The History of Cancer

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Photos: Shailendra Pandey

BARKHA DUTT: I want to start by asking you about that iconic genius Steve Jobs, obsessive about fitness and health, who goes just like that, in his 50s. Great leveller, that story of Steve Jobs. We just don’t understand cancer, do we?
SIDDHARTHA MUKHERJEE:Well Steve Jobs’ death was a brutal reminder about the extent to which we’ve failed people like him. Here’s a man who gave us life-altering technologies and did we give him lifealtering technologies? What prevents us today from changing the landscape of cancer? It’s really a failure of imagination. The answer to the question you’re asking — how does someone who’s so obsessed with life, with living, become susceptible — is that cancer, unlike any other disease, is built into our genomes. Let that thought sink in. Because it’s not just biological, it’s really a philosophical thought. If you take the very genes that allow our bodies or embryos to grow and distort them, mutate them, you unleash cancer. You can’t, therefore, un-twin from your body, it’s very much part of the normal cellular growth process going awry. That gives rise to one of the biggest challen – ges in cancer medicine in general: how does one discriminate normal growth from malignant growth? That’s the challenge faced by Jobs’ doctors as well.

BD: You do make that point in your book: about how in a sense all of us in this room are possibly carrying a cell that can mutate at some form into a cancerous cell.
SM: By its very nature.

"If there are no archetypal human beings, there are no archetypal memories. So why should there be an archetypal hope?” Siddhartha Mukherjee
“If there are no archetypal human beings, there are no archetypal memories. So why should there be an archetypal hope?” Siddhartha Mukherjee

BD: In a sense, this really undoes previous understanding of how to stop this, how to prevent this, how to deal with this. If we are all potentially cancerous beings, if I may use that phrase, how do you still make the point in your book — and you have made this repeatedly in conversations afterwards — that you wanted to challenge the nihilism in a mental response to cancer. Because there seems to be something so fatalistically ordained if we are all potentially going to have our bodies mutate into cancerous cells.
SM:
 Well, the simplest way to counteract that nihilism is to make the argument that Richard Doll does — the famous epidemiologist who eventually figured out the link between tobacco and lung cancer. Doll says that death in old age is always an inevitability — it’s death in young age that’s the problem, that’s the new frontier. Some numbers are important in this context. In the US, one in two men and three women develop cancer during their lifetime. One in four men and women will die of cancer. It’s a statistical inevitability, in that sense. If you just take young men and women dying of cancer, that, let’s say, the cut-off might be the age of 60, you’re still at hundreds of thousands of deaths per year. So it’s actually simple to counteract the nihil – ism because you can’t be nihilistic about an illness that is killing hundreds and thousands of men and women every year. You have to have some way of understanding this and moving ahead.

BD: This beautiful morning in Goa, what I’m actually hearing is this: the best a doctor can do is, say, you want to live long enough to see your son graduate, I’ll help you get there; you want to live long enough to take your mother for that one last holiday, I’ll get you there. Beyond that, you can’t do much.
SM:
 My point is that lives are stitched together through memory. So the question of the beyond becomes abstract unless it’s made into the concrete question of what is now, what happens next, what you are waiting for, what you are trying to do. I tried to address some of these questions in the book.

BD: But how do you offer hope?
SM:
 There are no absolute hopes. My sense of it is that it is negotiable. If there are no archetypal human beings, there are no archetypal memories. So why should there be an archetypal hope? People’s hopes change, they become reconciled to realities and those hopes cha nge over time. If we anatomise it without understanding that there is a personality behind that anatomy, I think we do a big disservice.

BD: So did medical technology fail Jobs because it hasn’t kept pace with new understandings of cancer or did it just fail him because the human mind has not reached that critical moment in medical technology?
SM:
 As we move into the future, we just have to face up to these problems: energy, food, water and health. My suspicion is that we are far from committing the kind of resource intensiveness that we need to address these problems, the kind of problems that affect human health not only globally but also across specific nations. The termination of life caused by human deficiency viruses in sub-Saharan Africa has already changed African history. So unless we contend with these kinds of figures, we’ll lose our grip on what the real big problems are. I think the lack of resources is a major problem.

BD: The Emperor of All Maladies is as much medicine as it is history and literature, in many ways. When you go back in history, you’re looking for the first recorded incidents of cancer — they may not have been called that. There is this absolutely riveting account of a Persian queen who cuts off her breast, which would be the modern-day mastectomy. But you make the interesting point that from then to now, the response, let’s say, to breast cancer hasn’t changed. There is still this whispery stigma, embarrassment associated with it. Why is that?
SM:
 Well, for breast cancer, in particular, it is not only about the shame of the pathological body, but sexual shame. It’s the juxtaposition of those two. I’ll give you a good example. About a decade ago, a group of researchers at Harvard were interested in the question of a link between obesity and breast cancer. It started as a clinical epidemiological study and they went and collected a cohort of women with breast cancer and an agematch cohort of women without breast cancer and they asked them what their diets were in the preceding 10 years. The answer was crystal clear: women with breast cancer had consu med diets higher in fat. But there was a twist. These women had also recorded (they’d been chosen for this reason) their real diets before the diagnosis of breast cancer 10 years ago. So, women with breast cancer had selectively remembered consuming diets (this in 1997) higher in fat. Why? Because of guilt. They said to themselves: I must’ve done something wrong.

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