A remarkable book by a MGH/DFCI trained oncologist traces the history of cancer and its treatment from its first description in 2500 B.C. to the present. From Galen (160 A.D., black bile/humors), thru Vesalius (1533, anatomy), to Baille (1793, pathology) to Hunter (1760, surgical extirpation, to Halsted (1890’s, radical surgery) up to Farber’s anti-folate beginning to chemotherapy and Roentgen/Curie’s radiation oncology in the 1895-1902 period, he tells a story tinged with hubris, arrogance, and headlong rushes into blind alleys. Observing that chemotherapy was a unique instance where the emphasis on treatment eclipsed a focus on prevention, he tells of cigarettes, asbestos, the Pap smear, mammography and the fiasco of the autologous bone marrow transplant for breast cancer, before the era of understanding cancer’s basic biology as built into our very natures. Proto-oncogenes and tumor suppressor genes are mutated by x-rays, cigarettes, viruses, etc. and lead to jammed accelerators or failed brakes. These out of control genes lead to hyperactive kinase pathways and acquired cellular capabilities (no propton, angiogenesis, metastases) which are the expressions of cancer. More than 100 of these genes have been identified and cancer genome mapping is revealing that cancer tissue has dozens of these mutated genes—some drivers, some passengers, but with 10-20 key drivers in each cancer. New drugs are focused on blocking these proteins (Gleevee for CML) or pathways (anti-angiogenesis). Mukherjee argues that cancer is in our nature and success is living to old age with cancer in balance and under control.

His writing style needs comment—superb. His description of scientists and doctors usually involves 3-5 adjectives and conjures up a vivid picture. He is driven by equal parts of wonder at the biology of cancer and the dedication of MD/PhD’s and contempt for egotists, cheats, and monomaniacal doctors who have harmed innocent patients. His greatest admiration is for scientists. He uses wonderfully creative, vivid and simple metaphors and interposes personal anecdotes with complicated biology very successfully.