The idea of developing or dying from cancer – which is caused by an uncontrolled division of abnormal cells in the body – is unsettling, and the disease has recently come under the spotlight after American President Barack Obama, during his State of the Union address earlier this year, announced a new national effort to cure it. And especially with the rising incidence of cancer this ambitious “moonshot”, in the words of the president, appears well-timed. “Indeed, as the fraction of those affected by cancer creeps inexorably in some nations from one in four to one in three to one in two, cancer will, indeed, be the new normal – an inevitability”, Siddhartha Mukherjee wrote. “The question then will not be if we will encounter this immortal illness in our lives, but when”.
In fact Obama’s characterisation of the effort as a “moonshot” becomes much clearer in “The Emperor of all Maladies: A Biography of Cancer”, because the first campaign in the 1960s lobbying for more cancer research – which culminated in the National Cancer Act of 1971 signed by then President Richard Nixon – was inspired by the success of the Apollo 11 spaceflight. The two individuals central to this medical and political milestone were Sidney Farber and Mary Lasker, regarded as the father of modern chemotherapy and a health activist and philanthropist respectively, and both therefore feature heavily in Mukherjee’s book.
And around the indefatigability of Farber and Lasker, a coherent historical account of cancer is documented. The challenge of a book about a medical disease is the need to balance scientific explanation with accessibility for the lay reader, and in fact above and beyond that balance Mukherjee also weaves in anecdotes – about patients he interacted with as a fellow and as an oncologist, about predecessors and peers, and even about ancient chronicles – patients and their struggles emerge front and centre of the narrative. “The Emperor of all Maladies”, in this vein, can be heartbreaking, yet the resilience of doctors and patients alike are inspiring.
“It is an old complaint about the practice of medicine that it inures you to the idea of death. But when medicine inures you to the idea of life, to survival, then it has failed utterly”. This thought lingers through the chapters: centuries of discoveries and setbacks, the suffering of patients, the importance of prevention, genetic discoveries, and finally a more optimistic view of the future.
What I also enjoyed was Mukherjee’s clever use of quotes at the beginning of each chapter and section, how the chapters and sections – while in general, chronological fashion – were coherently stitched together, and appropriately-placed summaries of the more complex or lengthy scientific explanations. For instance, having explained the genesis of the diseases and how it developed in one’s body, he wrote: “This story of one cancer’s genesis – of carcinogens causing mutations in internal genes, unleashing cascading pathways in cells that then cycle through mutation, selection, and survival – represents the most cogent outline we have of cancer’s birth”.
It will probably take additional reads to fully understand the processes, or to appreciate the progress made – from radical surgery which involves the extensive removal of organs or body parts to targeted therapy which goes after specific molecular differences between cells – yet one develops useful cancer literacy. Cognisance of cancer research and emerging therapies should increase, and while that would not necessarily reduce the fear of the disease, or for me the persistent thoughts about the ethical implications of randomised controlled trials to test the efficacy of drugs, I take solace in the commitment of scientists and oncologists in their battles, moving ahead a step at a time.