Science-writer George Johnson and his wife heard three words that changed their lives - "you've got cancer" - when she was diagnosed with a metastatic uterine form of the disease. As a result, Johnson embarked on a quest to learn everything he could about cancer and has written an interesting overview of what is known, which turns out to be less than you might hope. Cancer is not one disease but many and has been around a long time, and evidence of different cancers have even been found in dinosaur fossils. In fact, it has been with mankind as long as we've been around, but if it seems to be increasing it's only because we're living longer. With some cruel exceptions, cancer is mostly a disease of older people but, beyond age, the only other reliable factors that can be said to cause cancer are smoking and obesity.
If you're looking for a positive, upbeat, "let's beat Cancer!" kind of book, this probably isn't it. Johnson says that while we've made significant strides, our understanding of why it happens and how to treat it still has a long way to go. He points out that studies are frequently flawed and inconclusive, and recommendations that eating fruits and vegetables or any particular food will help prevent cancer do not hold up under more rigorous testing. There is some correlation that exercise and maintaining a healthy body and diet helps, but the benefits are often small and disputed. And as he discusses the effects of drinking water tainted with chemical pollutants he illustrates very well why it is so difficult to *prove* causation. Even if a specific chemical or activity can be linked to a 30% increase in cancer (which sounds very dramatic), if your odds were only 1.2% in the beginning it only translates to new odds of 1.56%, which is still within normal and random variations. (See Toms River: A Story of Science and Salvation for an excellent account of why it is so difficult to conclusively link environmental concerns with cancer.) Even exposure to radiation isn't as cut and dried as you might think.
This is an informative book but often the information is thrown at the reader in a rapid-fire listing of facts and figures that make it hard to absorb. As one who is not overly familiar with the different types of cancers, I frequently felt like I was in a whirlwind of data and trying to make sense of too much random information. Still, it's a sobering overview of the current status of cancer research and isn't a bad introduction (I plan to move on to Siddhartha Mukherjee's book soon).
I was eager to read this book because, as a surgeon, I am always searching for new information,fresh ideas and innovative techniques in the management of cancer.
I read the 280+ pages of The Cancer Chronicles hoping maybe to discover a new treatment, or a novel approach or cutting edge therapy to combat this vicious disease that has plagued all living creatures since life began on earth. Tumors have been found in fossils of dinosaurs.
Sadly I found nothing new; the promised "explosive new ideas" touted by the publicity hype were neither new nor explosive, but just fizzled. Most of it was common routine knowledge in the medical field. On page 17, I learned that "mammals appear to get more cancer than reptiles or fish. Domesticated animals seem to get more cancer than their cousins in the wild. And people get the most cancer of all." It is a great piece of information with which to stomp your friends at trivia.
Even some information was inaccurate; the author confuses the function of free radicals with antioxidants.
The book touches on the genesis of cancer, mostly unknown except for a few causative relationships such as smoking and environmental hazards (Eg. asbestos) associated with mainly with lung cancers. It correctly challenges the myths of unproven causal links between cancer, the environment or diet. Many studies are inconclusive, flawed or biased.
Screening tests like mammograms, PSA and CA 125 are not specific or sensitive enough for an absolute diagnosis and often result in a false positive, leading to unnecessary, often radical, treatment. Ideally, early diagnosis and treatment lead to cure; best examples of screening are Pap smears and colonoscopy that can detect pre-cancerous lesions and allow early therapy.
Robust research is being conducted on genetics, obesity, inflammation and aging as triggers of malignant cellular metamorphosis and cancer. The quest for biomarkers is a giant step forward in the search for an accurate screening test. In my opinion, the answer shall be unlocked in the study of the human genome.
Surgical interventions, preceded or followed by radiotherapy and/or chemotherapy remain the standard of care in the treatment of cancer. These therapies are being constantly refined to minimize collateral damage to nearby tissues and to mitigate general side effects and complications. The "one size fits all" approach is slowly being replaced by custom designed treatments for each individual and their specific cancer.
