May I take your metaphor? – how we talk about cancer

"The war on cancer rages on". "It's the start of a long journey". "I feel like I'm on a carousel that won't let me get off". "I'm on the road to recovery". "She lost the fight". "We will beat cancer sooner."

Whether you're a patient, a carer, a fundraiser or a doctor – talking about cancer almost invariably means using metaphors.

But is one metaphor better than another? And how do different metaphors affect different people?

That's the question Professor Elena Semino, a linguist from Lancaster University, has spent the last few years trying to figure out.

Her team's recent study examined how metaphors are used in different groups of people affected by cancer – cancer patients, family carers and health care professionals – and how they resonated with them.

Drawing on a dataset of 1.5 million words, collected from interviews and online forums, what Semino found was really quite interesting – as she told us at a recent talk.

Battles and journeys

The two most common metaphors her analysis uncovered are what she termed "violence" metaphors – fights, battles wars, etc, – and "journey" metaphors.

When it comes to "violence metaphors" some people find them motivational. Semino remarked that they're particularly effective at motivating groups of people to do something, which may explain why they are so commonly used for fundraising campaigns.

But they aren't motivational for everyone – particularly when used about an individual's experience of cancer, rather than a collective effort.

She explained that patients often feel "disempowered" by violence metaphors as they aren't given the right "weapons" to fight or that the doctors are "the generals" and they're just common "foot soldiers".

"There's also disempowerment when the person doesn't want to fight. And then you've got people, specifically at the end of life, who feel that they're losing – and it's their fault – and that is very negative," she said.

But Semino isn't the first person to recognise the harm violence metaphors can have. The BMJ wrote a piece about the negative impacts they can have on patients back in 2014 and the Guardian argued militaristic language is doing more harm than good in March this year.

So journeys are better?

But while the 'journey' metaphor doesn't lead to feelings of failure in some, like violence metaphors can, it's not necessarily 'better'.

It can certainly be positive – Semino found in her data that some people use the journey metaphor "in a very empowered way."

"They talk about being on a journey with everyone else who has the illness, they talk about themselves as companions on the same journey, and the people who have been ill for longer leading the way for the ones that have got a more recent diagnosis. They also talk about a sense of purpose in planning one's journey one step at a time."

However, for some the 'journey' is less like an epic adventure, and more like the trip from hell.

"For some other people, there is this idea of a reluctant journey. One person says 'how the hell am I supposed to navigate this road I don't even want to be on.' [Another] person says it's like trying to go uphill in a coach without its back wheels. So they use the metaphor of the journey to express a sense of helplessness and frustration."

But ultimately, what Semino's research showed was that everyone is different.

Each person might find that one metaphor better resonates with him or her than another.

But while creative people may be able to come up with their own unique metaphor that works perfectly for them, what happens to those of us who are less creatively inclined? Are we forced to pick between a journey and a fight?

"We need a 'menu' of metaphors," suggests Semino, "a collection of quotes with all these different metaphors: the journey ones, the fight ones, the fairgrounds, the music in nature and unwelcome lodgers, and there are others, so these can be shared with people, and people can pick the ones they want, as you do at a restaurant."

Semino is currently collaborating with oncologists to create this metaphor 'menu' – to help doctors and patients pick a way of talking that works for them.

And what of the war on cancer?

At Cancer Research UK, we know that 'violence' metaphors can, in some circumstances, do harm – we've got guidelines around using them, and avoid using them when it comes to individual people where there's clear evidence they can be unhelpful.

However, violence metaphors can be great at unifying and motivating people when it comes to fundraising.

And we're involved in a collective effort, an odyssey – or, if you like, a struggle– against a disease that claims 161,823 lives a year in the UK alone.

So while we'll be keeping a keen eye on research like Professor Semino's, and make sure we're always aware of the wider context, we'll also keep on making sure that we can raise every pound we can to fund the scientists in labs around the UK, in their quest of discovery, to find new ways to help more people survive.