The book is written as a biography of cancer. Mukherjee does a good job delivering just that.
It’s probably the most lost I’ve been reading any book that won a Pulitzer Prize and a NYT best seller. Both of those marks typically mean it’s a book I’m really going to enjoy, obviously in the non-fiction category. I did learn a lot. I wish I could talk to an oncologist (in a pure academic setting! *not to jinx myself*) and ask questions about the book because I have questions that I’m not certain if I didn’t understand, or if oncologists just don’t understand yet. One of the things I’ve learned in physics is you often run into areas that the physicists don’t know much about, but they can describe attributes of it. That makes learning confusing, that is, staying up to date on when the teacher knows the subject well, or when the teacher knows parts of the subject. I do not have that same level of comfort with chemistry and biology as I do with physics, but I suspect it is similar in the need to be comfortable with certain amounts of ignorance in order to get up to date. Not because you’re ignorant, but because the field is ignorant.
I’ve had lots of family die of cancer, and just the other week had a cancer scare with my mom. Luckily, she’s 100% fine and it was unrelated. I’m 31 and I’ve had 6 family members die of cancer, in a family of 26 total. Luckily none of my direct family. I’m sure nearly every reader has some experience with cancer as well.
In Guns Germs and Steel, I was better prepared for Covid thanks to Diamond explaining the flu from the virus’s perspective. Mukherjee does something similar here, helps you relate to cancer. Understand how it works, why it’s a part of us, and the difficulty in treating it.
One of the most striking parts of the book was the difficulty in finding patients for experimental drugs. It’s hard to unbiasedly run randomized control trials with a deadly disease. Would you want to run the risk of getting a placebo? Or getting the drug we know isn’t very effective? Doctors want to save their patients, they put their worst patients in the riskiest trials and their best patients in less risky trials.
I also found it interesting that the genes for cancer are basically encoded in every cell. Essentially in each cell we have genes that cause reproduction, and then genes that tell the cell to stop. Should the genes that tell the cell to stop become damaged or mutate incorrectly, you can start growing a cancer cell. However, the body has backup genes to prevent this. So, the odds of getting cancer are really a statistical game. Smoking can increase the odds of getting lung cancer, no question about it. However, you can smoke your whole life and not get lung cancer too. That’s because life is finite and damaging the cells needed to stop cancer is a statistical game, something else might get you before the cells are ever damaged in the correct way to cause cancer. Essentially smoking just increases the odds of you damaging enough of the genes needed to have a cell reproduce rapidly and non-stop.
It leaves me with three questions:
#1: Would Crispr be able to make a targeted therapy for early cancers to attack the specific mutations in the cancer cells? Should technology with Crispr be fast enough, could we even go after entire networks of cancer that metastasize? Cancer essentially tries to grow into your body and survive, I imagine there will never be a day medicine can cure a cancer that’s really spread, but what do the leading scientists think?
#2: Why do some organs never seem to get cancer? Do they produce cells at a slower rate? Or do they have more backup genes that turn off reproduction? Could those two qualities in a cell be related?
#3: If exercise essentially damages the body and causes it to repair, why is it so effective at preventing cancer? My guess is it is a very different degree of damage, and the energy expenditure does something very beneficial at the cell level besides just damage.
All of these questions might just prove I didn’t follow everything from the book. It’s a good book. If you’re going to learn about cancer, this is where I’d recommend you start.