Johnson did an in-depth research of the subject when his wife was diagnosed with an advanced stage gynecological cancer. He interviewed researchers and visited their labs, attended conferences and read the literature, and all the while trying to relate his findings to his unfortunate wife's condition and management. The stories are related in parallel and are intertwined, which gives a disjointed sequence of chapters that are neither organized thematically nor chronologically. Johnson peppers his account with stories of cancer in hamsters, Tasmanian devil and accidental self-contamination from a needle poke. Even the some Italian nuns are not spared from conjecture. No theory, however far fetched, is ignored; Gould's theory of "punctuated equilibrium" is mentioned and left hanging (it refers to an evolutionary process in two stages, rapid cell development and death in one and stasis in the other). Wienberg's work on oncogenes (cancer-causing genes), mitosis and entropy is explained to its conclusion "If we lived long enough...we all would eventually get cancer."
He tends to drone on about his interface with researchers, conferences and history mixed in with results of studies, and to cram in numerous facts, figures and anecdotes; causing confusion in the lay reader and loss of interest in the medical professional.
Johnson seems oblivious of the SEER (Surveillance, Epidemiology and End Results Program) and EPIC (European Prospective Investigation into Cancer and Nutrition) that prove the importance of diet in the prevention and treatment of malignancies. A vegetarian food regimen or Mediterranean diet stand out as the best choices.
The culmination of all Johnson's efforts is his eureka moment "whether any one person gets cancer or does not will always remain mostly random". I had to read 203 pages to get to that conclusion? This is after he already quoted Elio Riboli (epidemiologist) half way in the book, "as much as 50% to 60% of cancer, we didn't have the slightest idea of where it comes from". Yeah, I got it the first time; it's a crapshoot. Cancer is unpredictable. We are also reminded that cancer is not just one but myriad diseases "with no cure in sight."
Towards the end of the book Johnson chronicles his brother Joe's courageous encounter with cancer of the head & neck and his untimely demise. This adds to the poignancy and fatalism of the work, for what he calls "The Immortal Demon" no permanent cure is presently available.
It is a well-written book in the style of investigative journalism and a good overview of the state-of-the-art in the diagnosis and treatment of cancer, for the interested layman. The poignant account of Johnson's wife's battle with cancer, encompassing about a quarter of the book, adds emotion and sympathy to, what would otherwise be, a minor textbook of facts and figures, and of little interest to the academic or medical professional.
Overall the book is a good introduction to what is available today for the management of cancer in general and a good place to start to begin to understand the complexity of the disease and the intricacies of its treatment.
Interested readers should add "The Emperor of All Maladies", "The Truth in Small Doses" and "The Philadelphia Chromosome" to their reading list to get a more complete picture on the subject.
I noticed that all the "vine" reviewers have given the book 4 & 5 stars. I shall be an outlier, but I cannot give it more than 3 stars for, in my opinion, it did not deliver any "new explosive ideas" as promised.
Having had cancer myself when I was 21, I've been devouring every bit of info on health, nutrition, and cancer since then. This book certainly tackles things fairly comprehensively and brings up issues and viewpoints I never thought of, or heard. He talks about why many previous studies were flawed or nearly useless, and how new studies will remedy those errors.
Ironically, the chapter on metabolism and cancer was the one I was looking forward to the most, but turned out to be the most disappointing. He does mention Gary Taubes' excellent book "Good Calories, Bad Calories" and some of the statistics he uncovered involving hunter-gatherer societies and their low-carb diets allowing those cultures to live without many western diseases. He says it makes sense, but then doesn't go into ANY examination or review of any studies, statistics, etc. He only says that, at this point, fat-storage, diabetes, and insulin levels are one of the few significant dietary factors we have to go on.
He also makes a very strange comment about free radicals. He says people would never want to completely get rid of free radicals, because they are actually a good thing. He says they are the bodies garbage collector and keep toxins from building up. It sounds like he's describing anti-oxidants, not free radicals. I have never, in my years of reading about this subject, ever heard anyone say free radicals were in any way positive.
Still, this book has some surprising revelations and I can almost guarantee you will be thinking differently about cancer when you're finished.
on July 27, 2014
This book is a realistic (even pessimistic) take on cancer research and the elusive quest for a cure. The main points put forward in the book should be matter of an intense public debate. Unfortunately many people have an interest (pecuniary or otherwise) in hiding or blurring them.
