AUTHOR DISCUSSES PULITZER PRIZE-WINNING EPIC
Interview by Jacquelin Sufak
Perhaps no one knows cancer better than Siddhartha Mukherjee, author of The Emperor of All Maladies: A Biography of Cancer, which won the 2010 Pulitzer Prize for nonfiction. (A paperback edition was released in August.) Geared to a general audience, Mukherjee’s 600-page epic traces cancer from its first written description more than 4,000 years ago to the promise that genome mapping holds for the future of cancer medicine. A physician and researcher at Columbia University, Mukherjee provides an engrossing history of the disease along with fascinating and not-always-flattering portrayals of the people—scientists, clinicians, activists, and patients—whose lives and careers it intertwines. Reading by turns like a novel, biography, and scientific text, ‘Emperor’ provides an enlightening and ultimately hopeful depiction of the perplexing puzzle that is cancer.
Why did you call your book a biography instead of a history?
If we look at the same entity over time, it’s like developing a portrait of a character. In that sense, the fundamental creature cancer is extremely diverse. It turns out not to be one thing, but many things, and even those things keep changing. There’s an evolutionary quality to cancer.
Some cancer physicians say they hate the disease. You seem to have a fascination, even a respect toward it.
From the standpoint of medicine or biology, you have to have some degree of awe for one of the most elemental families of diseases we’ve ever encountered. The fact that we are struggling to prevent and treat and cure some cancers is a testimony to how complex the biology of the disease is. As a scientist, you understand that if your corrupt the very processes that keep our cells alive and growing, you get cancer. So if you have any awe for normal cellular physiology, then you have a similar awe for cancer.
If you could rewrite history, what would you change in cancer treatment?
At a fundamental level, one thing that I would change is the idea that one solution fits all and more is better. We now know that’s not true. In fact, in many forms of cancer, specificity is more. It turns out that high-dose chemotherapy is relevant for certain cancers, but treating other cancers the same way is a mistake. Treating breast cancer is very different from treating ovarian cancer. We need to be sensitive to the differences.
How do you view the legacy of the so-called “War Cancer” that began in the 1970s?
The good thing about the War on Cancer was that it took away some of the stigma around cancer. It created a kind of public platform on which we could become, as a nation, invested in the idea that we were going to cure cancer. That investment was important—not only the financial investment, but also the psychological one. But we’ve been sufficiently humbled by the hype around that campaign [which touted finding “a cure” within a few years] that I don’t think we’ll go back to that idea or that kind of timeline.
Can you imagine a future with no cancer?
Certainly we can change our habits, our environment, and reduce the risks of certain forms of cancer, but the idea that we could eliminate cancer completely from our society and our bodies is very unlikely. Many cancers are part of our genetic inheritance in the sense that the very genes that allow embryos to grow and our bodies to grow—if you distort them, you get cancer.
Is that why you write about making cancer a chronic, manageable condition, versus curing it?
I think that goal is probably the best we will be able to achieve for many forms of cancer, and even that is a major undertaking. Our understanding of cancer is still changing, and the capacity to convert many cancers into chronic diseases will be very important, but we’re not there yet.