“Surviving is not the same as living”: Cancer and Sobrevivencia in Puerto Rico

“Cancer survivorship” is an evolving concept that has been elaborated to a large extent in the mainland U.S. through the work of national advocacy organizations, and it has served as a source of cohesion for many people who have experienced cancer. However, anthropologists and other social scientists have argued that dominant meanings of survivorship—such as the idea of “cancer as a gift” or the role of positive thinking in influencing the disease course—reflect distinctively American cultural values, and survivorship outside the U.S. has remained largely unexplored even while the concept has gained some traction globally. This paper explores how the concepts of “survivorship” and “survivor” are engaged in the setting of Puerto Rico, an unincorporated territory of the U.S., and how well they are seen to explain the nature of post-treatment life. Ethnographic fieldwork for this study was conducted over 12 months split between two field visits (2 months and 10 months) between June 2010 and March 2012 in San Juan, the capital city, and Ponce, a smaller city on the southern coast. This paper is based on interviews with 23 participants treated for cancer as young adults. Participants drew from many of the prevailing discourses of survivorship—such as transformation and the importance of optimism—as well as from what they understood to be distinctive aspects of Puerto Rican culture and identity, in the crafting of a local understanding of post-treatment life. Support organizations played a key role in shaping roles and expectations associated with having had cancer, and in solidifying particular views of survivorship more broadly.