The immortal illness

by Listener Archive / 07 April, 2011
Siddhartha Mukherjee’s The Emperor of All Maladies is a biography of cancer, “the defining plague of our generation”.

When Fanny Rosenow called the New York Times to place an announcement about a support group she was starting for survivors of breast cancer, the paper’s society editor said that was fine, but she couldn’t use the words “breast” or “cancer” in its pages. Perhaps she would like to call it a support group for sufferers of “diseases of the chest wall”? This was the 1950s: not only was cancer not mentioned in polite society, but the treatments were hit or miss and often brutal, and the causes of the disease were so poorly understood that many doctors, as well as tobacco companies, scoffed at suggestions smoking might cause lung cancer.

By the 1970s, it was okay to talk about cancer. One huge advance was the US National Cancer Act of 1971, which provided a US$1.5 billion budget for cancer research. The lobbying and campaigning that preceded the passing of the Act had broken the ice and cancer was talked about in government, in books like Alexander Solzhenitsyn’s Cancer Ward, in movies like Love Story and, at last, in newspapers. But all this focus on cancer, and some treatment breakthroughs, led to the expectation that the “cure for cancer” was just around the corner; that today we’d be living in a cancer-free world. Instead, as Siddhartha Mukherjee says in The Emperor of All Maladies, cancer is often described as “the defining plague of our generation”.

This book is Mukherjee’s “biography of cancer”, his attempt to “enter the mind of this immortal illness to understand its personality, to demystify its behaviour”. Given that introduction, I was expecting a book that was bigger and broader in its approach to the subject: instead, I found a huge chunk of the book is about chemotherapy and blinkered in its focus on the US. I don’t know enough about the topic to know what he’s missed, but a reference to early use of mammograms being confined to “the far peripheries of medicine” – meaning France and England – raised my eyebrows.

That gripe aside, this is a fine book, and Mukherjee worthy of a science writer’s jealousy: this Rhodes Scholar, Harvard-educated doctor manages to be an award-winning science writer while also working as an oncologist and assistant professor of medicine at Columbia University.

One of the book’s many richly drawn characters is chemist Sidney Farber, who in the 1940s was responsible for a breakthrough in cancer treatment, until then treated with surgery or radiotherapy, when he used an antifolate to force
childhood leukaemia into remission.

This was the first time a chemical drug had been used to treat cancer, and although the remissions were temporary, it made it possible to dream of a cure for cancer.

For decades, advances in chemotherapy were just a matter of finding another poison, or combination of poisons, that killed the cancer without killing the patient, but real advances in drug therapy came once cancer was better understood.

The discovery of oncogenes, genes that predispose a person to develop cancer, led to the first oncogene-targeted drugs – rather than being a general poison, they attacked only the cancer.

For some cancers, like chronic myeloid leukaemia or some forms of breast cancer, the prognosis – with the right treatment – is now so good as to say the diseases are curable. For other cancers, like some forms of pancreatic or gall bladder cancer, medical advances have done little to affect prognosis.

Mukherjee envisages no magic “cure for cancer” in the future, but sees our tools improving, particularly as we better understand the myriad different diseases that come under the banner of “cancer”. And although future physicians might laugh at our use of primitive cocktails of poisons to kill cancer cells, he sees much about the battle against cancer remaining the same, “the relentlessness, the inventiveness, the resilience, the queasy pivoting between defeatism and hope”.

THE EMPEROR OF ALL MALADIES: A BIOGRAPHY OF CANCER, by Siddhartha Mukherjee (Fourth Estate, $39.99).

Rebecca Priestley is the Listener’s science columnist.
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