Cancer is an enormous subject: its influence on the history of medicine, on society, on politics... can't be over-estimated. Somebody was bound to take the risk of trying to capture all of this in one book. `I started off by imagining my project as a "history" of cancer. But it felt, inescapably, as if I were writing not about something but about someone. My subject daily morphed into something that resembled an individual - an enigmatic, if somewhat deranged, image in a mirror.' So Siddhartha Mukherjee, cancer physician and researcher, redefined his project: it became `a biography of cancer' - although `a thrilling piece of sublime literary non-fiction' captures the book just as well.
Mukherjee starts off the book on familiar ground: a woman being asked to return to the hospital as soon as possible, because something has shown up in the tests she underwent. This something is leukemia, a liquid cancer, and it catapults us back in time: to 1847, when the term leukemia was coined.
The first chapter is dedicated to the earliest known cases of cancer. We consider cancer a "modern" illness (and it is, because only in the last two centuries have we started to grow old enough for cancer to become the second most common cause of death) but there are some freakishly ancient occurrences. Atossa (550 > 475 BC), queen of Persia, had her breast cut off - a breast cancer that even made an army change direction. (I'm not going to explain this: it's one of the mesmerizing anecdotes you have to read for yourself.) And then there's the Peruvian mummy with a thousand year old preserved cancer. `It is hard to look at the [mummy] tumor and not come away with the feeling that one has encountered a powerful monster in its infancy', Mukherjee observes.
This same chapter also introduces one of the book's "heroes": the pediatric pathologist Sidney Farber, whose research produced the first-ever remission in a leukemia patient. He was the man who realised that, to get the funding for large-scale cancer research, the disease, any disease `needed to be marketed, just as a political campaign needed marketing. A disease needed to be transformed politically before it could be transformed scientifically.'
The second chapter, `An impatient war', focuses on a double war. First battlefield: the political struggle, the perception of science by politicians and the public. Second battlefield: the first attempts at chemotherapy, `near-complete devastation' of a patient, in an attempt to stamp out any trace of the evil.
In the subsequent chapters, Mukherjee writes about patients demanding visibility - as late as the 1950s, the New York Times refused to take an ad for a support group for women with breast cancer, claiming neither the word "breast" nor "cancer" were suitable for print - and a more humane form of care. About the influence of feminism and HIV on cancer treatments. About the slow process of finding the correlation between smoking and lung cancer and the even slower process of accepting this scientific fact.
Finally, we return to cellular level and learn more about the nature and origin of cancer. These last two chapters are a more difficult read, because the more one discovers about the workings of cancer, the more complex it all becomes.
In passing, we learn more about the working of DNA, about the medical definition of the word `cause', about the discovery of X-rays (first thought to be a cure for cancer, but turning out to be a major catalyst of the disease), and much, much more. The emperor of all maladies is an unputdownable piece of medical history, with breakthroughs, competition, pipe dreams and disappointments, Eureka!-moments and the odd incidence of deceit. Reading this book is a rewarding as well as a highly enjoyable experience: here is some excellent non-fiction, with elements of horror, adventure novel and science fiction. Muhkerjee's exploration of cancer - from a factual, historical, biological and poetic point of view - changes your way of thinking about the disease.