Siddhartha Mukherjee, M.D., presented cancer’s story of major tragedy and future hope to more than 400 people at the Sixth Annual Cindy Wool Memorial Seminar on Humanism in Medicine at the Fox Tucson Theatre on March 31.
The Pulitzer-Prize winning author of “The Emperor of All Maladies: A Biography of Cancer” recounted his story of the book’s creation, and how it became a three-part Ken Burns PBS special that aired last month.
In 2010, his unbound manuscript wound up on the desk of film producer Laura Siskind, who herself was undergoing cancer treatment. She told Mukherjee, “You will win the Pulitzer Prize.” Siskind wanted to start film production of a book that wasn’t even published yet, he said. “About four and a half weeks later, Ken Burns called me. Laura died of breast cancer in the middle of production.”
Cancer remains a scourge for many people around the world. But the main character in “The Emperor of All Maladies” is the disease itself, as it’s been diagnosed, treated and thought about over the last 4,000 years, said Mukherjee, who is a Columbia University assistant professor of medicine, researcher and staff cancer physician at CU/NYU Presbyterian Hospital.
The Cindy Wool seminar included a noon lecture to medical students and faculty at the University of Arizona College of Medicine, which sponsored the seminar in conjunction with the Maimonides Society of the Jewish Federation of Southern Arizona.
The book tells the stories of several cancer patients, and of prominent researchers such as Sidney Farber, who pioneered the difficult treatment of childhood leukemia in the 1950s. Mukherjee showed a video clip of Farber’s lab, where two chemotherapy treatments were first combined. “Every child back then died of leukemia,” he said. “Even today, that’s chilling. There was absolute chaos when [the idea of combining chemotherapy drugs] was first announced, injecting children with such poisons, pushing children to the brink of death” to try to save them.
Considering earlier treatments of the disease, Mukherjee asked physicians in the audience, “How far would you go” to push this disease away?
In September 1962 four drugs were combined to treat children with leukemia. “Incredibly, some of the children in the trial began to recover, bringing lasting remissions,” he said. “How do we evaluate hope? We hope too much and that is because we’re so tied to our humanity.”
Often when people receive a diagnosis of cancer they ask, “What have I done to myself? We haven’t removed the stigma of cancer. We search our brains to blame ourselves,” said Mukherjee. “Physicians are trying so hard to come up with stories for hope.”
An era’s accepted treatment plays a big role in what happens to cancer patients. Dr. William Stewart Halsted first tried to uproot the afflicted cells in breast cancer patients by performing radical mastectomies. “Those words would become a trap,” said Mukherjee. “In 1905, what woman would go to a surgeon and say, ‘You know, I really want the non-traditional approach.’ It’s so toxic to think you can cure cancer with more radical surgery. If you think about the biology of cancer it makes no sense,” he said, explaining that the disease is either localized or it’s already spread.
But for almost a century, the Halsted radical mastectomy — which was devised in the late 1800s, only 36 years after the introduction of anesthesia — reigned as the standard treatment of breast cancer. In recent years, the extreme procedure’s dominance has been challenged by advances in cancer biology as well as other forms of surgical, radiation and drug therapies.
Cancer still occurs in one of 300 children and in one of four adults, noted Mukherjee. In the future, “the human errors we make with our own judgment will remain the same,” he said, adding that we’re in the midst of “a molecular medicine revolution. We will fight every cancer if we have the resources, something that existed in the 1960s that has gone missing.”
At the same time, “we know more about cancer than any other disease in history,” he said. “There are more cancer drugs than ever before, better technology. Cancer mortality has decreased every year 1 percent to 2 percent a year for the last 20 years.”