi Dennis deride it all as “the disease Olympics” — an unfortunate game of “who has it worse.” That controversial video remains emblematic, prompting Dennis to describe it with one word: “Yikes!” More broadly, instances of “cancer one-upmanship” remain an undercurrent of the cancer culture.
“It isn't nasty intentionally. It’s tone deaf and ignorant and produces reactions that can skew nasty,” Dennis said via email. In 2010, she was diagnosed with stage 3 breast cancer, undergoing chemotherapy, radiation and surgery. Today, Dennis, who lives in Maryland, has no evidence of disease.
Sure, humans tend to measure themselves against others on countless levels — money, looks, family, Facebook. Comparing dire health situations — including cancer — is just part of that psychology. It can even be therapeutic when the competitive aspect is removed, experts say.
“It’s absolutely normal and helpful to compare our experiences when we are facing an unknown situation,” said Dr. Karen Syrjala, a psychologist and co-director of the Fred Hutchinson Cancer Research Center Survivorship Program. “We even use this approach clinically by ‘normalizing’ an abnormal situation with descriptions of other people’s experiences.
“It might be a new cancer or treatment or even scary, bad news. It’s especially helpful when people are able to hear about others at a similar place in their lives,” Syrjala said.
Interviews with cancer patients, survivors and bloggers indicate there are at least three basic levels on the “cancer Olympics” podium. Here’s a brief tour through each version.
This can be overt, as with the pancreatic cancer campaign. This also can be subtle.
Earlier this year, a lung cancer advocacy group published a flier noting that lung cancer annually kills more U.S. women (about 72,000) than breast cancer (about 40,000). However, lung cancer remains “the hidden women’s cancer,” the flier read, with research funding levels lagging far below those for breast cancer.
Dennis, who blogs as "the Cancer Curmudgeon," said “the biggest divide I perceive is between lung cancer and breast cancer” and this seems to be driven by “the higher body count lung cancer causes.” That disturbs her.
“The high or low body count doesn’t matter to the one doing the dying, or to the ones that love them,” Dennis wrote in a recent blog on this topic. “We can argue about which disease community has it worse all damn day. The answer will always be not one community — no, it will be the dead, regardless of the cause, and their loved ones. They have it the worst. There is no competition.”
From a psychologist’s view, people have different ways of thinking that help them cope with traumatic events. Those differences are often expressed in stark themes or tones — including the notion that they are walking a far harder (or far easier) road than other patients, Syrjala said.
“Some people emphasize how their situation, even when it looks dreadful from the outside, could be worse and is better than someone else’s. Other people tend to think nothing could be worse than what they’ve had to endure, and I’ve never found them receptive to the idea that it may not be that bad,” said Syrjala, who is also director of Behavioral Sciences in the Clinical Research Division at Fred Hutch.
In her experience, she’s learned that it’s helpful to validate how bad the situation is or how scared the patient or survivor must feel — but also how well they’re managing given the medical difficulty they’re facing, she said.
“Then I move on to what could make things better for them or to what might have been gained from their terrible experience,” Syrjala said, “rather than sticking with the topic of who has it worse. There’s just no gain in staying with that topic.”
No question, various cancers and different disease stages have better long-term outcomes, on average, than others. That’s the cold, mathematical reality.
But some patients who are diagnosed with cancers caught early and with forms that require minimal treatment come to believe they don’t have “real cancer.” Sometimes, other patients make them think that way.
Breast cancer survivor Marie Ennis-O’Connor has encountered this sentiment with the readers of her blog, Journeying Beyond Breast Cancer. One woman confided that fellow breast cancer patients in a support group had made her feel “like a fraud” because she had undergone less-intensive treatment than they had and, thus, “I hadn’t gone through as much agony.” Another woman revealed to Ennis-O’Connor that because she was not treated with chemo (but with radiation and surgery), “I didn’t want to make any fuss when so many others had real cancer.”
“Is there a hierarchy among cancer survivors?” Ennis-O’Connor wrote in her blog. “Do some of us ‘suffer’ more than others? Are some of us ‘braver?’ Do some of us look up to/look down on others who have ‘suffered’ more/less?” (She purposely used those cancer clichés, like “suffer” to underscore her message).
She then answered her own questions: “Cancer is cancer, is cancer, and how you process that, regardless of the treatment you did/didn’t receive, can only be truly assessed according to your own individual experiences.”
But patients often voice that sense of being unworthy to hold a place in serious cancer conversations, said Tammy Weitzman, a clinical oncology social worker at Seattle Cancer Care Alliance, Fred Hutch’s clinical care partner.
“I hear that all the time from patients,” Weitzman said. “You can have somebody who, say, has chronic-phase leukemia or they’re on an oral chemotherapy and they look well and for the most part are functioning well, and they feel guilty for even sitting in the waiting room because what they have is essentially well managed.
“They feel grateful for that but, at the same time, they think: ‘What am I doing here in this waiting room? I’m not that sick and I’m taking away from somebody else.’ It’s a form of guilt,” she said.
This corner of the “cancer Olympics” can sound a bit like a humble brag. But it also can be a sincere rallying cry from patient to patient, a moment when one person is simply trying to inject optimism and remove fear in another.
“This is not uncommon at all amongst cancer patients to help newly diagnosed patients alleviate stress (or) give one hope and support,” said Randy Broad, a lung cancer survivor from the Seattle area, He was treated at SCCA.
Broad hasn’t encountered the “cancer hierarchy,” he said. Turning any cancer into a badge of honor and using that to compete with other patients is “incomprehensible,” added Broad, who was diagnosed with and treated for stage 3 non-small-cell lung cancer. Since the end of 2008, he’s had no recurrence.
But he remembers a fellow patient — he describes her as his “stage 3 lung cancer mentor” who embodied some of that rallying-cry attitude.
“I recall her downplaying her treatment almost as if it was like having a cold, stating (it was) no big deal,” Broad said.
“She is no longer with us, by the way.”
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Bill Briggs is a former Fred Hutch News Service staff writer. Follow him at @writerdude. Previously, he was a contributing writer for NBCNews.com and TODAY.com, covering breaking news, health and the military. Prior, he was a staff writer for The Denver Post, part of the newspaper's team that earned the Pulitzer Prize for coverage of the Columbine High School massacre. He has authored two books, including "The Third Miracle: an Ordinary Man, a medical Mystery, and a Trial of Faith."