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“Cancer will always be in our midst:” A conversation with physician-writer Siddhartha Mukherjee

MukherjeeTonight PBS television airs its new documentary Cancer: The Emperor of All Maladies. The six-hour feature (shown over three nights) is an in-depth look at the past, present and future of cancer, told primarily through the eyes of those dedicated to understanding and treating it.

The video preview promises the kind of data-rich and intensely dramatic storytelling we expect from acclaimed filmmaker Ken Burns, especially when he describes his acute awareness in early childhood that “something was desperately wrong with my mother.” That something was cancer, and his mother died before Burns was 12 years old.

As its title implies, the film is based on the Pulitzer Prize-winning work The Emperor of All Maladies: A Biography of Cancer by Siddhartha Mukherjee, MD, PhD. Now an assistant professor of oncology at Columbia, Mukherjee earned his undergraduate degree from Stanford, and last year he returned for a guest lecture. During his visit he sat for an interview with the Stanford Cancer Institute. Here is an excerpt:

What motivated you to pursue medicine?

I became interested in natural biology while here at Stanford. I took my first biology class as an undergraduate and became fascinated by the natural world. Over time I began to understand that medicine is actually applied biology, in that there is a direct connection between understanding human physiology and translating that understanding to people who are ill.

Why cancer?

I started as a cell biologist working on immunology and virology, then become interested in viral cancers and ultimately human cancers. In a way, I sort of backed into medicine by becoming interested in human biology and virology research first, and then decided to pursue clinical medicine as well.

It seems the more we learn about cancer, the more complicated it becomes...

Just because something turns out to be more complex that we initially thought does not mean that we cannot simplify it. The complexity allows us to evaluate what the reality is, and our interventions depend on us teasing out which part of the complexity are relevant and which parts are not. Complexity is just a description of the physiology of cancer, and interventions can follow from that. We should not be daunted by the fact that cancer is complex, and scientists aren’t, because the complexity makes our understanding deeper and more real.

In fact, there is an argument that cancer’s complexity may be its weakness. The fact that cancer cells have to create such interconnected networks of behavior just to sustain growth may make cancer more vulnerable to disruptions in those networks. Just because a chain is longer does not necessarily make it stronger, and cancer’s chain may have profoundly weak links. We just have to continue to work to find what they are and how to exploit them.

You’ve written cancer’s biography; will its obituary ever be written?

Cancer will always be in our midst for one simple scientific reason: the very genes that allow us to grow and adapt, when mutated, lead to cancer. And these are not incidental genes – we are not talking about the periphery of human physiology – we are talking about the genes that function as the centerpieces of normal cellular growth and development.

So, I think cancer will always be with us, but we will continue to evolve our interaction with the different forms of cancer in the future. We will learn to prevent some forms, learn to treat some and learn to cure some. We will turn some cancers into chronic conditions. And this sort of cat and mouse game with cancer will go on for a long time. This will be a reiterative contest that we will have to play over and over again. And I believe that as soon as we declare victory over cancer, then that will be the beginning of our defeat.

Are you optimistic about the potential to improve our overall approach to cancer?

I am extremely optimistic, but I am also sober about the realities of cancer. Just because certain cancers remain refractory against treatment today only means that we should double our efforts against them. There really is no other option but to continue to research cancer as aggressively and thoroughly as we possibly can.

What can people do to reduce their cancer risk?

This is a bit of an unexplored universe, and while there is no “silver bullet” for cancer prevention, there are a few basic things people can do: quit smoking, eat a healthy diet and exercise.

The truth is that we have really only been effectively working on the nature of cancer for 20 or 30 years - a short blip in time. Before that it was all darkness.

Previously: Cancer's Pulitzer Prize winner: Siddhartha Mukherjee, MD  and A conversation about the history of cancer 
Related: Cancer's biographer: A conversation with Siddhartha Mukherjee
Photo by Deborah Feingold

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