Photography by Deborah Feingold
Although oncologist Siddhartha Mukherjee, MD, has written a magnum opus on cancer, he doesn’t think his über-expert status will change how he interacts with patients. The 2011 Pulitzer Prize winner for nonfiction says, “I try to be very humble about the possibilities and achievements of what can be done and what cannot be done in cancer. I think, unfortunately, becoming an expert is as much a poison to writing a book as it is to treating a patient.”
Mukherjee realizes that America’s 40-year war on cancer (or for that matter the 2,500-year war since Queen Atossa of Persia had a tumor excised from her breast) is littered with hopes and dreams for cures that never appeared. The Emperor of All Maladies: A Biography of Cancer is a sober assessment of the state of cancer and makes no claims that defeating it is within our reach. Yet Mukherjee, an assistant professor of medicine at Columbia University, acknowledges a biomedical renaissance is under way, writing, “The tools that we will use to battle cancer in the future will doubtless alter so dramatically in 50 years that the geography of cancer prevention and therapy might be unrecognizable.”
Paul Costello, chief communications officer for the School of Medicine, caught up with the Stanford graduate in August as Mukherjee was on vacation winding down from the year’s non-stop action as a clinician, researcher and celebrated author.
Costello: I was intrigued by your suggestion that quite possibly cancer is our normalcy. What did you mean by that?
Mukherjee: The idea that we can eradicate cancer completely from our bodies and societies forever in the future, I think, is somewhat absurd. And that’s not because I’m being pessimistic or nihilistic about this project. It’s the very biological nature of cancer that makes this true. The very genes that allow our embryos to grow, our cells to grow, our bodies to grow — if you corrupt those genes, then you get cancer. And in that sense, cancer is sort of the corrupted side of our normalcy.
And that is bolstered by what I call the statistical reality of cancer — that one in two men and one in three women will face cancer in some form or the other, and one in four men or women will die of cancer in the United States. So, if those are the numbers, we can barely start calling cancer an abnormal event in our life.
Costello: You’ve said that one reason you decided to write the book was that you found a lot of what’s been written about cancer vaguely insulting. Why insulting?
Mukherjee: There’s a simplisticness, which I was reacting to. I’m talking about a typical book on cancer, which you find in the health and wellness section, which says, “Eat broccoli and cure cancer,” or “Take this magic diet and you’ll never get cancer.” I think those have a kind of insulting simplisticness about them. I mean, patients need to know more. We need to have a much more sophisticated conversation around what cancer is, how long it’s been with us, what is happening, how we got here, what is the Cancer Genome Project, what are the new directions in cancer therapy.
Costello: Why did you choose the words The Biography of Cancer?
Mukherjee: The word “biography” in the title came very late in the process of writing the book. For the longest time, the book was subtitled “A History of Cancer.” I chose the word “biography” for three reasons. The first was that I was drawing a portrait of the same subject, looked at over time, several times over: cancer in 1885, and then again in 1892, and then again in 1922. And every time, much like human beings change their appearance, their persona, it seemed that the imagination of cancer had changed radically in the public life. So in that sense, it was a biography.
The second reason is somewhat more prosaic, and that is that the book is stitched together using the condensed biographies of various cancer researchers, various cancer patients, cancer advocates, men and women like Mary Lasker and Sidney Farber. So in a way, the narrative structure of the book is biographical.
And the final reason, and perhaps the most complex, is that when patients describe their illness — Susan Sontag does this very movingly in the very first lines of the book — they describe it, often, as moving in or inhabiting an altered state. It is as if their biographical sense of who they are changes as well.
Costello:You just had a piece in The New York Times about cancer prevention and politics. Can you talk further about that?
Mukherjee: We think of cancer prevention as a sort of silo, as a kind of entity in and of itself. But, in fact, cancer prevention has multiple dimensions, and every dimension needs action.
The first challenge of cancer prevention, I think, is a scientific or a biological challenge — how does one carefully, rigorously identify carcinogens and other biological phenomena that are linked to cancer?
But the other problems, I think, we tend to ignore. There is a political problem, and that is that once these carcinogens have been identified they might turn out to be involved in some industry or another. For instance, famously, the tobacco industry vigorously denied the carcinogenicity of cigarettes for decades and there was a lull between the discovery of the carcinogen as a biological entity and its revelation in the political realm. That lull was about 10 years, maybe even longer. So, for instance, the first studies that linked cancer to cigarettes actually predate even the 1950s, but it’s not until 1964 that the Surgeon General’s report makes a definitive conclusion about this in the political realm and thereby kicks off stronger control on tobacco.
And the final challenge is that once you finally establish that carcinogen in the public realm, the carcinogen has the capacity to keep coming back. As we know now, there are pockets of America where young teens have started smoking again. This is not only decades but almost 50, 60 years after the first discovery of tobacco as a carcinogen. So that’s a social problem.
Costello: Right now, the words that we use in cancer are “race for the cure,” “the war on cancer.” And I wonder if you think we need to change those words.
Mukherjee: I think we do. I think we need to re-create narratives to understand what is happening. Harold Varmus [director of the National Cancer Institute] said to me, “Wars are things we win and lose, but solving cancer is like solving a jigsaw puzzle. And you don’t win or lose a jigsaw puzzle; you solve it or you don’t solve it.”
This interview was condensed and edited by Rosanne Spector.