When this year's presidential candidates were children, the word cancer - the Big C - was something of a taboo. As adults, these candidates are discussing their various cancer battles with almost matter-of-fact candor, chatting about PSA tests and lymph nodes and the like as they try to frame their health histories as just another part of their political profile.
Voters, too, have developed a more nuanced view of what it means to have cancer. But the 2008 elections may help to measure whether there is any lingering fear factor attached to presidential contenders who have had the diagnosis. As actor Fred Thompson, who is considering a run for president, acknowledged earlier this week when he announced he has a slow-growing type of lymphoma, "anytime you mention the C-word, it causes concern."
Geoffrey Garin, a Democratic pollster not aligned with any candidate, said voters have come a long way in their attitudes toward cancer, and seem willing to discriminate between different types. Prostate cancer, for example, "is a kitchen-table subject for a lot of people these days," he said.
Acknowledging cancer
"The way voters respond depends very much on the specific illness involved and the extent to which they tend to think of it as being a risk to the candidate's long-term health," Garin said.
The candidates themselves seem intent on banishing any concerns by bombarding voters with information about their particular medical situations.
Thompson did a multimedia rollout this week to reveal he has non-Hodgkin's lymphoma. Former New York City mayor Rudy Giuliani brought along some radioactive seeds as a visual aid when he went on TV to discuss his treatment for prostate cancer in 2000. Arizona Sen. John McCain, who has battled melanoma, the most aggressive form of skin cancer, released hundreds of medical records during the 2004 campaign.
These days, Giuliani and McCain both stress that they have been cancer-free for years. Thompson says his cancer is an "indolent" version that has given him no sickness.
In the case of Democratic candidate John Edwards, the former senator and his wife, Elizabeth, called a news conference to announce that her breast cancer had returned in incurable form and spread to other parts of the body, but that it would not slow his presidential campaign.
"The interesting question that remains to be answered is: How are the people who vote going to look at this?" said Dr. Len Lichtenfeld, deputy chief medical officer for the American Cancer Society, who keeps a cancer blog on the Internet. "How all this plays out remains to be seen. I think it shines the light on a very important fact, which is that we have many more cancer survivors today."
Lichtenfeld, who is 60, recalls being smacked as a child for daring even to mention cancer to an aunt who had the disease.
"The candidates are part of that entire change that's ongoing in society, and it's a healthy change," he said. "People are going to be much more open to the consideration that this is in fact a chronic disease than they would have been 10 years ago."
Polling is scant on the politics of cancer, but suggests that people are willing to set the diagnosis aside if it appears that the trouble is in the past.
In a February poll for Fox News, two-thirds of those surveyed said a candidate's past health problems would not be a major factor in determining their vote. In 2004, 92 percent of those surveyed by Gallup said they were unconcerned that Democratic presidential candidate John Kerry had been treated for prostate cancer the previous year.
More than a decade earlier, when cancer survivor Paul Tsongas was running for president in the 1992 campaign, 90 percent of voters said that if someone had cancer in their past it should not disqualify them from becoming president. Tsongas, however, serves as a cautionary tale. He was diagnosed with an aggressive form of lymphoma again shortly after the 1992 election and died five years later, at age 55.
A number of politicians for other offices have been re-elected as cancer survivors, including former Sens. Bob Dole and Jesse Helms, who both had prostate cancer. Rep. Sue Myrick, R-N.C., has had breast cancer, and Rep. Rosa DeLauro, D-Conn., is an ovarian cancer survivor. Rep. Charlie Norwood, R-Ga., was re-elected last November after a cancerous tumor had been removed from his lung. But more cancer was found on his liver and he died in February.
Dole, who ran for president in 1996, managed to wage a vigorous campaign five years after his surgery. Giuliani, though, abandoned his plans to run for the Senate in 2000 after being diagnosed with the disease.
As the population ages, and new treatments allow people to live longer with various types of cancer, the disease is one that people increasingly grapple with in their daily lives. Ten percent of Americans reported in a 2005 survey that someone in their own household had been diagnosed with cancer.
Many more keep it on their radar screen. Nearly half of all Americans reported in a 2004 survey that they worry at least occasionally about getting cancer.
In some ways, a cancer diagnosis can help a politician establish common ground with voters who may see candidates as "completely crafted by their political consultants," said Dr. Robert Blendon, a health policy specialist at the Harvard School of Public Health.
"It makes people identify more with the character of the candidate," said Blendon.
The downside, from a political standpoint, kicks in if voters fear that a candidate will become so debilitated that they can't complete their term in office. And voters attach far greater importance to that question when the presidency at stake, Garin said.
While this year's candidates won't discuss internal polls, it's a safe bet that each campaign in sifting through data to determine how voters are viewing their own candidate's medical conditions - or those of the opposition.
Garin, the Democratic pollster, added that while voters have a much better understanding of cancer than they did a few decades ago, there still are generational differences in their perceptions.
"Voters who have come of age in the past 10 to 20 years have a much greater experience of cancer being a curable condition," he said. "Some much older voters still have a sort of instinctual feeling of cancer as a death sentence."
"At the end of the day," he added, "people need to be comfortable in their own minds that the candidate is healthy enough to serve in office for four years."