Monday, March 30, 2015

The Cancer Biography

Several years ago, this book the history of cancer, was written and released by doctor/researcher Siddhartha Mukherjee.  I read it earlier this year and was, by turns, horrified, baffled, impressed, moved and hopeful.

Cancer occurs when some switch activates in the body, causing abnormal cells to multiply in one area or several or the blood system.  Cancer is the name for not just one disease but a variety of diseases, each with its own series of variations.

Early in the last century, cancer research began in earnest.  Attempted treatments included surgery, radiation and chemotherapy.  The clinicians meant well, of course, but author's descriptions of their efforts read like torture inflicted on desperately sick people.

If a mastectomy could eradicate a breast cancer, it was reasoned, maybe the further removal of all a woman's lymph nodes and tissue up to her neck would be even more effective.  If mustard gas, a chemical weapon deployed in World War I was deadly, maybe it could be coaxed to kill metastasizing cancer cells.

The researchers and the cancer patients were desperate and, more often than not, frustrated.

Congress began allocating research money in 1971 for a War on Cancer.  Research accelerated, but progress was fitful at best.  Here is a chemotherapy milestone report from about the middle of the book:

        "In 1985, the worst blow to oncology came from the discoveries of Harvard biologist
        John Cairns. By researching  state registries of cancer deaths, Cairns found that new
        oncological treatments saved 35,000 to 40,000 lives a year. Unfortunately, this was
        still less than five percent of cancer patients: More than 30 years after . . . initial
        research, only one in 20 patients had lived longer because of cancer treatment."

Still, the work continued.  Dogged researchers, each devoting years to one small piece of the huge puzzle puzzle -- a specific cancer, a cell process, genetic correlations -- gradually improved our understanding of how specific cancers arise and grow.

A high point in the book comes around the year 2000, when a new drug, Gleevec, proves effective in the treatment of CML, a pernicious and deadly leukemia.  The drug targeted an enzyme that allowed leukemia to grow.  Patients with hopeless diagnoses suddenly felt well again; their white blood cell counts returned to normal.

Reading about the CML victory after a long slog through many small accretive advancements makes the reader want to whoop for joy.  But then, after a period on Gleevec, many CML patients found that their cancer had mutated again and resumed its attack on their bodies.

Fortunately, the pace of progress has accelerated in the years since.  There are many reasons for hope.

The book is not an easy read, but its writer weaves the stories of driven researchers, ardent fundraisers and individual cancer patients into a narrative that explains the science behind each new problem and each new discovery.  It is a real achievement.

Tonight PBS will begin the broadcast of a three-part series based on the book and with the same title.  The filmmaker, Ken Burns, has turned out many fine documentaries.  Just about all of us have a family member or friend who has had cancer.  I think the program will be worth a look.

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