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The 5,000-year war on cancer

An oncologist’s beautifully written history attempts to grapple with the disease


 

 

The 5,000-year war on cancer

Cancer has eclipsed many rival diseases, but there has been treatment in progress, especially in children's cancers | Davide Monteleone/Contrasto/Redux

Sometime around 2600 BCE the Egyptian genius Imhotep—statesman, architect and physician—compiled a medical manual. Case 45 described “bulging masses on the breast, hard and cool to the touch.” As for therapy, he wrote only, “there is none.” His careful clinical language is a textbook description of breast tumours, according to New York oncologist Siddhartha Mukherjee, author of The Emperor of All Maladies, a beautifully written account of all the ingenuity, hubris, courage and utter confusion humankind has brought to its attempts to grapple with cancer.

As Imhotep’s terse remarks illustrate, it has been killing us, on the record, for 5,000 years. In reality, for much longer: since cancer is a matter of uncontrolled cell growth, of our own bodies turning on us, it is the oldest human disease. “Cancer is us,” Mukherjee adds in an interview, except more perfect—we seek to extend our years, but the undying cancer cell is already immortal. We have dispatched so many of cancer’s rival diseases that we have cleared its path to us and our age-related cellular mutations: today we are both available for cancer and prone to it. The disease is still reaping its lung-cancer harvest from the 1900s, the century of the cigarette. Cancer, in fact, is entering upon its glory days. In Canada and the U.S., one in three women will contract it, and one in two men.

For 100 years we have viewed the disease’s climb up the mortality tables through the lens of a martial metaphor. We are locked in a “war against cancer,” with wonder drugs touted as “magic bullets,” and victims perishing after “long battles.” It’s a conceptual framework that equates “victory” with a cure, Mukherjee says, a way of thinking that results in manic highs, when new insights are gained or new routes of attack invented, and pessimistic lows, when the endlessly mutable disease continues to flourish.

Pioneering 19th-century surgeons like William Halsted, distressed that their breast cancer patients relapsed and died scant months after simple mastectomies, thought they could cure cancer if they cut out every last piece of diseased tissue. So they sliced ever deeper, removing ever more layers of muscle in disfiguring and debilitating operations. Half a million women underwent radical—in the original meaning of down to the root—mastectomies. Few benefited: for local tumours, far less invasive surgeries would have sufficed, and for cancers that had already spread into organs, any surgery was futile.

The champions of chemotherapy and radiation were just as driven—and reckless. By 1896, Emile Grubbe was blasting tumours with X-rays, destroying some and causing others. It’s very easy to kill cancer cells, Mukherjee sardonically notes; the trick is to do so without also annihilating healthy tissue. Grubbe achieved no miracles, but he did lose all his fingers, amputated one by one, as the radiation consumed him too. And all this time the “Big C” was wrapped in secret shame. When a 1950s breast cancer survivor asked the New York Times to insert a notice about a support group, she was told that Times notices did not allow either word, breast or cancer.

By the 1990s, as the magic bullets missed their mark and final victory seemed as far off as it did on the Western Front in 1916, the oncological mood was alarmingly nihilistic, says Mukherjee, despite enormous piecemeal progress (especially in children’s cancers). What’s needed now, he argues, is hope and humility, and a redefining of “victory” from cure to manageability. “We are not going to obliterate this disease, so intrinsic to us, from human history. But we can make it chronic and livable.” Perhaps even make most cancers what prostate cancer is now: something most sufferers die with, not from.

That will still require serious dedication. Five years ago, Mukherjee was present at his daughter’s birth—not just to experience the moment with his wife but to extract blood from the umbilical cord. The stem cells in it, too often flushed down hospital sinks, are a prime source for bone marrow transplants, and the very stuff of life for Mukherjee’s leukemia patients. Even in a transcendent moment, he was not about to give an inch to the great adversary.


 

The 5,000-year war on cancer

  1. More propaganda about a disease easily prevented an cured by nutrition. I am not trying to be crass, and I understand that many people (myself included) have lost loved ones to cancer, but I think its time people stopped putting blind faith and billions of dollars into the conventional cancer industry.

    • How about cancer in animals then? Don't they have good nutrition but they still get cancer ? Isn't it basically to do with the immune system?

    • Not that simple, JimD. I am a woman who has for decades adhered to an optimal diet. Presently I am two weeks post surgery for breast cancer. I will continue to use nutrition as a vital part of my recovery but I now know that this alone will not assure me of a cure just as it did not prevent me from contracting the disease.

    • "a disease easily prevented an cured by nutrition." I'm sure that there are millions of people around the world, particularly "in Canada and the U.S., one in three women, and one in two men", myself included, that would love to know about this miraculous "nutrition" which you mention. Please, JimD, enlighten us.

