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Telling the Story Behind Cancer

January 25, 2011 at 6:00 PM EST
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Health correspondent Betty Ann Bowser talks to Siddhartha Mukherjee, author of "The Emperor of All Maladies: A Biography of Cancer," a history of the search for ways to treat cancer and how it has been perceived.
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JIM LEHRER: Finally tonight: a book conversation about our understanding of cancer and the search for breakthroughs to treat it.

NewsHour health correspondent Betty Ann Bowser has our story.

BETTY ANN BOWSER: This year, more than half-a-million Americans were diagnosed with cancer. And although it is no longer an automatic death sentence, cancer is still the second leading cause of death in the United States.

Dr. Siddhartha Mukherjee knows that reality well. He’s an oncologist and cancer researcher at the Columbia University Medical Center in New York City. In a new book called “The Emperor of All Maladies,” Mukherjee writes a history of cancer.

He tells the stories of people he’s treated and those of leading reserchers who dedicated their lives to a disease for which the doctor thinks may never have a complete cure.

We sat down with him recently in his lab.

First of all, thanks very much for being with us today.

DR. SIDDHARTHA MUKHERJEE, author, “The Emperor of All Maladies: A Biography of Cancer”: Thank you for having me.

BETTY ANN BOWSER: So, why did you decide to write a book about the history of cancer?

DR. SIDDHARTHA MUKHERJEE: Well, I really decided to write the book — I started writing the book when I was in training in cancer medicine. And I wrote the book really in order to answer a question that was raised by a patient. And this was a woman who I was treating for abdominal cancer.

And she at one point in time during her therapy asked me — she said: “I’m willing to go on with what I’m battling, but I need to know what it is. I need to know it — I need to know its history.”

And this was — she wasn’t the only person. This question kept on coming over and over again in different forms. And — and the book is an attempt to answer kind of that very basic cancer: What is cancer? It’s a disease that clearly affects all of our lives, but what is its history? What is its past?

And so I put it all together in the book.

BETTY ANN BOWSER: You make it almost a biography, like cancer is an individual, a person. And you use terminology like, it’s immortal…

DR. SIDDHARTHA MUKHERJEE: Mm-hmm.

BETTY ANN BOWSER: … whereas human beings aren’t.

DR. SIDDHARTHA MUKHERJEE: Cancer is not one disease, but a whole family of diseases. But all these diseases are linked at a very fundamental level, at a biological level. And they’re characterized by the abnormal, uncontrollable growth of cells.

And it’s in fact this very feature, this fact that these cells keep dividing, that gives them what I call their immortality. And if there’s one really chilling realization at the bottom of this book is that, although cancer can be unleashed by chemicals and various things from the environment, the fundamental genes that control cancer cells are very much part of the human genome.

BETTY ANN BOWSER: You start the book by talking about a patient whose name is Carla.

DR. SIDDHARTHA MUKHERJEE: Mm-hmm.

BETTY ANN BOWSER: And you come back to her throughout the whole book. And you more or less end the book with her. What was it about this particular patient that — that drew you to do that?

DR. SIDDHARTHA MUKHERJEE: Well, I think she — she — she was an emblem to me of everything that goes into making or into — into facing cancer.

She was resilient. She was brilliant. She was inventive. She was — she brought every bit of her resourcefulness to this moment in her life.

BETTY ANN BOWSER: She had leukemia…

DR. SIDDHARTHA MUKHERJEE: She had leukemia.

BETTY ANN BOWSER: … which — and a — and a very — very dreadful form of leukemia.

DR. SIDDHARTHA MUKHERJEE: Absolutely, a very dramatic, very dreadful form of leukemia.

And the one other piece of it, of course, is that her history, which is happening — which started happening in 2005, was, of course, linked to Sidney Farber, the other major character in the book, who eventually, bit by bit by bit by bit, finds a cure for a particular form of leukemia, the same kind of leukemia that she had.

So, it was very — it was — Carla was very reminiscent to me of the connection through so many historic years between a time present and a time past. And that’s why I thought she would connect the book together.

BETTY ANN BOWSER: When you were doing your research, it was interesting. A lot of the — the things that people learned that led to breakthroughs in cancer were unexpected.

DR. SIDDHARTHA MUKHERJEE: Yes.

BETTY ANN BOWSER: They — they weren’t aha moments.

