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Vol. LXIII, No. 16
August 5, 2011
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Telling Cancer’s Human Story
Pulitzer Winner Mukherjee Constructs History of Cancer

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Dr. Siddhartha Mukherjee
Dr. Siddhartha Mukherjee
In recent years, science has made astounding progress in cancer treatment and prevention. But in the midst of these technological advancements, oncologist and author Dr. Siddhartha Mukherjee asks his colleagues to remember one key point: “Ultimately, the story of cancer is a human story. It’s a story about patients.”

In his lecture on June 15, he spoke, as a special guest of NCI, on “Constructing a History of Cancer.” Mukherjee, of Columbia University, won the 2011 Pulitzer Prize for his non-fiction book, The Emperor of All Maladies: A Biography of Cancer.

Mukherjee said that a patient was his inspiration. This patient, battling a gastrointestinal stromal tumor, had tried several treatments but relapsed each time. “I’m willing to go on with all of this,” she told him after one relapse, “but you have to tell me what I’m fighting.”

Continued...

“This is a question that’s come to all of us,” Mukherjee told the oncologists in the audience. However, books that might have helped his patient understand her foe were “unsatisfying,” he said. “They were dumbed down. They did a disservice to cancer.” To solve this problem, he set out to write a book himself.

In his lecture, Mukherjee outlined the progression of humanity’s understanding of the disease and its treatments over thousands of years, from the ancient Egyptians to the Enlightenment and beyond.

Mastectomy, the removal of cancerous breast tissue, is a still-common procedure that has its roots in centuries-old anatomical texts. From the late 19th century through the 1950s, mastectomies removed more and more tissue in an effort to prevent cancers from recurring. But beginning in the 1940s, researchers began developing chemotherapy, which eventually offered doctors a new way of battling this disease.

Participants in the first, groundbreaking trial of a chemotherapy agent were children with leukemia, identified in the researchers’ notes only by their initials. In his commitment to showing the human side of cancer, Mukherjee sought out the identities and stories of these children.

For a long time, he was frustrated by many dead ends. But while visiting his parents’ home in New Delhi, Mukherjee met the biographer of one of the scientists involved in the trial.

“A cancer cell [is], like Grendel, a distorted version of our own selves,” said author Mukherjee.

“A cancer cell [is], like Grendel, a distorted version of our own selves,” said author Mukherjee.

Photos: Bill Branson

Through the biographer, he found a newspaper clipping with the picture and names of one of the trial participants, Robert Sandler, and his brother, Eliot.

“I can’t believe I had to go thousands of miles to find someone in Boston,” Mukherjee said. A second coincidence followed: Eliot was surprised to find his brother’s name while flipping through The Emperor of All Maladies in a bookstore. He contacted Mukherjee and shared his memories of this long-lost brother, whose contribution to cancer research nearly had gone unrecognized.

The early successes of chemotherapy began a new era of optimism. Mukherjee read from a full-page newspaper advertisement addressing then-President Nixon: “Mr. Nixon,” it read, “You can cure cancer.” In fact, the ad suggested, cancer could be eradicated by the bicentennial of the United States.

Mukherjee emphasized the “single c’s” in this ad: one cancer and one cure. As scientists learned more about cancer, however, this assumption began to seem unrealistic.

Despite the lack of a single cure, there has been a “change in the relentless trajectory of cancer deaths,” he said, with lower mortality every year. A great part of this success comes from our growing understanding of the genetics of cancer, he explained. We now know that each person has his or her own cancer, with hundreds of unique variations in numerous growth-control genes, which, in aggregate, cause the uncontrolled cell growth at the heart of the disease.

“This answers the question of why the ‘single c’ was so hard to come by,” said Mukherjee. Instead, researchers are working on individual, targeted therapies, optimized for each patient’s particular collection of genetic variants.

Mukherjee quoted his host, NCI director Dr. Harold Varmus, whose 1989 Nobel Prize banquet speech said: “A cancer cell [is], like Grendel, a distorted version of our own selves.”

Unlike the epic hero Beowulf, we have not yet defeated this foe, which arises from our own, unique genetic makeup. But, said Mukherjee, at least we are starting to understand it. NIHRecord Icon


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