This book provides a panoramic view of humanity's fight against a deadly scourge. Cancer has plagued human beings down the ages. As people's lifespan lengthened and they became less likely to fall victim to infectious diseases, it emerged as a major killer in both rich and poor countries. One in eight deaths worldwide is now caused by cancer.
An oncologist and an active researcher, Siddhartha Mukherjee, who spent his boyhood in New Delhi and went on to study and work in the United States, has come up with this highly readable account of how ideas about the disease and ways to treat it evolved over time. Such a history could easily have suffocated in turgid prose, stuffed with an endless litany of facts.
This book is refreshingly different. It provides a fast-paced, deeply fascinating, and often intensely moving, account in which doctors, scientists and patients come alive as people on the frontline of a grim struggle against the body's own cells that have gone completely out of control.
One such person, to whom the book is dedicated, is Robert Chandler, a two-year-old in Boston who developed leukaemia and became, in December 1947, the first to be successfully treated with a drug against cancer. But the young child's remission lasted only a few months; the cancer soon reappeared in a drug-resistant form that ultimately claimed his life.
There is the towering figure of Sydney Farber, a paediatric pathologist who made a profound difference to cancer treatment when he made the leap from examining the dead to aiding the living. This is the man who treated little Chandler and created the field of chemotherapy, despite a marked hostility from fellow doctors in the early stages of his effort.
The first chemicals used by Farber against cancer were provided by a team of scientists led by Yellapragada Subbarow, who trained as a doctor in India before moving to the U.S. in 1923. Subbarow, a talented researcher, was responsible for the discovery and synthesis of a wide range of medically important compounds.
There is an interesting account too of how mustard gas, the deadly chemical used against troops during the First World War, was turned into a drug against cancer.
A sneaky disease
But cancer is a sneaky disease. Even when it seems to have been eradicated it can reappear in a more virulent form and spread to other parts of the body. Therefore, doctors and patients would like to see all traces of it destroyed. The book serves as a caution against the danger of taking such martial metaphors too far.
Thanks to William Stewart Halsted's initiative, radical mastectomy came into vogue for the treatment of breast cancer. This surgical procedure involved the removal not only of the breast but also the underlying muscles and associated lymph nodes. If the cancer recurred, it was taken as a sign that more tissues ought to have been removed. But, after nearly a century, when it was properly tested (in the wake of resistance from surgeons) against alternative procedures, it turned out that this disfiguring operation brought about little improvement in survival or disease recurrence.
Radical mastectomy
A particularly poignant paragraph in the book runs thus: “Between 1891 and 1981, in the nearly one hundred years of the radical mastectomy, an estimated five hundred thousand women underwent the procedure to ‘extirpate' cancer … Many were permanently disfigured; many perceived the surgery as benediction; many suffered its punishing penalties bravely, hoping that they had treated their cancer as aggressively and as definitively as possible ... When radical surgery fell, an entire culture of surgery thus collapsed with it. The radical mastectomy is rarely, if ever, performed by surgeons today.”
There were similar missteps in chemotherapy as well. More of the dangerously toxic drugs in various combinations and at very high doses, it was thought, would root out cancer entirely. But such efforts too took a terrible toll without improving the outcome. In the end, doctors learnt to match treatment with the type of cancer involved and how advanced it had become when discovered, appropriately combining surgery, chemotherapy, X-ray, and other forms of radiation.
New techniques were developed to detect cancers at the very early stage — such as mammograms for breast cancer and Pap smears for cervical cancer. Also highlighted in the book are some of the recent developments in cancer research and therapy. They include drugs that specifically target the cellular alterations that cause different types of cancers and the ongoing massive effort to sequence various cancers as a step towards understanding the underlying genetic changes that put normal cells on an errant course.
Cancer is “stitched into our genome,” and, for that very reason, there may be limits to our ability to cast it off, says Mukherjee. But the struggle against this terrible disease goes on relentlessly and his book takes us to the heart of that endeavour.
