Everything you did -- or didn't -- want to know about cancer

Book review: "The Emperor of All Maladies: A Biography of Cancer," by Siddhartha Mukherjee. Scribner, $30.

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Cancer, the poet Jason Shinder has written, forces its victims to press their faces "right up against the glass of their mortality." As their daily lives are consumed by the illness, adds Siddhartha Mukherjee, "what they see is not a world outside cancer, but a world taken over by it."

A terrifying, shape-shifting scourge, the disease is replete with contemporary images. The cancer cell is a non-conformist, an invader, a colonizer. It's "a parallel species, perhaps more adapted to survival than even we are."

Dr. Mukherjee, a physician and researcher at Columbia University and CU/NYU Presbyterian Hospital, provides an informative, elegant, comprehensive and lucid survey of the history, culture and politics of cancer. Using non-technical language, he manages to enter into its essence, understand its behavior, and "demystify its psyche."

It's hard to believe that so young a man -- the author completed his residency in medicine and graduate work in immunology in 2003 -- could write such a masterful book. But he has.

Dr. Mukherjee recounts with precision and passion, the surges, surprises and setbacks in the search for the causes and cures of cancer.

The premise that breast cancer should be attacked by "cleansing" surrounding tissue, even when no sign of the disease could be detected, to stave off relapses and metastasis in distant organs, he writes, resulted in "grotesque and disfiguring mastectomy, foisted indiscriminately on women with even small locally restricted tumors." And it didn't reduce the rate of mortality.

In "cure obsessed America," Dr. Mukherjee acknowledges, physicians resisted palliative care, the branch of medicine that delivers relief and comfort to patients. "Allergic to the smell of death," which they equated with failure -- their failure -- surgeons and oncologists argued that opiates masked symptoms and caused addiction, deterioration and suicide.

They pushed "hopeless" cases out of sight and mind. And so, anti-nausea drugs were first dispensed and hospices established in England, where Cecily Saunders, a former nurse who became a physician, helped patients die with dignity.

Although the author says he prefers lab research to clinical practice, his book is suffused with his compassion for cancer patients.

It's there in his portrait of Carla Long, whose regimen of chemo and radiation, back to back, "one dark tide after another," robbed her of sleep, hair, appetite, and something more important, "her animus, her drive, her will."

The woman's struggle became "so deeply personalized, so interiorized," that she dropped everyone who needed to be needed, including the friend who had accompanied her to the hospital.

It's there as well in Dr. Mukherjee's account of the birth of his daughter, when, gowned and gloved, he was oncologist as well as daddy. As he cut the umbilical cord, he carefully harvested the blood, the richest known source of stem cells, useful for bone marrow transplants, a precious resource that is often flushed down a sink.

Happily, the author can credibly conclude his book on an optimistic note. Over the past 20 years, mortality for nearly every major form of cancer -- lung, breast, colon and prostate -- has declined. Scientists have demonstrated that the disease is caused, not by a virus, by the "activation" of a precursor to a cancer gene in our genome.

Cancer is still a scourge; more than 500,000 Americans perished from it in 2005. But, according to Nobel Laureate Harold Varmus, we can now see "our monster more clearly and describe his scales and fangs in new ways."

We can proclaim with more than a hope and a prayer that the monster is losing his power.

Glenn C. Altschuler is the Thomas and Dorothy Litwin Professor of American Studies at Cornell University.


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