I'd summarize the main points as follows:
1. Cancer is not a disease. It is a process. "You don't have cancer. You are cancering".
2. Cancer is a tragic (but predictable) consequence of entropy.
3. Cancer is as old as multicellular life. Signs of cancerous tumors have been found in fossils of dinosaurs, birds, hominids, etc.
4. Cancer doesn't come from (in any significant measure) from the poisonous actions of unregulated corporations.
5. Metasthasic cancer doesn't have a cure. Big pharma has been more successful in selling false hopes than in extending the lives of cancer patients. The impact of even the most advanced medicines is still measured in weeks, not in years.
6. Universal screening is also questionable. The cost-benefit of mammograms and PSA, for example, is dubious. To say the least.
7. Cancer research is not underfunded. Billions of dollars are spent annually in the US, Europe and elsewhere in the hope of a definitive breakthrough that has happened yet and won't happen soon.
8. Smoking and lack of physical activity are consistently associated with cancer (through various pahtways, direct and indirect).
9. Cancer and socioeconomic progress go hand in hand. Cancer is associated with longer lives, better nourishment, obesity, and so on.
10. Modern health systems are affected by the tyranny of hope (to use Katy Butler's felicitous expression). Despite all scientific and technological advances, we are coping with cancer in a traditional way, i.e., by lying to ourselves.
All in all, this is a great book. Honest. Well-written. With the right blend of realism and compassion. I recommend it strongly.
Cancer, what is it good for? Absolutely nothing. (to parphrase Edwin Starr's song, "War.").
Author George Johnson writes a damning argument on the futility of the War on Cancer. Despite having a ringside seat - due to his wife's metastatic adenocarcinoma - this isn't a cancer memoir. Yet, that personal experience motivates him to research the cancer universe and document its scientific terrain in layman language without prejudice or agenda.
It's grim reading. Johnson describes a disease that operates like a terrorist organization. It doesn't acknowledge boundaries, conventions, or consequences. It advances without regard to human suffering or collateral damage. It evades detection and defeats defenses through stealth and cunning by hijacking local networks. It's on a suicide mission. It recruits converts. And it does all this by feeding off and weakening the system in which it exists.
It is a ruthless, relentless and resilient enemy that has not retreated despite medical advances. What makes cancer all the more dangerous is that it is also capricious and random.
I've read the survivor and spiritual, the academic and scientific, the genetic and medical, the historical and evolutionary, the diagnostic and surgical, the financial and legal, and the governmental and political books on cancer. But this is the most ominous book I've read on the disease.
Practically speaking, says Johnson, we have no earthly idea what we're dealing with or how to prevent or treat it. "We rage," he says, "against the machine." This book is a terrifying reality check that challenges our notion of who - or what - is "winning the war on cancer."
on September 11, 2013
George Johnson opens his book, on the page preceding chapter one, with an epigraph from Reynolds Price's memoir about his own struggle with cancer that left him in a paraplegic state. I mention this because I was moved by my reading of Price's book almost two decades ago and, while it was an eloquent expression of the experience of cancer it did not, as I remember, inform me significantly about the nature of the disease itself. With The Cancer Chronicles George Johnson, a writer whose book Fire in the Mind impressed me several years ago, shares both the history and nature of the disease called Cancer and a memoir of his wife's own battle with that disease.
The history of cancer begins very far back in prehistoric times for it seems that scientists have found that the disease was already present in the age of Dinosaurs. This revelation along with others made the book both informative and interesting to read. His chronicle of the history of the science of cancer explores the realms of epidemiology. clinical trials, laboratory experiments while sharing information from evolutionary biology and other sciences. Even the economics of the Cancer research juggernaut is described -- an industry that has grown to an immense size in the search for an elusive "cure" for cancer.
Cancer the disease is at the core of the book and permeates the narrative, but the chronicles reveal what is in reality multiple different diseases. Each cancer affects different parts of the body and different groups of humans in unique ways. This is an important part of the story and represents some of the basis for many of the obstacles scientists continue to face in analyzing how to stop or prevent the disease.