DR. SIDDHARTHA MUKHERJEE: Yes. You know, the Scottish surgeon George Beatson was walking through the highlands in England, and he heard some shepherds saying, oh, you know, when we remove the ovaries of cows and goats, the pattern — or the breasts of these animals changes; the pattern of milk production changes.

So, Beatson began to wonder, well, what is the — this was a time when no one knew about estrogen. So, Beatson began to wonder, what is the connection between ovaries and breasts? And he said, well, if ovaries are connected to breasts, then maybe they’re connected to breast cancer.

And he took out the ovaries of three or four women with breast cancer and had these spontaneous, had these, not spontaneous, but amazing remissions. And it was — this is the basis for tamoxifen, the drug that actually blocks estrogen, and thereby affects breast cancer.

I mean, who would have thought that walking through and talking to a shepherd in Scotland would affect a billion-dollar drug, which is very, very powerful against breast cancer today?

BETTY ANN BOWSER: Where are things today with cancer in the United States of America?

DR. SIDDHARTHA MUKHERJEE: I think there has been remarkably — a remarkably important record of progress.

That’s not true for every form of cancer. There are some forms of cancer which are still lagging in terms of the attention paid to them. But, overall, there’s clearly a record of progress.

BETTY ANN BOWSER: What are some of the most disturbing things where there have not been a lot of progress?

DR. SIDDHARTHA MUKHERJEE: Pancreatic cancer is a great example.

We still don’t know very well why it is that pancreatic cancers respond so poorly to chemotherapy. We know a little bit about it, but not enough about it.

Esophagus cancer, cancer of the esophagus, we still don’t know very much about exactly why that cancer is so hard to treat. One last example, a very worthwhile example, lung cancer was a big disease. You know, adenocarcinoma of the lung was one big — considered one big entity.

And we know now that even that cancer can be subdivided up. And, in fact, some sub-portions of lung cancer respond very, very well to this one medicine. So, that gives you a direction as to where we’re going next. Even a single cancer will be broken up into smaller entities, and specific medicines will be designed to those small entities or specific prevention mechanisms to those particular entities.

BETTY ANN BOWSER: A lot people when they have children will say when they’re very proud of their child, oh, he or she is going to grow up and find a cure for cancer.

DR. SIDDHARTHA MUKHERJEE: Right.

BETTY ANN BOWSER: Do you think that’s a commonly held belief among Americans, that all of these can be cured?

DR. SIDDHARTHA MUKHERJEE: The word cure is such a seductive word. It is such a tantalizing word.

In 1969, a group of advocates who I talk about in the book brought out this advertisement which said — in every newspaper, in every major newspaper, full-page advertisement, which said, “Mr. Nixon, you can cure cancer.”

The implication of that advertisement is two things. Number one is that there’s one cancer, so you can cure all of it. And the second thing is that it’s a curable disease. You know, this is a time when men had landed on the moon, you know, the Manhattan Project had been an incredible success. So, there was a real feeling that, if you poured resources in, money, brains, et cetera, that you would find a single magic bullet cure.

The reality is that — that that’s unlikely to happen. But, that said, one shouldn’t be nihilistic about it. There will be many, many, many advances which will, you know, convert cancers into chronic diseases.

BETTY ANN BOWSER: Do you think writing this book has been the kind of experience that makes you a better doctor?

DR. SIDDHARTHA MUKHERJEE: I think so.

I think — you know, I think — I think one of the most important things that the book — the book made me realize is the narrative aspects of medicine. And that is that medicine is about storytelling. And if you stop hearing a story, the fundamental activity of medicine will change.

I’m told — I had — there’s a wonderful anecdote. It’s a study actually that was performed several years ago in which they asked the question, when a patient begins to tell his or her story, how quickly and on average does a doctor interrupt the patient? And the answer, I — you know, what would you guess?

It’s a surprising number. It’s 18 seconds. So, less than a sentence opens in medicine before the doctor interrupts, and the doctor, he or she, says — you know, starts putting in her own — his or her own story, intervening.

That reminds us that, you know, one of the best things to do about medicine is first listen, shut your mouth, until — until the full story has been told.

And, actually, I’m told that the practice is changing. It is now up to 21 seconds, I’m told.

BETTY ANN BOWSER: Doctor, thank you so much for being with us.

DR. SIDDHARTHA MUKHERJEE: Thank you. Thank you for having me.