    • I am a cancer survivor and given a choice between a stem cell transplant and a nice fresh organic salad, I think I will still opt for modern medicine. Good Luck Jim.

    • heh. Well if it was that easy, cancer wouldn't be a problem. But that is not what cancer is. Cancer is just as much a part our lives as breathing. Cancers occur from random mutations which are pretty much unavoidable. You can get mutations in your DNA from merely going out, sitting around, eating, not eating, you get my point. You can help get less of these harmful mutations through lifestyle better lifestyle choices. But either way there will be mutations and you may be the healthiest person in the world but just have the bad luck of being victim to a number of coincidentally harmful mutations that cause a malignancy.

  2. So instead we should put blind faith into nutrition? Cancer is a complex disease and saying that it can be easily prevented by managing what we eat is naive and ignorant.

  3. Why are there so much Cancer nowadays? Did anyone attributes it to the very processed foods we all are consuming every day? Even scarier, how about all the chemo/radiated cancer patients whose urine & poop goes into sewage system. Does our treatment system get rid of these harmful chemicals & residue radiation?? These waters is eventually home to fishes we eat & also used to water vegetables we consume. There must be a cumulative effect on humans comsuming/drinking these waters. Anyone research on this potential culprit?

  4. Professor Mukherjee: This is my comment at the Robert Buckman review
    of your book in The Globe and Mail today. Buckman's review, is, of
    course, quite slight in the context of The New Yorker's.

    I am interested in the intellectual uptake of your book, which has
    been slow in Canada despite the reviews. What university or state, for
    example, do you believe has adapted to your book most rapidly and
    effectively?

    Among the NMOs (national medical organizations) in Canada, the
    response seems to have been muted.

    You allude to music, and you are probably aware of the McMaster
    initiative in painting and diagnostics. (I have not yet found
    references in your book to Columbia University narrative medicine). In
    terms of the interface between the life sciences and the humanities, I
    am mostly interested in language.

    For example, I would like to see a major study in Boston or New York
    on the benefits of linguistic abstraction in medicine (ideally, the
    experiment would be coordinated with similar ones in New Zealand or
    Australia, and the UK, so as to take advantage of time zones).

    Students are strikingly bad at abstraction, limiting their cognitive
    range considerably. For example, if you asked your students to master
    the most magnificent tale by Henry James, "The Beast in the Jungle,"
    would they be able to understand it and compose a coherent and
    persuasive diagnosis of May's fatal illness?

    I suggest that Columbia University medicine make the COBUILD English
    Grammar official. Chapter nine should be part of the introduction to
    abstraction in a two-year two-hour per week experiment in
    psycholinguistics or psychology for students in medicine who want to
    grasp abstraction.

    What I have found is that, in terms of consciousness, a powerful
    control over abstraction (as in Kant, Henry James, and Roger Penrose)
    is extremely invigorating, with perceptual and cognitive payoffs
    unavailable from any other source. It is sort of like a fundamentalist
    and evangelical pharmaceutical (perhaps a silly simile).

    What labs do you think would be promising for this type of experiment?

    Clayton Burns PhD Vancouver 604 222 1286.

  5. Instead of trying to 'cure cancer', we should be spending our time and money on finding how cancer is caused and eliminate the causes. Our industrialized society and it vast array of pollutants are the reason breast cancer has doubled in the last 20 years. Ask why the money is not being spend on Prevention.

  6. I remember musician Bif Naked commenting about how she was shocked at her breast cancer diagnosis. At the time she had been a raw food vegan for years and exercised daily. It does not appear nutrition is the only factor in who gets cancer. From my experience cancer is less selective than a barn cat on who it choses to partner with.

  7. Keep up with eating all the processed, GMO crap wrapped in plastic and see what you get. There are many, many examples of native populations of different ethnicities in which cancer is virtually or completely non-existent. It has very little to do with their DNA, and a hell of a lot to do with their diets. I personally know a woman who was given three months to live by her oncologist after discovering she had pancreatic cancer. She immediately went on a regime of injecting marijuana oil (basically hash oil) every night. She did that for several months and is now completely healthy, a year later.

    Google "Royal Rife". Google "Rick Simpson". Read the research of Weston Price. Stop eating processed foods, and get some actual sunshine once in awhile. Or is it easier to take the pablum being spoon fed to you by pharmaceutical companies whose ONLY motive is profit. Chemo and radiation "therapy" do far more harm than good.

  8. Why is the virus angle always overlooked? What percentage of cancers are caused by viruses? Just askin'.

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