Can cancer teach us about being human?

SHAFAQNA –  When Dr. Siddhartha Mukherjee wrote his Pulitzer Prize-winning book The Emperor of All Maladies: A Biography of Cancer he couldn’t know he was launching a small cultural industry. His 2011 history of the disease is the genesis for a six-hour PBS documentary miniseries backed by the master of that genre, Ken Burns.

Mukherjee, a New York-based physician, researcher and assistant professor of medicine at Columbia University, wrote the sweeping tale of cancer from its first written records in ancient Egypt to today’s genetic research while training to become an oncologist.

Cancer is the leading cause of death in Canada with one out of four people expected to die from the disease in some form. Although the chances of surviving cancer have risen in recent decades, the number of people diagnosed continues to rise with an aging population.

The Vancouver Sun met Mukherjee at the BC Cancer Agency’s research centre in Vancouver a day before his lecture at the University of British Columbia. The conversation has been edited for length.

Q. Your book documents the history of some torturous cancer treatments — disfiguring radical mastectomies and poisoning in early chemotherapy. Are some of today’s options in surgery and chemotherapy equally as torturous?

A. No. Cancer medicine is trying to limit toxicities and kill or remove cancer cells while not harming the body in the same way. We’ve learned over many decades that maximizing poisonous therapies doesn’t often lead to good outcomes. In some of the most striking examples, there are currently medicines that will attack cancer cells and have absolutely no effect on your normal cells: Gleevec (for chronic myeloid leukemia) or herceptin (for certain breast cancers). They may have some toxic side-effects, but not in the same way that mustard gas, and other medicines, were poisonous.

Q. You also told the story of chimney sweeps with scrotal cancer in early industrial England, a fascinating example of soot as an environmental carcinogen. Are carcinogens in the environment today playing a greater or lesser role than in 18th century London?

A. It’s hard to compare 18th century London with today because the age structure of the human population has changed dramatically. You and I may not be alive in 18th century London, but we’re alive today, therefore the nature of our exposure to carcinogens has changed dramatically.

We’ve found several important environmental carcinogens — tobacco, asbestos — but the more we’ve looked since the 1980s and 1990s, we haven’t found a major chemical carcinogen that has a huge impact on public health. There may be many lurking carcinogens, as I call them, but their individual impact is much smaller than something like tobacco. It’s also possible that the methods used to detect these other carcinogens need to be more sophisticated. This science is undergoing a radical updating.

Q. Aren’t we just getting old and that’s why more people have cancer?

A. It’s clear that rising cancer rates around the globe are being driven primarily by age. The question is, do we get more cancer as we age because of some fundamental process in the body that begins to go wrong or do we get cancer as we age because of an environmental carcinogen whose exposure increases over time? The answer tends to be more the former; that there are more genetic accidents that accumulate as we age rather than toxic environmental influences.

In most Western countries I don’t think we’re living in a toxic stew.

Q. You’re working on a Ken Burns PBS production called the Story of Cancer that will air next spring. Why does this disease rate a six-hour miniseries?

A. If this doesn’t rate, I don’t know what else does. You can use cancer to look at the history of the West. The topic is wide enough to reflect on the way our culture has handled one of the most significant human challenges in our history. Cancer affects all of us directly or indirectly.

There is something particularly special about cancer because of our relentlessness in the fight against it. The great gains, the great losses. It’s like the First World War writ though the lens of medicine. It tells you more about human beings: how have we attacked it, what’s the extent of our knowledge? Does money help? How much? Do we need to declare war on some things? All of these questions can apply to any major quandary that’s facing us as humans.

Dr. Siddhartha Mukherjee gives a free public lecture Saturday, Oct. 4 at 8:15 p.m., in Lecture Hall No. 2, at UBC’s Woodward Instructional Resources Centre. The event is sponsored by the BC Cancer Foundation as part of the The Vancouver Institute’s 2014 speakers’ series.

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