Writing the history of medicine’s epic battle with cancer through the ages

TAKE any copy of the New York Times and the word cancer is bound to be mentioned in its pages at least once.

It’s hard to imagine, then, that back in the early 1950s the paper refused to carry an advertisement for a breast cancer support group. Both “cancer” and “breast” were taboo. A well-intentioned editor suggested that the ad referred instead to “diseases of the chest wall”.

Thank goodness that sort of prudishess is long gone. Fast forward to the early 70s, and the term “War on Cancer” was coined by the Nixon regime in the US, with the New York Times now relaxed enough to carry this plea to the President:

“Dr Sidney Farber, past president of the American Cancer Society, believes ‘...we are so close to a cure for cancer. We lack only the will and the kind of money and comprehensive planning that went into putting a man on the moon. If you fail us, Mr President, this will happen: one in six Americans now alive, 34m people, will die of cancer unless new cures are found.’”

Nixon’s answer was to sign the National Cancer Act and provide $1.5bn over three yers to fight the war, as though cancer was one dreaded monolithic disease rather than the many complex diseases we know it to be. Some of which have proved to be highly treatable or even curable while others still out-fox the efforts of the world’s sharpest scientific brains.

Oncologist Siddhartha Mukherjee traces the life story of cancer through 4,000 years of human history in his first book The Emperor of All Maladies – A Biography of Cancer, a great ambitious swoop along the trajectory of a disease which in 2010 alone killed around seven million people worldwide.

The first medical description of cancer was written on papyrus in 2,500BC, a report of a “bulging tumour in breast” for which there was “no treatment”. The ancient Persian queen Atossa had a slave slice off her breast in a barbarous attempt to get rid of a lump. This “radical mastectomy” treatment did not become a standard procedure until the end of the 19th century.

By the mid-20th century a less drastic mastectomy was more usual, or a lumpectomy of a smaller tumour, followed by radiotherapy. Since the 1970s, chemotherapy has taken over as the dominant treatment for breast cancer. More recently we’ve had the age of the genome, with a few women carrying the breast cancer gene electing to have prophylactic mastectomy.

Dr Mukherjee hasn’t decided to write the life story of cancer as some sort of retrospective on a scourge that we largely have the measure of. Sadly no. He calls himself “a clinical realist and a scientific optimist” – which means he enjoys working in the fast-changing field of oncology, giving patient care and also carrying out scientific research, but admits that no single universal cure is in sight, “nor is there ever likely to be’.

The best way forward, he believes, is to give a new definition to the word “victory”, by celebrating the fact that although an ageing population means more people are getting some form of the disease, a higher proportion are spending a long period with good quality of life thanks to modern treatments.

Born and educated at a Catholic school in New Delhi, 40-year-old Mukherjee studied Biology at Stanford University followed by a PhD in immunology as a Rhodes Scholar at Oxford. He then studied medicine at Harvard, by which time he had set his sights on oncology.

These days, as assistant professor of oncology at Colombia University in New York, he divides his time between patient care and staring down a microscope. He decided to write a biography of cancer simply because such a book didn’t exist and a patient had asked him what she was up against.

“There are probably 5,000 books on different aspects of cancer, but none has attempted to tell its over-all story, and I do think that understanding its history has also helped to make sense of the present both in practical ways and in more ineffable ways such underlining what it is to be a truly compassionate doctor.

“For instance today during ward rounds I was talking to junior doctors about a woman who has metastatic colon cancer, and we were discussing the nihilistic approach some new doctors can have – asking why bother to treat someone who is so far down the road with cancer.

“My answer to that attitude is that history argues against nihilism. Looking back at the story of acute lymphoblastic leukemia (ALL), between 1950 and 1960 nearly every child who got it died.

“By the late 60s things were improving and, having added piece after piece to the puzzle, learning more and more about drugs, the appropriate nursing skills, radiology and neurology, we now have an 80 per cent cure rate. History teaches us not to be pessimistic.”

The story of cancer, as told so eloquently by Mukherjee, is one of myths and legends, ingenuity, resilience and persistence as well as brilliance, failure, arrogance and misperception. He describes the next stage in cancer’s history as the age beyond the genome.

“We know what genes do, and now need to understand how they are, why does cancer go to certain organs and not others, and why your breast cancer is not responding to a drug that another woman’s is responding to very well? We have to continue exploring areas such as whether certain cancers in different organs have similar characteristics and what that means for treatment.”

Few are now afraid to utter the C word. Recently, celebrities including Michael Douglas and Kylie Minogue have talked openly about their own battles with the disease, and countless fundraising projects take place in aid of reseach.

This openess is to be welcomed, but Dr Mukherjee has little time for those who increase what he calls the cancer patient’s psychological burden.

“Being positive in your attitude is obviously a good thing, but there are those, particularly in the blogosphere, who berate cancer patients for not being positive enough. They use guilt as a weapon to beat people up.

“I have known people with a very positive attitude who have died and people who’ve been very negative and have survived. The idea that the body will not respond to treatment because you are not positive enough is wrong.”

Parts of his book seem to imply that, as we lived to greater age and the incidence of cancer grows, we should somehow all see ourselves as “pre-cancerous”. He says that was not his intention.

“That’s a grim view. For some it is statistically true that we will get cancer, but I advocate being vigilant rather than constantly fretting. I don’t want to endorse perpetual fear.”

He is very excited by anthropologists’ work in Peru that reported how, in a certain remote community of people of very short stature, cancer is virtually unknown. “There seems to be a mutation in a growth-controlling gene connected to insulin.

“One of the things that makes me optimistic about the world is that such stories can and do emerge to surprise us.” Is he optimistic that one day we’ll have cancer licked? “Beat cancer? No. Learn to treat and in some cases cure, yes.”

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The Emperor Of All Maladies – A Biography of Cancer by Siddhartha Mukherjee is published by Fourth Estate, £25. To order from the Yorkshire Post Bookshop call 0800 0153232 or go to www.yorkshirepostbookshop.co.uk Postage and packing costs £2.75.