Thinking About Skin Cancer as a Chronic Disease
A while ago, when someone who knew I had had skin cancer asked me how I was, I said I was clear…for now. But I said I knew that I would most likely get more squamous cell cancers down the line. How do I know? Because more than one doctor has told me that due to my medical history, that’s the way it is.
Is it chronic or isn't it?
This got me to thinking about how in one sense of the definition, my skin cancer is a chronic disease, but in many others, it isn’t. It adheres to the Merriam Webster definition of chronic as something that is “continuing or occurring again and again for a long time,” but falls outside of the CDC’s definition of “conditions that last 1 year or more and require ongoing medical attention or limit activities of daily living or both."1
MedicineNet.com states, “A chronic disease is one lasting 3 months or more, by the definition of the U.S. National Center for Health Statistics. Chronic diseases generally cannot be prevented by vaccines or cured by medication, nor do they just disappear."2
As the authors of an article in Frontiers in Public Health wrote, “There is not only tremendous variation in the diseases that are included under the umbrella term ‘chronic disease’ but also variation in the time a disease must be present for something to be referred to as chronic…Differences in how ‘chronic disease’ is used are largely dependent on the data used for the research and the discipline of the lead authors.”3
The authors wrote that “the Centers for Disease Control (CDC) classify the following as chronic diseases: heart disease, stroke, cancer, type 2 diabetes, obesity, and arthritis… but in fact, only certain types of cancers (i.e., multiple myeloma) can be viewed in terms of a chronic illness."3
They keep happening
So, according to some definitions, my squamous cell carcinomas are chronic. They have occurred again and again since my fourth stem cell transplant 10 years ago. But they don’t persist in a continuous form, thankfully. And--knock wood--they have been cured by medications such as Efudex (fluorouracil), or removed by cryosurgery and Mohs surgery. In terms of diseases that cannot be cured by medicine, they are not chronic.
It’s enough to make your head spin.
A change in definition
In terms of my treatment, it doesn’t matter to me whether my skin cancer is called chronic or not, but in terms of the way I explain it to people, the broadest definition of chronic is helpful. To the authors of a recent article in The Journal of the American Academy of Dermatology, a broader definition has implications for prevention, education and treatment.
They wrote, “Nonmelanoma skin cancer (NMSC) has become an epidemic. The annual incidence of NMSC is estimated to be 5 million, and we spend more than $4.8 billion annually on treatment. Our group has proposed that NMSC be considered a chronic disease in a subset of patients, with the goal of developing chronic disease management strategies that focus on prevention.”4
They propose a “reconceptualization of NMSC as a chronic disease in patients with 5 or more skin cancers.”4
Skin cancer is a chronic pain
I’ve definitely had more than five, for sure, so in that sense, I have a chronic disease. I think of them as more recurrent than chronic, but in either case, they are a chronic pain to deal with.
How often do you speak to your family members about skin cancer?