How language shapes our perception of reality

For most people, hearing the word "cancer" during a doctor's appointment would immediately trigger panic or fear. But - even if a patient does have some form of cancer - what if the word itself does more harm than good?

Linguistics professor Jessica Rettis part of an interdisciplinary UCLA team determined to find out.

With Dr. Joseph Crompton, an oncology surgeon, and Dr. Rajam Raghunathan, a general surgeon, Rett is exploring the ways simple word choice can affect doctors' decisions, patients' anxiety levels and even public health spending. Their Semantics of Cancer projectfocuses on how patients interpret words like "cancer," "carcinoma," "tumor" and "abnormal cells," and the different nuances encoded in each of them.

Rett's interest in the subject stems from her background in formal semantics, the study of how meaning is constructed through language.

"As a semanticist, I study how words mean what they do and how people use them in context," she said. "I've always worked on very theoretical problems, so getting to apply my skills to a medical issue with real-world consequences has been deeply rewarding."

The research also shines a light on how language can shape, and sometimes distort, our perceptions of reality. In this interview, Rett discussed the study's key findings and broader implications.

A fundamental assumption of the cancer study seems to be that nearly every word can be interpreted differently depending on the person, the context or the situation. How so?

We now have a lot of evidence that few things in the world are black and white. Other than a very small number of terms that can be neatly defined - like "prime number," where the objects described meet an incredibly proscribed set of conditions - almost everything else in the world is on a spectrum of "membership" into a category.

When it comes to defining, say, a sandwich, the answers are based on the criteria and conditions we impose. And people have different criteria for each category. You might think a sandwich needs to have two pieces of bread, but some people would argue that tacos and burritos could be defined as sandwiches.

So there are infinitely many contexts in which you consider that question. It's just a fact of the matter that the world is blurry. But it's also a fact that our brains like categories, and that effective language requires categorization.

And cancer is one of those very blurry terms.

Right. Philosophers who study biology and metaphysics agree that there is no such thing as cancer, which is to say that there's no list of criteria that are all - and only - satisfied by that term. If you look at the criteria we use to define cancer, there are some conditions we label as cancer that don't satisfy all of those criteria, and other conditions we don't think of as cancer that do.

And this is news not only to patients and the general public, but to scientists and medical practitioners as well. They're surprised because it's just as useful for them to think of cancer as a defined category as it is for the rest of us.

What has been the most surprising finding from the study?

There are several, but one that really stood out is how much scarier people find the word "cancer" than "carcinoma" - even though the two are virtually synonymous in the medical community. Subjects rated "cancer" as much more fatal and painful. Curiously, "tumor" was also rated nearly as scary as "cancer," even though most people know not all tumors are cancerous.

This tells us a lot about how the emotional charge of a word can override what we intellectually understand about it.

How can the word "cancer" lead patients and their doctors to make decisions that might not be in their best interest?

One of the things we looked at are low-risk cancers - conditions like papillary thyroid microcarcinoma, or PTMC - which are effectively harmless and best addressed with monitoring or active surveillance.

We found that when doctors tell patients they have a cancer, even a low-risk one like PTMC, patients often can't hear anything else. The label "cancer" is so emotionally charged that patients push for aggressive treatments, even in scenarios in which they do more harm than good. This is contributing to a costly and upsetting overtreatment epidemic, and our work aims to interrupt that.

Are you planning to share your findings with doctors directly?

Eventually, we want to educate both doctors and patients - we want to help them have productive conversations about best practices that are unimpeded by the alarming connotations that the word "cancer" can have.

When someone's diagnosis involves the word "carcinoma" or "cancer," a lot of doctors don't feel comfortable not using those terms when they deliver a diagnosis. We're coaching them that they can still mention them, but maybe later in the conversation.

They could start off instead by talking about the atypical cells they found, what symptoms the patient can expect, what the timeline might be, and then finally, about treatments. And then maybe after that, they could show the patient their chart, where the word cancer appears, and they can have a conversation about what that means.

What larger conclusions does this study provide about how people process language?

One key insight is that words don't have intrinsic power; the same word can mean different things to different people depending on context, history and emotion.

But, of course, it's also the concepts we associate with them that carry weight. That's why substituting the label "cancer" with "atypical cells" might have a temporary impact, but eventually that new term would likely become scary too. Language evolves based on how we use it socially and culturally, not just by definition.

Will this study be a model for similar work in other fields?

Long term, I'm also interested in how this applies to other emotionally powerful words - like "genocide" or "fascism." People fight over definitions because they think there's a "right" one. But if we realized that meaning depends on context and intent, maybe we could have more productive conversations - not just in medicine, but across all kinds of social and political issues.

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