THE EMPEROR OF ALL MALADIES: A Biography of Cancer, by Siddhartha Mukherjee. Scribner, 571 pp., $30.
BY MARION WINIK
While my mother was being unsuccessfully treated for the lung cancer that killed her, she kept worrying that I had forgotten to reschedule her upcoming mammogram.
This seemed ironic at the time, but after reading "The Emperor of All Maladies" I see it in a richer context. Among the things I understand, after what feels like a college course on cancer: that our greatest victories against the disease have come in the area of prevention (pap smears, mammograms, colonoscopies, etc.); that my 79-year-old mother represented the last of a generation of smokers who were misled about the connection between cigarettes and lung cancer until very late in the game; that most of the treatments available now - radiation, chemo, surgery - are primitive in contrast to the progress in our understanding of the disease at the genetic level.
Reading Siddhartha Mukherjee's 500-page tome is a project, but it helps make sense of the endless torrent of cancer-related experiences and information in our lives. Between the fundraising, the awareness campaigns (my 10-year-old daughter is now wearing a pink hair extension for breast cancer), the annual screenings and the science-section news, cancer is a daily preoccupation. When someone we know has cancer (or we ourselves are diagnosed) the level of involvement swiftly escalates, and suddenly we are experts, spouting acronyms and medications and percentages. No one is untouched by it since, as the first page of this book chillingly notes, one in three women and one in two men in the United States develops cancer in their lifetimes.
"The Emperor of All Maladies" provides a crucial frame of reference for this avalanche of data. And because Mukerjhee, a cancer physician and researcher on staff at Columbia University Medical Center, is a fine writer and a great teacher, the experience of reading it is, mostly, a fascinating intellectual adventure. To create what he calls both a "military history" and a "biography" of cancer, Mukherjee brings together the voices and stories of patients, doctors, researchers, advocates and writers spanning not just centuries but millennia.
The first written record of cancer goes back to 2500 BC, where it is mentioned in the writings of the Egyptian physician Imhotep - one of the only maladies for which he does not offer a treatment. A couple thousand years later, in 440 BC, we meet the Persian queen Atossa, who had a slave amputate her diseased breast.
Following these ancestors comes a parade of doctors, patients, researchers and crusaders. Mukerjhee is particularly good at giving a bird's-eye view of the work and personality of each. There are early surgeons like the Scotsman John Hunter in the 1760s, who "worked at breakneck speed, having drugged his patient with alcohol and opium to near oblivion," only to see the few who survived the operation die "even more miserable deaths in their own beds soon afterward." There is William Halsted, the pioneer of radical mastectomy, Sidney Farber, a tireless researcher and crusader, and many doctors who, poignantly, succumbed to the disease themselves.
I only found myself skimming in the section that details genetic approaches to cancer treatment. I was glad to understand the cellular qualities that make cancer "a parallel species, one perhaps more adapted to survival than even we are," but the level of detail in Part V of the book (there are six parts) lost me.
Like Atul Gawande, Jerome Groopman and Oliver Sacks, Mukerjhee shares his personal experiences with patients, though he is more a historian than a memoirist. One case runs all through the book, the 36-year-old woman with leukemia whom Mukherjee began treating in 2004, and for whom he initially had little hope. He was sure, he writes, that the book would end with Carla's relapse and death.
It does not. And though Mukerjhee stops far short of predicting we will eradicate cancer, he quotes at the end of his saga a favorite aphorism of the cancer researcher Richard Doll: "Death in old age is inevitable, but death before old age is not." With the current state of prevention, therapy and treatment for specific types of cancer, we have come a good part of the way toward stopping the disease from cutting people down in their prime. While he cannot offer us the comfort of a "magic bullet" or universal cure just around the corner, Mukherjee makes us understand that along with our terrible losses, great gains have been made.