Johnson capably personalizes the story with interludes where he shares his wife's struggle with Cancer. In doing this he reveals a view of the disease from the point of view of the everyday person who must deal with the practicalities of diagnoses and treatments and hospital stays. For those of us who have family or close friends who have had the experience of this disease the narrative is a moving personal story. I also appreciated the literary allusions whether explicit, like the reference to Solzhenitsyn's masterpiece Cancer Ward, or implicit. The author is eloquent both in his telling analysis of the disease and in his personal memoir; he demonstrates an ability to convey scientific concepts lucidly enough for the layman to understand. These characteristics and the fascination that the author shares for scientific discovery make this a great book full of insights into the deep mysteries of some of the most complex areas of modern medicine.
If Siddartha Mukherjee's "The Emperor of All Maladies" is the biography of cancer, George Johnson's "The Cancer Chronicles" is the still-incomplete biography of the cure, written in a lyrical, engaging style that's tinged with wonder at the complexities of curing the dreaded disease.
"Things are rarely as simple as they seem," he tells us, "and what appears to be complex may be no more than ripples on the surface of a fathomless ocean." The search for cancer's cure is that fathomless ocean. Readers share the hopes and too-frequent frustrations of scientists as they struggle to navigate that ocean. For each step forward, at times, it seems cancer pushes researchers two steps back: erratic mutations and pathology, environmental factors, and bad habits--all serve as a shield of sorts to protect cancer from the best efforts of medical researchers.
What makes Johnson's book a treat to read is the sense of shared experience, of "being there" with the author and sharing his experiences: "As I thought about these numbers, I began to feel a tightness in my chest. I imagined my lungs heavy with a miasma of cold, radioactive air." Throughout the book, Johnson speaks directly to readers; this is an intensely personal journey for the author.
The book strikes a tone between optimistic hopes and pessimistic reality, but one paragraph near the middle sums up the book's cautious, thoughtful balance between these two poles quite nicely:
"'Cancer is not a disease. It's a hundred different diseases'--how many times has that been said? Now the talk is of cancer as tens of thousands of diseases each with its own molecular signature. One day, as technologies develop, scientists may be able to routinely analyze the unique characteristics of every individual cancer and provide each patient with a personally crafted therapy. It is a lot to hope."
Indeed it is, but thanks in large part to the men and women of Johnson's book, each generation moves, however little, closer and closer to slaying the Emperor of All Maladies.
Reading this it appears that cancer is a copying problem of immense complexity that is more or less inevitable eventually (if an organism lives long enough). Cancer is in fact, Johnson assures us, many diseases, perhaps thousands. And regrettably there is no cure in sight.
Johnson's tone is reserved, cautious, bordering on the resigned. At times he grows impatient with the cancer industry, although he doesn't use that term. At other times he is fatalistic. Indeed, the title of Chapter 12 "The Immortal Demon" may sum up what he feels.
He begins with the fact that dinosaurs had cancer. Fossils provide inconvertible evidence. Then he begins sewing a thread through the narrative, the story of his wife's cancer and her experience with treatment. And then he gives us historical examples of cancer and then examines the putative causes of cancer and comes to some surprises. In fact he comes to a great big surprise: not only is cancer many different diseases, it has a multitude of possible causes, or more precisely, correlative suspects. Furthermore, quoting epidemiologist Elio Riboli, "for as much as fifty or sixty percent of cancer, we didn't have the slightest idea of where it comes from." (p. 143)
Part of the book recounts some attempts at understanding cancer from an evolutionary perspective. I think this is certainly something that should be done. However the evolutionary experience of cancer is limited to just one individual, one body. The cells that have "learned" to multiply wildly and to evade the body's defenses do not have the ability to pass on that cleverness to their daughter cells since they die when the organism dies. The entire evolutionary experience takes place in a time frame that is almost always less than a hundred years, usually much less. So the question is how can they mutate so fast without prior evolutionary experience?
The answer I have derived (and Johnson seems to agree) is that if certain gene-directed "no `i' in team" restrictions are removed, the cell's lust to multiply at will is released. This is the essential ability that the single-celled creatures developed before there were multicellular organisms on earth.
With this understanding it is hard to see how cancer is going to be cured any time soon. It is sobering to realize that single-celled organisms went through something like a couple of billion years of learning how to reproduce in some very inhospitable environments in and on the early earth. The genes that code for "multiply no matter what the environment throws at you" are very strong, so strong that the restrains put upon our cells--descendants of the mighty one-celled creatures that ruled the planet for so, so many millions of years--will again and again prove ineffectual.
