Cancer: The Emperor of All Maladies – A Documentary All Should Watch
Everyone has been touched by cancer in some way. Whether it is a loved one afflicted with the disease, or ourselves, it affects us all. When we hear someone has cancer, there is a common ground of empathy with that individual. Ken Burns' documentary, “Cancer: The Emperor of All Maladies” just debuted last week on PBS, based on a the Pulitzer Prize winning book by Siddhartha Mukherjee. It is a three-part, six hour film that discusses the history of cancer, the scientific efforts in fighting cancer, and what the future holds for cancer discovery and research. This article will give a brief overview of some of the points made in the documentary. Please note that this is just the tip of the iceberg, and as a result, I strongly recommend that everyone watches it. The link will be provided at the end.
According to the documentary, it is estimated that 1 in 2 men will die of cancer, and 1 in 3 women will die of cancer at present. As a result, this is a problem of global proportions. The history of cancer actually goes back 4,000 years, where an ancient Egyptian physician noted an abnormal growth that killed patients. In fact, cancer was known by physicians up until the beginning of the last century as a killing disease. Everyone who was affected by cancer died due to lack of scientifically discovered treatments. With the advent of surgical techniques and eventually radiation, cancer became somewhat treatable but there were still some missing pieces of the puzzle.
U.S. Presidents Lyndon B. Johnson, Richard Nixon, Bill Clinton, George W. Bush, and Barack Obama have all mentioned some sort of goal while in office of curing cancer. In 1971, Mary Lasker, a wealthy socialite and cancer advocate, convinced President Nixon to pass the National Cancer Act. At that point, President Nixon officially declared a “War on Cancer”. The act provided federal funding to cancer research, and strengthened the National Cancer Institute. This was a paramount first step to the cancer revolution that we are experiencing at present. At that time, the focus was attempting to cure childhood leukemia. There were major strides made prior to 1971 in attempting to cure leukemia (in large part due to Sidney Farber), and breast cancer had been studied since the late 19th century due to its prevalence. As time went on, physicians and scientists started to discover newer techniques to combat cancer.
There are some major components to the treatment of cancer that the documentary focuses on. They include but are not limited to: viral, chemical (chemotherapy), surgical, radiological, and genetic. Chemotherapy is the use of chemicals to reduce the size of tumors and potentially treat cancer. This originated in the early 20th century, when Sidney Farber studied and tested the chemical use of treatment on patients with leukemia. Although the chemotherapy has harmful effects, it does help treat cancer. As medicine is moving forward, the goal is to create a targeted version of chemotherapy, where the chemical attacks the cancer cell only rather than the cancer cell and everything else. Certain pharmaceuticals such as Glivec and Herceptin have attempted to keep the side effects on the lower end and treat cancer cells. They have both had success, but there is still room for improvement.
William Stewart Halsted and Wilhelm Rontgen were both critical figures to discovering methods to treat cancer via surgery and radiation, respectively. Halsted pioneered many surgical techniques, including the radical mastectomy. Rontgen discovered x-rays and Emil Grubbe thought that he could somehow use them to concentrate on cancer cells. All of them had a strong desire to help their patients, even though there were some serious side effects. Nevertheless, it is important to remember that if it weren't for historical figures like these, the foundation would have never been set to treat cancer and make the advancements we have today.
During the 1970s, scientists started to discover that there were genetic components to understanding cancer. One of the earliest discoveries was the mutation of the BRCA gene, which caused an abnormally high risk of breast and ovarian cancer in females. This is in large part due to the technology and funding that was available during the 1970s. It was called an, “oncogene”, or cancer causing gene. The idea was that if these genes were mutated, it would cause tumor cells to multiply rapidly. In addition, another gene called the tumor suppressor gene was discovered. It is a gene that when normal, would stop the proliferation of cells. However, in some cancers, when the tumor suppressor gene was mutated, it would not be able to perform this function. The documentary states a great way to remember it. Think of the oncogene as the “gas pedal” and the tumor suppressor gene as the “brakes”.
The discovery of the human genome in the early 20th century was revolutionary for cancer research. The genetic mutations that were the focal point of cancer research at up until this point were only a handful. However, the unraveling of the human genome allowed us to focus on all of the genetic mutations in cancer, which scientists would have never been able to find before. Despite this good news, cancer became more and more complex. There are genetic cancer markers that we only know by name, but still have yet to discover fully. Because scientific research takes place at a slow pace, it requires great patience.
The idea of preventative care has a history that goes back just a little over 100 years. During World War I, soldiers used to smoke cigarettes in order to relieve stress when out on the battlefield. The cigarette boom in the United States took place between the 1900s and the 1960s. Each decade, cigarette smoking increased, and the rate of lung cancer followed the trend. Since the 1970s, there have been certain restrictions on cigarette smoking advertising and increasing bans in public places. As a result, the rate of lung cancer has somewhat decreased. At present, we face an even more dangerous environmental hazard: obesity. It is estimated that 2 in 3 Americans are currently obese, and obesity is a major risk factor for some cancers. It was actually stated in the documentary that obesity will have a more harmful effect than cigarette smoking did previously in causing cancer.
One of the most recent innovations that has shown early promising results is cancer immunotherapy. In summary, it involves using the patient’s own immune system to fight cancer. This can be done by a few methods. One involves extracting healthy t-cells from a patient, growing them in the lab, and re-injecting them into the patient to treat the cancer. Another is based on the idea that one of the main problems in cancer is that the immune cells do not recognize cancer. The treatment involves a system to mark the tumor cell so the immune system can proliferate and attack that particular cancer cell. This was referred to in the documentary as putting a “homing device on cancer.”
Based on the information presented in the documentary, the approach to preventing and treating cancer will require a multidisciplinary approach. It will involve looking at a patient's DNA, family history, lifestyle, and environment in order to determine what the best course of action is for a particular patient. In other words, the goal is for treatment to become more individualized rather than generalized. Preventative science is very young but promising. According to Dr. Bert Vogelstein from Johns Hopkins, “If we implement all preventative measures that are well known, cancer deaths would be reduced by 50%.” The key concept is that if you don't contract cancer, you won't die from cancer. This approach must be taken with great caution. According to the documentary, the media has speculated a lot of unproven theories in treating cancer. It is important to understand that providing a scientifically sound causal relationship is not as easy as it seems, and requires many years of scientific research.
In essence, this was a great documentary to watch. It is quite long, but extremely informative. I like that it discusses cancer from a factual and scientific perspective, rather than personal inclinations and beliefs. The documentary also juxtaposes history with real world case studies so you can see how much we have evolved in treating cancer. Although there is still a shadow of mystery behind cancer, we have made more significant strides in the battle against cancer in the past 30 years than we have in human history. As a result, there has been a decreased mortality rate due to our strides in cancer research. The only path is forward. I highly encourage everyone to watch the documentary, which can be found here: PBS Documentary
Part 1 is “Magic Bullets”, Part 2 is “The Blind Men” and The Elephant and Part 3 is, “Finding the Achilles Heel.”
About SC Ali
S.C. Ali is an author/editor. He has a degree in Chemistry, and is interested in the study and practice of medicine. His blog can be found here: http://thebronzelifestyle.com/