Biography of cancer tells story of discoveries, setbacks
Published Saturday, October 8, 2011 12:48PM EDT
It is no easy feat to write an entire history of cancer, a disease that has maybe 200 forms, depending on how you categorize them. But that's what Siddhartha Mukherjee attempted to do with his celebrated bestseller, "The Emperor of All Maladies: A Biography of Cancer."
Mukherjee, an oncologist, researcher and assistant professor of medicine at Columbia University, set out to document the disease from its first appearance a few millennia ago, to the genesis of modern treatments, to a look at how much more is still left to understand.
As he lays out the milestones, the achievements and the setbacks, Mukherjee weaves in stories of his own patients, some who won their fight against this complex monster and many others who didn't.
The result is a work that won this year's Pulitzer Prize for non-fiction. The Pulitzer committee, in their citation, describe the book as "an elegant inquiry, at once clinical and personal, into the long history of an insidious disease that, despite treatment breakthroughs, still bedevils medical science."
Mukherjee says he set out to draw a portrait of cancer.
"I used the word 'biography' because this is not a standard history," he recently told CTV's Canada AM.
"My patients are part of this history; I'm part of this history. I enter it, and historians don't generally enter their histories. But I wanted to make it much more personal. And therefore the word ‘history' seemed just a little bit too academic," he explained.
As the book unfolds, Mukherjee illustrates how cancer is not one disease, but really a constellation of illnesses, some fierce and destructive, others slow and plodding, that affect different patient, require different approaches in research, and different treatments.
The book takes readers back to 550 BC, to one of history's first mentions of cancer, and describes the experience of Persian Queen Atossa, who discovered what historians now believe was a cancerous tumour growing in her breast.
Atossa's first reaction was to hide her growth and hope that it would go away on its own – a reaction not unlike what many cancer patients still have today.
"Atossa was part of the ancient world and yet her response to what we think was breast cancer so was contemporary. Her response was shame. She hides it and she wants to push away the diagnosis," he said.
Atossa "swaddled her cancer-affected breast in cloth to hide it," Mukherjee writes, until she finally prescribes herself a mastectomy. "In a fit of nihilistic and prescient fury, (she) had a slave cut it off with a knife," the book reads.
The story was included, Mukherjee said, because it illustrated how little has changed in cancer care, which, until only recently, has succumbed to few weapons.
"It reminds us that even in ancient stories, there are such contemporary stories that it could be yesterday."
The book also describes the first discovery of a carcinogen. That occurred in 18th-century London, when a surgeon noticed that chimney sweeps -- typically otherwise healthy teenagers -- were coming down with cancerous tumours of the scrotum.
A local surgeon realized it must be something about the chimney sweeps' job that was causing their disease, finally narrowing down the culprit to chimney soot.
Mukherjee also looks at radical mastectomies, and their rise and fall in popularity among surgeons. He says it was sometime in the 1980s when cancer surgeons began to think that lumpectomies weren't enough to eliminate breast cancer.
"Surgeons began to think, particularly Dr. William Halsted, ‘Well, if you cut open the breast to remove the cancer, to really cure someone you should cut out more.' And this became… larger and larger surgeries," he said.
Soon, not only was the tumour being removed, but so was the breast, the lymph nodes under the armpit and the collarbone, and much of the muscle underneath.
The surgeries were carving out women's chests, leaving them with diminished quality of life, but no one was willing to question the practice.
Mukherjee writes: "Pumped up with self-confidence, bristling with conceit and hypnotized by the potency of medicine, oncologists pushed their patients - and their discipline - to the brink of disaster."
It wasn't until 1980 -- about 100 years after the invention of the procedure -- that a clinical trial proved that for most women, radical mastectomies made no difference whatsoever to survival, Mukherjee says.
"And it was really the breast cancer advocates who demanded answers and said, ‘You're performing this huge surgery on women's bodies -- where's the proof?'" Mukherjee says.
The book describes dozens of other "eureka" moments in cancer's history, as well as the centuries of despair when doctors had few answers and cancer patients had little hope.
With recent advances in genetics, it's now become clear that cancer is disease caused by changes to a cell's genes and that all humans are "destined to carry this fatal burden in our genes," Mukherjee writes.
"A cancer cell is an astonishing perversion of a normal cell," his book says. "Cancer is such a phenomenally successful invader and colonizer in part because it exploits the very features that make us successful as a species or an organism."