Interestingly enough Johnson points to examples of cancer spreading beyond its host organism. There's the example of Tasmanian devil facial tumor disease in which tumor cells are spread by bites. Mosquitoes can spread cancer between hamsters. There are even human examples of accidentally getting a tumor from another person. A woman who poked herself with a syringe acquired colon cancer in her hand. (pp. 180-181) But of course these instances are rare.
Johnson refers to the "notion" of punctuated equilibrium championed by Gould and others. (p. 179) It's more than a notion I have to say. Punctuated equilibrium refers to evolution taking place according to two general stages, rapid species development and die off on the one hand, and stasis on the other. Rapid evolution occurs when many environmental changes take place relatively fast. Organisms must change and change quickly if they are to survive. The long periods of stasis suggest a large, well-adapted population.
Looking at punctuated equilibrium inside a single organism such as a human body we can imagine that if there are few stressors and few assaults and other changes to the internal environment, then the cells of the body will experience a period of stasis. However if there are assaults to the body in form of stress, injuries, pollutants, poisons, malnutrition, obesity, radiation, etc. the DNA of the cells as well as the body's DNA repair mechanisms and other safeguards against wildcat reproduction become less effective and rapid evolution of dividing cells takes place resulting sometimes in cancerous growths. Inevitably over the course of a lifetime for many human beings there will be periods of rapid change, and there will be cancer.
Some conclusions and observations:
Single greatest cause of cancer is smoking cigarettes.
Obesity is a clear correlative factor in cancer.
Eating fruits and vegetable doesn't do much one way or the other.(p. 146)
Exercise helps prevent cancer.
"[F]at cells synthesize estrogen. Insulin, estrogen, obesity, cancer--all are tied into the same metabolic knot." (p. 148)
Tall people are at greater risk. (p. 148)
Four million human cells divide and copy their DNA every second. (p. 186) (Mistakes can happen!)
From the closing chapter: "Whether any one person gets cancer or does not will always remain mostly random."(p. 203)
I would have liked a tighter focus and an index and bibliography. (Get the Kindle version so you can search.) But this is an outstanding piece of work that helps the reader to a better understanding of what cancer is all about.
--Dennis Littrell, author of "The World Is Not as We Think It Is"
on July 19, 2013
This book is a well-written, interesting look at the history of cancer treatment, with the story of Johnson's wife's cancer treatment told in parallel.
Johnson is a good writer, and I enjoyed the book, however, his conclusion seems to be that we know very little about cancer and that there is little one can do (short of not smoking and not working as a chimney sweep) to prevent getting cancer. If it all comes down to bad luck, I found myself thinking, then why educate myself about cancer? Why read the book?
In the end, though, Johnson's writing made the subject compelling, plus I wanted to finish reading about his wife's treatment, which is about 25% of the book.
I recently read the Cancer Chronicles by George Johnson and overall it is thoughtful and entertaining book which at times reads like a detective novel. It is an intimate tale of the author's association with cancer via several of his close family members (wife and brother) and how he immerses himself in the science trying to uncover the secrets of this eternal, emotional, and deadly disease. Through his research he uncovers that cancer has probably been associated with humans and other animals from the very beginning. While it might be convenient to believe the many carcinogenic industrial chemicals and foods introduced into the environment since the Industrial Revolution might be highly correlated with increasing cancer rates, the story unfortunately is more complex. Each cancer's evolution is as unique as the individual who is unfortunate enough to possess the uncontrolled growth. Factors like genetics, tobacco, obesity, inactivity, and randomness are important factors in human cancers. Mutations in a wide range of either cell replication and suppressor genes (and their associated proteins) have also been correlated with a wide variety of cancers. In terms of treatments, the basic 3 (surgery, radiation, and chemotherapy) still remain, but significant refinements have been made over the last 50 years, especially in the areas of targeted chemicals, which can mitigate a wide variety of malicious gene expressions, and minimize collateral damage.
Overall, this is worthwhile book to read, not only for its information content, but also for the human story it tells. However, while the book contains an extensive bibliography, I do believe it could have been significantly better, if the author would have included selective graphics to expand and better clarify on the sometimes complex arguments.