Review: Portrait of cancer sure to leave one transfixed

News that the burden of cancers in Uganda will grow in their frequency (by nearly 40 percent) and quite possibly ferocity in the next decade has been greeted with fierce angst. As more time is spent putting out fires created by cancers, the equilibrium of the Ugandan healthcare system looks primed to be disturbed in unforeseen ways. 
The emperor of all maladies: A biography of cancer—which won the oncologist Siddhartha Mukherjee a Pulitzer in 2011—uses a thoughtful if emotionally subdued and unemphatic tone to show how hope and despair live side by side. Anecdotes from cases the clinician shares in the book achieve the emotional intensity the subject demands. 

In the opening pages, Mukherjee draws attention to Carla Reed—a kindergarten teacher from Ipswich, Massachusetts—to show not so much how thunderously hostile cancer can be (of which it is) as to its abruptness. At least the diagnosis. After feeling “the kind of numbness that instantly tells you that something is terribly wrong”, Reed fought upheavals of showing signs of frightening weakness with mixed success. While the medical consultation sought had a reasonable aim in its way, it didn’t home in on why she had little of her old energy.

Every day was a challenge, every step caused pain. Then four weeks after her first medical consultation, “a routine test to check her blood counts” confirmed that Reed had leukaemia. She now found herself entering what one of Aleksandr Solzhenitsyn’s characters in a novel once called “a borderless medical gulag.” Her story ends with her beating cancer, but there are not that many ‘lived happily after’ endings. And, above all, she is not oblivious to the fact that a relapse could be a heartbeat away (which is why the revelation doesn’t merit a spoiler alert).
“Cancer,” she told Mukherjee, “is my new normal.”
Mukherjee says this “normalcy” is not exclusive to Reed. He proceeds to forecast rather darkly thus: “Indeed, as the fraction of those affected by cancer creeps inexorably in some nations from one in four to one in three to one in two, cancer will, indeed, be the new normal—an inevitability. The question then will not be if we will encounter this immortal illness in our lives, but when.”

Mukherjee is guardedly optimistic because—true to Greek term onkos from which cancerous tumours trace their roots—the malady places a great burden that weighs on the fragile shoulders of the human race. 
“Onkos was the Greek term for a mass or a load, or more commonly a burden; cancer was imagined as a burden carried by the body,” he writes. 
The manner in which different generations moved to extricate themselves from the mass, load or burden brings the gravest reflections. The portrait of mastectomies sketched is, for one, sure to retain a dark grip on readers of the book. 

We encounter a Persian queen—Atossa—who in 500 BC had her Greek slave perform a mastectomy devoid of sophistication. Atossa had “noticed a bleeding lump in her breast that may have arisen from a particularly malevolent form of breast cancer labelled inflammatory” before asking the slave to wield the knife.
In the 19th century, we are encountered with “radical mastectomy [procedures where] “a large excision of the tumour and removal of the deep chest muscles and lymph nodes under the armpit and the collarbone” is deemed adequate. 
The tumour is then targeted locally with X-rays (Marie Curie, an oncologist, died from a leukaemia caused by decades of X-ray exposure) in the early 20th century. Soon, terms like lumpectomy and adjuvant combination chemotherapy figured into what Mukherjee calls a “shifting landscape of trials.” And indeed these were trials (while not as radical, they remain in trial and error mode) in which patients were up against the ropes with no clear remedy to their predicament.

Eventually, Mukherjee concludes that “surgery, chemotherapy, radiation, hormonal therapy, and targeted therapy have likely added anywhere between 17 and 30 years to [the] survival” of someone grappling with breast cancer.
Far from assuming a mournful edge, Mukherjee’s biography of cancer dedicates space to crediting efforts of a number of laboratory scientists that have traced the molecular sequence of malignant cells. 
The likes of Robert Weinberg, Harold Varmus and Bert Vogelstein get extensive mentions. While a lot has transpired since the 17th century when fire, acid and leather bindings were used in the surgical removal of breast cancer, Mukherjee remains circumspect. And rightly so for this is the emperor of all maladies!