Towards the end of Siddhartha Mukherjee’s remarkable exploration of cancer, The Emperor of All Maladies, he brings up the figure of Atossa, queen of Persia circa 500 BC, who recurs through his book. On being diagnosed with cancer, Atossa bid her Greek slave to carve the malignance out of her breast, thus performing a primitive mastectomy that had more than a hint of self-destruction about it.
“Pitch Atossa backward in time to Imhotep’s clinic in Egypt in 2500 BC,” Mukherjee writes, recalling the earliest recognized mention of cancer in recorded history. “Imhotep has a name for her illness, a hieroglyph that we cannot pronounce. He provides a diagnosis, but ‘there is no treatment’, he says humbly, closing the case.” In 300 BC, Hippocrates would have identified her tumour, naming it karkinos after observing its crab-like features.
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Greeks after Hippocrates would identify cancer as an illness of the humours, the fluids they believed governed the human body. Medieval European surgeons would chip away at it to no avail; their counterparts in the post-Enlightenment flowering of surgical science would devise radical, but ultimately futile, experiments to eliminate it from the human body. A patient like Atossa would be cancer’s Dorian Gray, says Mukherjee: The world around her and she herself might change, but the tumour would remain the same.
Throughout his comprehensive attempt to understand this most stubborn and deadly of diseases, Mukherjee builds an awareness of this layered history into his narrative. He explains his decision to call his book a biography of cancer, rather than a history, because the character it assumes is almost human. Cancer cells do what ordinary human cells must do to survive. They adapt, grow, mutate and cling stubbornly to their collective life; but cancer cells do it with far more resilience than normal cells. To understand cancer, Mukherjee suggests elegantly, is to understand a malevolent, distorted mirror of humanity itself.
Sometimes he takes us as close as we can get to the disease through a book, by creating characters out of the patients that he—a cancer researcher at Columbia University, and a practising oncologist—meets. Mukherjee paints in broad strokes, but we perceive these portraits as vividly human. His patients are no avatars of Atossa.
Still, the most literally human—and social—history in Mukherjee’s book comes from its brightest, most morally ambivalent characters: the doctors who changed the history of cancer diagnostics and treatment over the last couple of centuries in the Western world. Men—and sometimes women—of their time, these obsessive, nimble thinkers tested, experimented, operated and often quite literally went to war with cancer.
Sometimes, as in the case of 1950s cancer researcher Min Chiu Li at the US’ National Cancer Institute, it meant reducing cancer treatment to a horrifying war of attrition in which he administered a toxic course of chemotherapy long after tumours seemed to disappear, thus reducing treatment to a fight against invisible values. It cost Li his job—the institutional board worried that he was “experimenting on people”—but it turned out to be the first chemotherapeutic cure of adult cancer.
Mukherjee is magnificent as he draws and redraws the contours of the fight against cancer by describing its principal combatants, battling not just a deadly and endlessly inventive enemy in the illness itself, but also public and bureaucratic indifference, ignorance, and sometimes, as in the case of the American tobacco industry and its refusal to acknowledge its product as the principal modern cause of cancer, plain injustice.
Mukherjee demonstrates that cancer is not the curse of civilization that it is sometimes assumed to be. Unlike AIDS or malaria, it resists being defined by any one population. But the study of cancer has a more specific history than the illness itself. The sterile complexes of labs and treatment rooms, where much of the medical discovery described here takes place, may bear no resemblance to the charitable hospitals of the developing world, overflowing with cancer patients of every age and background.
But Mukherjee is too erudite and too sincere to aim for a false universality. The specificity of his story reveals, instead, a fundamental truth of modern science: There are no Eureka moments here. Discovery is measured incrementally, over the work of dozens, sometimes hundreds, of different minds.
Cancer’s biography may have no end before humanity itself ceases to be, but in infinitesimal ways, patient by patient and doctor by doctor, it has built itself an awful, majestic history. Mukherjee’s fairy-tale title respects that terror; his learned, compassionate book also does it a fair measure of justice.