Wednesday, August 21, 2019

The Emperor of All Maladies: A Biography of Cancer by Siddhartha Mukherjee

★★★★★

This book is impressively approachable. I found the author's writing exceptionally concise and engaging, though admittedly I got a bit muddled in trying to understand the DNA research towards the end.

It's a sweeping account chronicling everything related to cancer from causes and prevention to detection and treatment, from laboratory scientists making discoveries to physician researchers running clinical trials to the individual patients facing down cancer with bravery and dignity.

As the author lays out the history of cancer, there are incredible stories of pathologists and chemists and physician-scientists whose individual contributions came together over many decades to eventually result in the discovery of a new cancer or a new chemical to treat cancer. It was nothing short of fascinating to follow the history of chemotherapy through textile dyes and mustard gas. Ideas changed and developed and were tied back to concepts first proposed centuries earlier.

Much of the history of cancer research has taken place in Boston, and growing up in this area, it was particularly enlightening for me to learn about the stories behind well-known institutions and individuals like the Dana-Farber Cancer Institute, the Jimmy Fund, and Vannevar Bush. (As a student at MIT, I walked by a room named for him almost every day, and attended events in the room, but never had any idea who he was.) I even learned that a nearby town, Framingham, is the site of a massive epidemiological study that has led to a number of medical findings.

Remarkably - and this is altogether beside the point of the book - I could not help but take note, especially in today's political climate, how a great many of the researchers in the U.S. who made strides in the fight against cancer were immigrants or from immigrant families. I also saw parallels between the tobacco industry's refusal to acknowledge the dangers of cigarette smoking and the present-day gun industry's refusal to acknowledge the dangers of gun violence. If Big Tobacco, "an industry once thought virtually impregnable," (p. 267) could eventually be well-regulated, then maybe there is hope that the gun industry could one day be well-regulated, too.

On a personal note, this book was a gift to my husband (a teacher) from a student who wanted to share the book that had an outsized impact on him, inspiring him to want to become a doctor. The book sat on our shelf for years, and I didn't pick it up until I was diagnosed with breast cancer myself. Suddenly, I felt drawn to the book, and reading it felt like a kind of opposition research. While the book discusses many different cancers from leukemia to breast cancer to prostate cancer, a good portion of the history of cancer centers on breast cancer. I repeatedly felt that much of the information was directly relevant to me. I certainly now have a better understanding of how surgery, radiation, chemotherapy, and hormone therapy are all tools in an oncologist's toolbox, but figuring out which tool will work, and how exactly to use it, is highly dependent on the specific stage and type of cancer being treated.

What is clear from this book is that I am thankful for - indeed I feel deeply indebted to - every person ever drawn to study, treat, and attempt to cure cancer, every patient whose diagnosis, illness, treatment, and death helped to further the understanding of cancer and push the community towards a cure. Poignancy abounds in the history of cancer. Scientists who discovered the healing properties of radiation, only to succumb themselves to radiation-induced cancer. Patients who made up the statistics that drove the research towards a cure, but who were all individual persons with families and interests and full lives they weren't ready to leave.

It's been a very long, arduous, terrifying fight. The descriptions of the earliest mastectomies are horrifying, and I feel immensely grateful for being lucky enough to be diagnosed in 2019, when anesthesia, sterilization, and pain killers are customary parts of the procedure. Particularly astonishing to me was the realization that much of my treatment as a cancer patient is heavily reliant on discoveries and advances in cancer medicine that took place relatively recently, over the course of my own lifetime.

I would not go so far as to recommend this book to cancer patients. I might be a weirdo in the extent to which I am curious about what I am up against. But it's definitely a book worth reading for anyone who wants to know more about cancer, for whatever reason.

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