The Emperor of All Maladies: A Biography of Cancer

by Siddhartha Mukherjee

Since the publication of Rachel Carson’s Silent Spring in 1962, environmental activists have stridently argued that the indiscriminate overuse of pesticides is partially responsible for the rising incidence of cancer in America. This theory has spawned intense controversy, activism, and public campaigns over the decades. But although the hypothesis is credible, large-scale human-cohort experiments directly implicating particular pesticides as carcinogens have emerged slowly, and animal studies have been inconclusive. DDT and aminotriazole have been shown to cause cancer in animals at high doses, but thousands of chemicals proposed as carcinogens remain untested. Again, an integrated approach is needed. The identification of key activated pathways in cancer cells might provide a more sensitive detection method to discover carcinogens in animal studies. A chemical may not cause overt cancer in animal studies, but may be shown to activate cancer-linked genes and pathways, thus shifting the burden of proof of its potential carcinogenicity. Similarly, we now know there is a link between nutrition and the risk of particular forms of cancer, but this field remains in its infancy. Low fiber, red meat rich diets increase the risks of colon cancer, and obesity is linked to breast cancer, but much more about these links remain unknown, especially in molecular terms.