“Life is structured like a language and disease is a misunderstanding” (Georges Canguilhem)

Cancer and ‘Chance’ – where Error is the Mark of Life, without which evolution would not have been possible. Lucretius invoked the swerve of chance, the ‘clinamen’,  to explain how atoms first collided so that anything ‘at all’ could happen. Cancer mutations seem to be a chance random event, mostly.

You might think that if it was known that cancer is mostly due to chance and not to environmental factors that this would be a good and reassuring thing to know.  After all, we would no longer have to worry so much about the possible harmful effects of lifestyle, diets etc. and could be more carefree.

A study (see REF below) has just asserted that because the rates of cancer are directly proportional to their stem cell division rates, that two thirds (21) of the cancers examined are due to chance mutations and not environmental factors, and that one third of the cancers (9) had rates that were in excess of that expected from the stem cell division rate, and therefore have an environmental influence.  Notably though breast cancer and prostate cancer were not examined because reliable stem cell division rates are not available, or so the authors claim.

However, even if breast cancer is mostly due to chance; and even if at the same time cancer becomes a ‘better’ way to die (see Richard Smith’s blog in the BMJ) than other ways (time to say goodbye, put affairs in order, achieve some ambitions); ‘eradication’ of cancer is cited still cited by the authors (and notably juxtaposed here as what the Subject-of-EBM should next think) as requiring early diagnosis.  Early diagnosis and better treatments rather than cure is receiving an extra bright spotlight. If cancer is to be (officially) less feared, this does not address the decisions to be made about borderline tissue representations from screening investigations, it also emphasises that a negative screening test is no longer reassuring since once the result is known, the ‘chance’ mutation could occur in the very next second; this sets up a paranoid repetition compulsion, this could have two opposing effects:

“Cancer is not only an OK diagnosis, ‘Phew I can say good bye’ and as Bunuel says I will know who closes my eyes…it is also (perversely) desirable because it means it might have been discovered early enough, that is just after the ‘chance’  mutation’  has occurred, in time to be ‘cured’.”

A negative result leaves a persistent (fear of the) fear of cancer; and a compulsion to re-screen yourself as soon as possible: constant anxiety and constantly repeated screening is the result.  It can be seen that the ‘chance’ factor adds an important element of time-pressure. A logic of time now has interpellated the subject as always already in the position of requiring urgent screening a moment ago. I do wonder whether there may be additional factors explaining the exclusion of breast and prostate cancers from the study on ‘chance’. Is there some reason why it would be unacceptable to say breast cancer is due to chance?  There is a vociferous element advertising preventable causes of breast cancer but I don’t know how powerful they are. It may be that the division rates for breast and prostate cancer are difficult to estimate for technical reasons I am unaware of.

An  unpredictable ‘chance’ cancer is Freud’s death drive (instinct) at work, it results in an emotional discharge and libidinous drive, the life instinct, to oppose it. The less predictable the harder it is to oppose, and the more sado-masochistic energies are expended paranoically in detecting the moment of mutation so that it can be neutralised. The screening frenzy that is ensuing is a self fulfilling prophecy since borderline diagnoses (or ana-gnoses, **qv) are compelled to appear and to be diagnosed as ‘precancerous requiring treatment’ by ever-deeper penetrations into the tissues/molecules by technologies revealing ever more mysterious representations that must be explained.  The cunning secret of the Order of EBM is that its ana-gnostic representations do not have a discernible meaning – they make non-sense, and it is this that must be disavowed.  If the subject suffers a crisis of investiture (after Santner, and his analysis of Schreber’s memoirs of his illness in ‘My Own Private Germany’), then transgressive behaviours may result.

REF [Variation in cancer risk among tissues can be explained by the number of stem cell divisions: Science 2 January 2015: Vol. 347 no. 6217 pp. 78-81 Tomassetti, Vogelstein.]