James Klagge's Reviews > The Emperor of All Maladies: A Biography of Cancer

The Emperor of All Maladies by Siddhartha Mukherjee
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's review
May 18, 2012

it was amazing
bookshelves: medicine, science, history
Read from April 11 to May 14, 2012

Subtitled: "A Biography of Cancer." A long and sometimes difficult book--but well-written, well-done, and well worth reading. How a doctor near the beginning of his career would have time to research and write this is beyond me. I'm glad he did.
When I started reading this I noted on Goodreads: "No, I don't." ...that is, don't have cancer. But I feel better prepared if I am diagnosed, or if someone I know is diagnosed. In fact I have not been much touched by cancer, but it did start me to thinking about how cancer has impinged on my life. My maternal grandmother had a radical double mastectomy in the 1950's. I didn't know this and wouldn't have guessed until my mother told me--maybe sometime in the 1990's. And my mother suspected that she hadn't in fact had breast cancer, but it was done as an overly aggressive preventive measure. That is very much in tune with the story told here. There was a trend at that time toward thinking that radical surgery was the fix. This was connected with a typical conflict between the doctor's desire to win at all costs, and the adverse effects on the patients. But it is true in this case that my grandmother did not die of cancer (if she ever had it). She lived to 94. My first conscious encounter with cancer was when my paternal grandmother's sister, who was a smoker, whispered to my parents about health problems that she had, but she would not use the word "cancer" and she would not in any case see a doctor. She did presumably die of lung cancer (in her 70's), but without having to suffer any of the indignities of treatment. "Cancer" is often feared as a dangerous word, as though saying it can cause it. And once when someone found out I was reading this book, the person reacted as though I was acting foolishly or playing a dangerous game of tempting cancer by reading about it. That magical aspect of cancer was never discussed in the book, but I recall it as a common feeling--especially in past decades. I suppose it is connected with the fact that we really don't understand the causes and cures for cancer, and what we don't understand we tend to treat supernaturally.
Another part of my history with cancer is that both my parents were smokers. My father switched from cigarettes to cigars and then a pipe before I was born. My mother smoked cigarettes until the mid-70's. I was quite aware when the Surgeon General's report about smoking came out in the mid-60's. That slowly but eventually led to both my parents stopping smoking. I am very impressed that they were able to stop, b/c I know that is not easy. I have never smoked, but I have 2 relatives who struggle with smoking--being unable to quit permanently.
My own closest connection with cancer is colonoscopies, which I have had every 5 years since I was about 40. These have been done b/c of my supposed family history. I am surprised how completely painless they are, and I would say they are a use of technology at its best. So, while no one close to me has died of cancer, it is striking how the structures that have grown up around cancer have involved me, as they have involved almost everyone.
I was very interested in the understanding of cancer that has emerged. We tend to think of cancer as a thing, but it really is not. Talk of a war on cancer is misleading, just like talk of a war on terror is misleading. Cancer is not an invader, so much as it is an exaggeration of processes that are normal in cells--reproduction and growth. Cancer occurs when genes in cells that control division through acceleration and braking and cell death become dysfunctional through mutation. Sometimes the mutation is caused by external agents, sometimes by inheritance, and sometimes by accident. That is why it is so hard to conceptualize a "cause" of cancer. It is really caused by things that occur naturally in cells, only when they get out of control. And the ways that can happen are quite varied. So the means for preventing or treating cancer are also quite varied. Since cancer is in a sense an exaggeration of life, it will not be cured per se. It can be countered in various ways. Again, like the war on terror, it will not be won--rather, we can hope for a satisfactory state of protection.
It was interesting that this was called a "biography" of cancer. A biography generally starts with a birth and ends with a death. This story has neither--but it certainly is a kind of life story. I am very grateful to researchers who have made as much progress as they have on ways to prevent, screen and treat cancer. It sounds like it is often a grueling process. In 2 weeks I am running in the local Relay for Life to raise money for cancer research. I have done this for a few years now. Having read this book, I know much more about what people are dealing with, and what can be hoped for.

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Reading Progress

04/12/2012 page 18
3.0% "No, I don't."
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