The Emperor of All Maladies: A Biography of Cancer by Siddhartha Mukherjee (Scribner, 592 pages)
By Diane Carman
Most family trees include ancestors who had cancer. Mine is no exception. A grandfather had lung cancer in the 1950s. Cancer was found in my father’s bronchial tubes in the 1970s. My brother had prostate cancer a decade ago. The list goes on.
Hopes and fears, triumph, resilience and grief characterize the cancer experience and not just on a personal level. Political, medical and scientific careers have been built on the quest to understand and cure cancer, with moments of spectacular achievement and equally dramatic periods of failure, disappointment and disillusionment.
“The Emperor of All Maladies: A Biography of Cancer” chronicles the human experience with cancer from centuries ago to the present, and it’s surprising how personal it feels as the trends intersect with memories from family histories.
My grandfather, a smoker, was treated during an era when surgeons were cancer’s gladiators. A woman diagnosed with breast cancer in those days usually underwent a mastectomy so radical that not only breast tissue and lymph nodes were removed, but her chest muscles and even bones such as her clavicle. My grandfather’s most seriously affected lung was removed, reflecting the best thinking in medicine in his day.
Later, when scientists better understood metastasis, the radical surgery era waned. Radiation and chemotherapy rose to the forefront, and hopes were high. Some cancer patients – including very young leukemia patients — were taken to the very brink of death via these treatments in an attempt to destroy every last cancerous cell roaming through their bodies. Then doctors – at least theoretically — would help them recover their strength and vitality.
My father underwent this treatment, believing, as the doctors said, that it might be possible to treat cancer like diabetes: possibly never eradicating it, but keeping it in check with just the right drug cocktail and hoping somehow to find a way to ameliorate the accompanying nausea, weakness and vulnerability.
Throughout the 1970s, the philanthropic and public policy communities rallied the public by comparing the campaign to cure cancer with the Manhattan Project to build an atom bomb and the effort to land a man on the moon. Faith in science was at its apex and a tidal wave of public and private money flowed into “the war on cancer.” The search for a telltale virus that triggered cancers was pursued in earnest, as were a wide range of scientific hypotheses.
With each scientific advance, however, came the creeping realization of cancer’s infinite complexity.
No single virus would be found to crack all of cancer’s mysterious code. No one cause lurked to be uncovered. No singular vaccine or treatment would emerge to conquer this disease no matter how much money was spent.
The giant step for mankind on the moon was simple science by comparison.
Recent decades have been marked by focused research on genetics, cell biology, prevention and development of more elegant treatments designed to target specific aspects of cancer cells and interrupt their growth.
My brother’s cancer was discovered through aggressive early detection techniques and treated with surgery.
Mukherjee profiles heroic figures in the universe of cancer: physician and researcher Sidney Farber, philanthropist Mary Laskey, and on and on.
Some, like William Stewart Halsted, who advocated ever more radical surgery techniques, were so revered even when the medical protocols that made them famous were discredited, physicians long refused to change their practices out of a sense of misguided loyalty.
Some, like Bert Vogelstein, opened whole new fields of cancer research with their discoveries in basic cell biology that identified genetic triggers that turn on and off the mechanisms for cell division.
Many, many more continue the quest.
My father and grandfather, as with so many cancer patients of those eras, died quickly as the relentless disease continued unchecked. My brother survives, but even in his cancer-free state, he questions the wisdom of his doctors whose methods for detecting and treating his cancer are under tough scrutiny and critical reconsideration.
Mukherjee skillfully intertwines the personal with the scientific and the political in “Emperor.” Cancer — as a source of inspiration, commitment, courage, dedication, vanity, hubris, frustration and despair — is a metaphor for so much of human endeavor.
After thousands of years, the often noble, sometimes venal, all-too-human quest to conquer it endures.
It’s certainly a scary prospect, speaking as a former smoker now creeping up on his 7th decade. The fact that there remain a plethora of diagnoses and treatment regimens suggests to me that we still don’t have a real handle on the disease beyond some very rudimentary ideas of both cause(s) and treatment.
My own decidedly non-medical, completely-without-expertise opinion is that it’s at least partly genetic, and isn’t likely to go away until the earth is no longer bombarded every second by gamma rays and assorted other things from space. I suspect, should that happen, cancer might be the least of our worries. It also seems to be at least partly a matter of environment. Lungs don’t know you’re smoking that cigarette on purpose, cancer is a response to the smoke-filled air that enters them. And, as long as I’m exposing my medical ignorance here, the third factor that occurs to me with frequency is that it’s at least partly a function of age. My guess, and it’s only that, is that far fewer people died of cancer during the Renaissance, in large part because the average life span in those times was probably in the high 30s or low 40s at most. The plague, or pneumonia, or “bleeding” you for a severe cold, or childbirth, or infection, probably killed you long before cancer had the opportunity.
I had a distant great-uncle, whom I never met, who died of cancer after years of pipe-smoking (I’ll spare you the grisly details). Other than that, however, my ancestors mostly died of accident or heart disease. Both grandfathers died of heart attacks. One grandmother succumbed to the same, while the other was hit and killed by an automobile. Mom died of heart failure at 89, and Dad was killed in a plane crash at age 35. I smoked for a long time, but have been smoke-free for more than 20 years. Personally, I worry more about heart disease than cancer, but maybe I’m just whistling past the graveyard.
And 592 pages is far more grim reading than I want to do. Diane merits an award of some sort for slogging through a tome of that size.