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Denial and disavowal

Tuesday, May 4, 2010; HE06

Denial and disavowal

I agree that denial serves as a positive coping mechanism when it doesn't go too far ["When it's helpful to tune out the truth," April 27]. I wanted to dispute psychologist Hanoch Livneh's quote: "Freud literally thought about it as very pathological . . . something that a normal person should not engage in." Later, however, in "An Outline of Psychoanalysis" (1940), Freud argues that not only patients with psychosis, but all individuals, have a part of the ego that denies reality and a part that accepts it. He came to see denial and disavowal as ubiquitous and not necessarily an indication of pathology.

Kerry Malawista

Potomac

The complexities of cancer

"War against cancer has more than one target" [April 27] was a thoughtful and direct assessment of the challenges and complexities that persist today in finding cures for cancer since our declaration of war was issued almost 40 years ago. These challenges could not be better presented than in the case of lung cancer, the leading cause of cancer death among women and men.

The article noted incidence rates for leading cancers. However, it did not include corresponding mortality rates of those same cancers. These figures tell an even more dramatic story about the ramifications of our cancer research funding these past four decades, such as where we have realized improvements in outcomes and where enormous gaps remain.

Last week, Brigham and Women's Hospital, in cooperation with the Lung Cancer Alliance, released a groundbreaking report on women and lung cancer.

Lung cancer is the leading cause of cancer death among women, taking more lives than breast and all other gynecological cancers combined. It is the least funded in terms of research dollars in comparison to other leading cancers, and its five-year survival rate has barely budged since the war on cancer began. Today, over 60 percent of those diagnosed with lung cancer will be former smokers who quit years ago, or those who never smoked at all. In fact, one in five women diagnosed with lung cancer today is a non-smoker.

Cancer is a complex disease requiring continued investment and better targeting of our resources. For all cancers, not just lung, we remain hopeful that the war on cancer can be won.

Laurie Fenton Ambrose

President and CEO

Lung Cancer Alliance

Washington

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