I was eager to read this book because, as a surgeon, I am always searching for new information,fresh ideas and innovative techniques in the management of cancer.
I read the 280+ pages of The Cancer Chronicles hoping maybe to discover a new treatment, or a novel approach or cutting edge therapy to combat this vicious disease that has plagued all living creatures since life began on earth. Tumors have been found in fossils of dinosaurs.
Sadly I found nothing new; the promised "explosive new ideas" touted by the publicity hype were neither new nor explosive, but just fizzled. Most of it was common routine knowledge in the medical field. On page 17, I learned that "mammals appear to get more cancer than reptiles or fish. Domesticated animals seem to get more cancer than their cousins in the wild. And people get the most cancer of all." It is a great piece of information with which to stomp your friends at trivia.
Even some information was inaccurate; the author confuses the function of free radicals with antioxidants.
The book touches on the genesis of cancer, mostly unknown except for a few causative relationships such as smoking and environmental hazards (Eg. asbestos) associated with mainly with lung cancers. It correctly challenges the myths of unproven causal links between cancer, the environment or diet. Many studies are inconclusive, flawed or biased.
Screening tests like mammograms, PSA and CA 125 are not specific or sensitive enough for an absolute diagnosis and often result in a false positive, leading to unnecessary, often radical, treatment. Ideally, early diagnosis and treatment lead to cure; best examples of screening are Pap smears and colonoscopy that can detect pre-cancerous lesions and allow early therapy.
Robust research is being conducted on genetics, obesity, inflammation and aging as triggers of malignant cellular metamorphosis and cancer. The quest for biomarkers is a giant step forward in the search for an accurate screening test. In my opinion, the answer shall be unlocked in the study of the human genome.
Surgical interventions, preceded or followed by radiotherapy and/or chemotherapy remain the standard of care in the treatment of cancer. These therapies are being constantly refined to minimize collateral damage to nearby tissues and to mitigate general side effects and complications. The "one size fits all" approach is slowly being replaced by custom designed treatments for each individual and their specific cancer.
Johnson did an in-depth research of the subject when his wife was diagnosed with an advanced stage gynecological cancer. He interviewed researchers and visited their labs, attended conferences and read the literature, and all the while trying to relate his findings to his unfortunate wife's condition and management. The stories are related in parallel and are intertwined, which gives a disjointed sequence of chapters that are neither organized thematically nor chronologically. Johnson peppers his account with stories of cancer in hamsters, Tasmanian devil and accidental self-contamination from a needle poke. Even the some Italian nuns are not spared from conjecture. No theory, however far fetched, is ignored; Gould's theory of "punctuated equilibrium" is mentioned and left hanging (it refers to an evolutionary process in two stages, rapid cell development and death in one and stasis in the other). Wienberg's work on oncogenes (cancer-causing genes), mitosis and entropy is explained to its conclusion "If we lived long enough...we all would eventually get cancer."
He tends to drone on about his interface with researchers, conferences and history mixed in with results of studies, and to cram in numerous facts, figures and anecdotes; causing confusion in the lay reader and loss of interest in the medical professional.
Johnson seems oblivious of the SEER (Surveillance, Epidemiology and End Results Program) and EPIC (European Prospective Investigation into Cancer and Nutrition) that prove the importance of diet in the prevention and treatment of malignancies. A vegetarian food regimen or Mediterranean diet stand out as the best choices.
The culmination of all Johnson's efforts is his eureka moment "whether any one person gets cancer or does not will always remain mostly random". I had to read 203 pages to get to that conclusion? This is after he already quoted Elio Riboli (epidemiologist) half way in the book, "as much as 50% to 60% of cancer, we didn't have the slightest idea of where it comes from". Yeah, I got it the first time; it's a crapshoot. Cancer is unpredictable. We are also reminded that cancer is not just one but myriad diseases "with no cure in sight."
Towards the end of the book Johnson chronicles his brother Joe's courageous encounter with cancer of the head & neck and his untimely demise. This adds to the poignancy and fatalism of the work, for what he calls "The Immortal Demon" no permanent cure is presently available.
It is a well-written book in the style of investigative journalism and a good overview of the state-of-the-art in the diagnosis and treatment of cancer, for the interested layman. The poignant account of Johnson's wife's battle with cancer, encompassing about a quarter of the book, adds emotion and sympathy to, what would otherwise be, a minor textbook of facts and figures, and of little interest to the academic or medical professional.
Overall the book is a good introduction to what is available today for the management of cancer in general and a good place to start to begin to understand the complexity of the disease and the intricacies of its treatment.
Interested readers should add "The Emperor of All Maladies", "The Truth in Small Doses" and "The Philadelphia Chromosome" to their reading list to get a more complete picture on the subject.
I noticed that all the "vine" reviewers have given the book 4 & 5 stars. I shall be an outlier, but I cannot give it more than 3 stars for, in my opinion, it did not deliver any "new explosive ideas" as promised.