Cancer and Society
Books The emperor of all maladies
The emperor of all maladies Siddhartha Mukherjee. Fourth Estate, 2011. Pp 592, £25.00. ISBN 978-0-00-725091-2 For A Biography of Cancer: An Evening with Siddharta Mukherjee, at the New York Academy of Sciences, April 14, 2011, see http://www.nyas.org/ events/Detail.aspx?cid=aac8a0aa698b-4dfe-864c-bb482fd2f510
Appreciation of the history of science is important, says Siddhartha Mukherjee, a medical oncologist at Columbia University, New York, USA, because our interpretation of concepts depends on our understanding of the past. A diagnosis of cancer, as for any illness, is of course still unwelcome; yet, in the second decade of the 21st century, the hopelessness and despair that such a diagnosis meant only 50 years ago is hard to imagine. Why is it that modern medicine oﬀers justiﬁed hope and respite to many patients with cancer and, in fact, an absolute cure for some? Mukherjee oﬀers an eminently readable history. Although cancer has been known to man from antiquity, as evidenced in mention of breast tumours in the Edwin Smith papyrus of 2500 BC, it was the advent of anaesthesia and asepsis that emboldened surgeons in
the late 1800s to go where no surgeon had gone before and perform heroic surgeries in an attempt to cure. The heady days after World War 2 saw bolder physicians—including Sidney Farber, Emil Frei, and Emil Freireich—who with the right mix of serendipity, educated guesswork, insight, obstinacy, guts, passion, optimism, and compassion for their patients made a cure for cancer their mantra. Mary Lasker, with indomitable zeal and charm, opened political and other doors for research funds. But the real heroes of cancer, says Mukherjee, are the patients who have stoically borne the terrors of untried therapies in their attempt to vanquish cancer and ﬁght death. Mukherjee ties up seemingly diﬀerent aspects of the history of cancer, from cause to cure, with apparent ease. The tobacco menace, randomised
trials, the race to ﬁnd tumour viruses, oncogenes, and magic bullets—and false prophets—make their presence felt. That scientiﬁc interpretation and progress is done in a particular social frame of reference is clear when you realise that the ancient Greeks, who contributed greatly to ﬂuid mechanics, saw health and illness as a balance between the four ﬂuids, the humours. In recent times, patient advocacy groups have guided the course of disease management. Medical thinking is often nonlinear and, often, advances in diverse ﬁelds aﬀect our approach to cancer. Mukherjee intersperses history with touching stories of patients in his clinic to illustrate that although progress has indeed been made, the war on cancer has just begun.
Sanjay A Pai
Principles of clinical cancer genetics
Principles of clinical cancer genetics: a handbook from the Massachusetts General Hospital Edited by Daniel C Chung and Daniel A Haber. Springer, 2010. Pp 227. £99.00. ISBN 978-0-387-93844-8
How can knowledge about changes in cancer genomes be translated into clinical management of patients with cancer or used to identify individuals at increased risk of the disease? Principles of Clinical Cancer Genetics was written by experts from the Massachusetts General Hospital Cancer Center (Boston, USA) and addresses topics from basic science to clinical cancer genetics. The target audience is clinicians. The ﬁrst two chapters review basic principles of cancer genetics and genetic testing. The ﬁrst chapter summarises the multiple complex aspects and basic principles of cancer genetics simply and comprehensively. Thus, readers who are unfamiliar with molecular genetic technologies or strategies for analysis of families or rearrangement of tumour genomes receive an instructive introduction. The second chapter explains the principles and complexity of cancer genetic counselling very well.
In particular, the importance of appropriate consent and the multifaceted ethics issues are described in detail. The bulk of the book addresses the major hereditary cancer syndromes that are most commonly encountered in the clinic—for example, gynaecological hereditary tumour syndromes, the various hereditary colon cancer syndromes, and childhood tumours such as retinoblastoma and Wilms’ tumour. The clinical features, genetics, genotype and phenotype correlations, and management in terms of treatment options, genetic testing, and counselling of index patients and their families are reviewed thoroughly. The last two chapters deal with current topics such as identiﬁcation of low-penetrance cancer susceptibility alleles or options to improve disease outcome with molecularly targeted therapies. The shortcomings of genome-wide association studies with
their limited genotype–phenotype associations are correctly described, as well as their contribution to the understanding of the biological basis of cancer. The last chapter addresses the evolving ﬁeld of personalised medicine by highlighting targeted therapeutic options in chronic myeloid leukaemia, gastrointestinal stromal tumours, and lung cancer. This book provides an eﬀective reference, especially for clinicians who want to gain insight into cancer genetics and its implications for patient management. As is usual for a book, in some cases the reader should consult up-to-date online sources for the latest developments. Furthermore, since many ﬁgures and tables are well suited for teaching purposes, the authors could have added a DVD with this material, as is the case with many other textbooks.
Michael Speicher www.thelancet.com/oncology Vol 12 April 2011