Not quite “abandon all hope,” but there’s not much to cheer about in this wide-angled survey of where we are in the fight against cancer.
Science writer Johnson (The Ten Most Beautiful Experiments, 2008, etc.) has steeped himself in cancer lore, attended conferences and interviewed experts to conclude that the more we learn about the disease, the more complex it gets. Yes, there have been declines in incidence, but new cases will offset those declines simply because people are living longer; cancers essentially reflect the accumulation of DNA hits to a cell as it divides and divides again over time. Johnson's involvement took off with the discovery of a rare uterine cancer in his wife, Nancy, which, when diagnosed, had metastasized to her groin. The detailed chapters on her surgery and multiple drug and radiation therapies enable Johnson to explain why such triple-prong treatment is standard today and what new drugs are in the pipeline. Nancy’s story may have also inspired his reporting on risk factors and cancer prevention. Here, the facts may shock: Cigarette smoking, ionizing radiation and certain viruses are serious cancer risks, but the contributions of other known carcinogens, environmental pollutants and conjectured microwave transmissions via cellphones are minor or unproven. Furthermore, there is no evidence that eating 5-per-day servings of fruits and vegetables will prevent cancer. Instead, researchers see cancer as an evolutionary process in which increasingly aberrant cell lines may compete or cooperate, stimulate the development of a blood supply and acquire the ability to metastasize. Factors that may encourage this behavior include hormones like estrogen, which stimulates cell division, and changes in metabolism due to obesity; insulin resistance may also play a role. But for the majority of cancers, as was the case with the head and neck cancer that ended the life of Johnson’s younger brother, the cause is unknown, a random event.
A thorough and nuanced presentation of the state of the science of cancer research, refreshing in its honest appraisal that the war is far from over.