Wednesday, April 18, 2012

BOOK REVIEW: The Emperor of All Maladies. A Biography of Cancer by Siddhartha Mukherjee

I have to find a cheerier book to read next.

Over spring break I decided to tackle The Emperor of All Maladies. A Biography of Cancer by Siddhartha Mukherjee. It’s a brilliant book. If you’re looking for a better understanding of the big picture of cancer, this is where to go.

I heard about this book awhile ago – it was, after all, the 2011 Pulitzer Prize winner for general nonfiction – but was not in a hurry to read it because, well, it is a fairly hefty-looking tome about cancer.

As a pathologist, I have a fair acquaintance with cancer – I know what it looks like. Pathologists look at resected organs and at specimens under the microscope, and one of the main questions we’re supposed to answer is: "Is it cancer?" So we have to know how to recognize it when we see it. I’m a pediatric pathologist, so we’re generally looking for a specific subset of tumors that occur in children. Over the years I’ve grown more accustomed to seeing the comparatively rare pediatric cancer variants rather than the much more common breast, colon, lung and prostate cancers that plague adults. However, as I’ve gotten older, those adult cancers have begun to swirl around me in a different way – they’ve begun to invade the circle of my friends.

So I decided I wanted to read this biography of the disease. I knew the book would be a history of cancer, but I was expecting something dry and more textbook-like. I wasn’t prepared for the scope of the book or for the clarity of the prose. Mukherjee is a physician/scientist but he is also a writer. He makes complex problems accessible without oversimplifying. He is able to take the reader backward and forward on a remarkable journey alongside the pioneers of cancer treatment, political advocacy, and research. He walks with patients, both survivors and those who succumb. Cancer treatment has not been a straightforward march from ignorance and poor outcomes to increasing knowledge and therapeutic success. There have been a lot of false starts and bumps in the road. Cancer is not one monolithic disease seeking one magic bullet, and the battle against it makes for a fascinating, heartbreaking tale.

In this extraordinarily readable book, Mukerherjee lays out the pathways that were explored, increasing incrementally the knowledge about specific malignancies. He explains how therapies added to understanding about cause and vice-versa. In the final chapters, we get to the unraveling of the genetic mechanisms of some cancers and the promise that molecular research holds for the eventual understanding of more and more types of cancer. Understanding the mechanism has led to some targeted therapies and will hopefully lead to more. The book is cautiously optimistic and I came away from it feeling like I had a better understanding of where cancer biology and treatment have been and where they are heading. Unfortunately, it’s also clear that there’s no escaping the suffering cancer has caused and will continue to cause.

If you’re curious about cancer, I highly recommend The Emperor of All Maladies - and the Pulitzer committee agrees.

Still, the next book I read has got to be fluffier.