The opening of George Johnson’s “The Cancer Chronicles” says it all: “Several years ago . . . I was driven to learn everything I could about the science of cancer.” This occurred after his own wife was diagnosed with the disease. Johnson, a veteran science reporter, offers up his own knowledge and insights into an affliction that in its many forms has become synonymous with suffering and death.
Starting out by showing that dinosaurs, too, suffered from cancer, Johnson moves on to discuss the difficulties inherent in trying to predict whether diets rich in certain vitamins or elements might protect against its development. Discussing folates, found in a wide variety of foods, Johnson notes that some studies have identified them as possibly preventing cancer while others have suggested precisely the opposite. He concludes, somewhat tongue in cheek, that “the most persuasive reason for eating spinach is that, sautéed with garlic or tossed in a salad, it tastes so good.”
As Johnson then goes on to explain, even though we know that certain things such as smoking, or exposure to radiation or certain chemicals, do indeed increase the risk of cancers, it remains very difficult to predict who will actually develop it as a result. He cites the example of Love Canal in upstate New York, which for over a decade served as a toxic-waste dump until it was covered up and a school built on top of it. When the area was evacuated in 1977, the Environmental Protection Agency initially calculated the cancer risk of the inhabitants as 1 in 10, revising those numbers a few weeks later to 1 in 100. However, at the end of 30 years of follow-up, Johnson writes, although the rate of birth defects in the immediate area was double that of the county, “the overall cancer rate was actually a little lower than for the general population.” Similarly, he cites the increased number of deaths from cancer in the approximately 90,000 people who survived the impact and radiation poisoning from the atomic bomb dropped on Hiroshima as being much less than originally feared. Compared to the national average, there were a total of 630 more deaths from cancer that would otherwise have been expected, or 0.7 percent of those exposed.
Johnson delves into all of the above and more, including molecular biology, drug discovery, and the pitfalls of overly aggressive screening such as the over-diagnosis and over-treatment of conditions which may or may not ever pose an actual risk to the patient’s health.
However, the book often seems too small to contain all of the topics he ambitiously tries to touch upon. The result is that although the coverage of each of these topics is interesting enough, the book seems to veer from one subject to another, often before it’s been allowed to develop what feels like the necessary depth. Only the personal story of his wife’s diagnosis is there to connect the often disparate elements. And even the telling of the story of how her battle affected their lives often seems spare, perhaps because they are no longer together. Had that been fleshed out more fully, it could easily have become the dominant theme of the book, through which some of the other topics might have been explored more fully, with others, perhaps, left for another book.
One of the most fascinating parts of the book was Johnson’s attempt to answer the biggest question of all: Why does cancer even exist? Impossible as it is to truly answer that, Johnson nonetheless tries by presenting various scientific theories. These include one positing that cancer is a necessary trade-off of the genetic repair and modification necessary for the incessant march of evolution, and another that the process of transformation of a single cell from healthy to malignant may be a result of an epic struggle for survival between the cell and its own mitochondria.
Notwithstanding the book’s subtitle, Johnson clearly shows that despite the breakthroughs made by scientists and physicians in understanding and treating cancer, especially in the last few decades, there remains a great deal to be unlocked in order to spare so many of us its ordeal.
Dennis Rosen is a pediatric pulmonologist practicing in Boston, whose book about communication between physicians and patients, “Patient Listening,” will be published by Columbia University Press in 2014.