How to slay ‘the emperor’? Ask Indian American cancer specialist

By Arun Kumar, IANS
Sunday, December 12, 2010

WASHINGTON - Indian American cancer specialist Siddhartha Mukherjee, whose very first book has become a runaway success, advocates a strong anti-smoking campaign and breast cancer screening to battle the growing incidence of the disease in India.

Less than a month after publication, Mukherjee’s book, “The Emperor of All Maladies: A Biography of Cancer”, on the history of the disease, features among “The 10 Best Books of 2010″ in the New York Times Book Reviews Sunday, a rare feat for a work of non-fiction.

“Cancer is growing dramatically in certain parts of South Asia,” New Delhi-born Mukherjee told IANS on phone from New York where he practises, blaming increase in tobacco smoking as “clearly one culprit among young men and women”.

“But there are other culprits too,” he says. “As the population ages and other diseases are slowly eliminated, cancer begins to come about.”

“Cancer rises in the double negative only when all the other killers have been killed. So I think that’s beginning to occur in some parts of South Asia.”

To those who wonder if it is relevant to a country like India as “cancer treatment can be so expensive and such a vast enterprise, his answer is “absolutely, at all levels.”

“A strong prevention campaign against smoking is not all that expensive and is highly relevant to the future of our health in India,” said Mukherjee, assistant clinical professor at the oncology department at Columbia University, New York.

Similarly, screening for breast cancer in the appropriate age group and its treatment with hormonal therapy “and certainly treatment of childhood cancers which are often curable are highly relevant to a country like India,” Mukherjee said.

Mukherjee, 40, who grew up in New Delhi’s Safdarjung Enclave, “immersed in reading and books” at home and at St. Columba’s School, says he “came into oncology in a sort of reverse, in the sense that I first trained as a cellular biologist when I was in Oxford as a Rhodes scholar”.

“So I really came from the cell into medicine. Many people first train in medicine, then eventually get fascinated by cells.”

Mukherjee says he wrote this book because when he was a fellow in training in Boston, “I kept coming over this question again and again: what is the history of cancer, what’s happening next and where are we going?”

In particular, a woman he was treating told him: “I am willing to go on with my chemotherapy, but I need to know what it is that I am battling.”

“Answering that question was the genesis of the book,” he said. The somewhat intriguing title “was found handwritten on an antiquarian book on cancer - emperor of all maladies and king of all terrorists”.

Mukherjee said he chose to subtitle it a “biography” after a lot of thought. “A successful biography allows you to enter the interior of the mind or the personality of someone. So as I was writing the book, I really felt I was drawing a portrait of cancer through time, acknowledging the fact that cancer was not one disease, but many diseases.”

“Nonetheless, there is a sentence in the book which says, ‘every era casts illness in its own image and certainly every era has cast cancer in its own image’. So I felt that this project could only be described as a biography,” he said.

The book isn’t meant for the medical profession alone. “The target is everyone. The point of this book was to make this world of medicine and science and culture accessible to anyone who is interested,” Mukherjee told IANS.

“This is a disease that has developed in our times in a very poignant way. So I intend this book to be read by anyone who wishes to find out about it: patients and people whose loved ones are affected by cancer or any person interested in its history.”

Mukherjee says one of the book’s key messages was “There is unlikely to be a single magic bullet against cancer given the level of heterogeneity.”

Secondly, given the fact that “many cancers are part of our normal genome, it’s unlikely that we’ll eradicate or cure every form of cancer” - like we did with smallpox or polio.

“Some variation of this disease is inherent to our genetic makeup and it’s more likely that we’ll learn to control it rather than eradicate it or cure it in the future,” says Mukherjee.

Though “still in a daze about what’s going on about this book”, he is quite sure he is not going to turn a full-time writer. “No I think, I will stay with where I am - which is practising medicine and writing about medicine.”

(Arun Kumar can be contacted at arun.kumar@ians.in)

Filed under: Cancer, Medicine, World

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