Euphemisms

Every week I receive a newsletter from World Wide Words, an interesting site if you enjoy words and language. This week there was a section about two new books on euphemisms which says

You might think of them as oil in the wheels of society, allowing us to discuss, using circumlocutions, matters that are too hurtful or shaming to be spoken of directly and which often replace a negative concept with a positive one. Others regard them as genteelisms that cloak our thoughts as well as our speech.

As some of you may know my mother has cancer. It is in fact bowel cancer and that is causing some interesting moments because my mother can’t bring herself to say bowel, let alone mention any bodily functions. I can’t imagine how she communicates with her doctor, with oblique references to “well, you know”. I let her go her own sweet way without troubling her sensibilities but my sister, at a safe distance of several thousand miles, confronts her head on with direct questions.

In this case I believe that I am experiencing the second of the suggestions – cloaking our thoughts as well as our speech. Her doctor and the nurses seem to find it impossible to tell me what is going on or what to expect. We have all been dancing around avoiding every possible fact.

It was a great relief to talk, eventually, to the surgeon whose call I was expecting during the so-called training session last week. He at least was able to tell me what I needed to know perfectly directly, as I expected he would. No holds barred there, but he is my hero-who-can-do-no-wrong of the moment.

Breast cancer awareness

From the University of Oxford news of a study which questioned almost 1500 women and found that they were unaware of the increasing risk of breast cancer caused by age.

They were given a choice of 10-year age bands and had to choose where the greatest risk lay. 99% of the women questioned answered incorrectly, 56% saying age doesn’t matter. Only 0.7% answered correctly that a woman in her 80s had the highest risk.

Age is the strongest risk factor for breast cancer, with the chance being 1 in 25 compared with 1 in 70 for a woman in her 40s. The researchers think that the confusion is partly the “Kylie” effect of publicity for younger, well-known women who have been diagnosed, and partly because routine screening is offered only up to the age of 70 in the UK, even though an older woman can request an appointment.

The study was funded by Cancer Research UK and the Breast Screening Programme.

When you couple this with the very recent report from the University of Manchester which highlights a lower level of care for older women, things start to look very depressing for older women. They are likely to present late, and receive worse care when they do. The Manchester study found that women over 80 compared with women between 60 and 69 are less likely to:

• have a triple assessment (clinical evaluation, imaging, cytology/histology)

• receive surgery

• have a steroid receptor test to assess the efficacy of tamoxifen

• if they do have surgery they are less likely to have radiotherapy

The main drawback of this study would seem to be that they didn’t take into account the preferences of the patients which may have a considerable bearing on the results, but with the population aging as it is, and with people staying fitter and more active longer, it is important that women realise that they are at increased risk and do continue to be vigilant, and that they receive the care and attention they need if they do need treatment.

I do believe, at least among the general public, there is an attitude that sees disease in old age as inevitable and hardly worth treating. I remember when my father in law died from a heart condition people were inclined to shrug as if to say, “well he’s old” whereas one imagines they would express more concern for a younger person. This must inevitably mean that more money/effort will go to charities funding research into areas which are perceived as problems for younger people, breast cancer included it seems. I recently came across someone who had been for a cervical smear test and had met a woman there in her eighties. To my horror my acquaintance expressed surprise and said “at that age, why bother?”

Advances in breast cancer detection

I've been in my present job for something like nine or ten years. In that time my then CEO's wife and two colleagues have died from breast cancer, and at the moment two colleagues' wives and another colleague have been diagnosed and are undergoing treatment. Yet another is waiting for an appointment at the hospital for further screening. All this out of a group of 50 to 60 people. It is utterly horrific.

So when I was yet again looking at Dr Dork's Grand Rounds, this post about detecting cancer early (two posts really) by Respectful Insolence caught my eye. It's long and involved but well worth reading if it interests you at all. It tells of how the recent advances in early screening can distort the apparent advances in treatment outcomes, and questions whether early screening is always an advantage.

I still think back to when the head of department of cancer sciences phoned one evening to ask me to apply for a job that was going. There was a situation developing in my present job which made me feel it wouldn't be fair to leave, so I didn't follow it through. Sometimes I wish I had.