Content
The book weaves together Mukherjee's experiences as a hematology/oncology fellow at Massachusetts General Hospital as well as the history of cancer treatment and research. Mukherjee gives the history of cancer from its first identification 4,600 years ago by the Egyptian physician Imhotep. The Greeks had no understanding of cells, but they were familiar with hydraulics. Hippocrates thus considered illness to be an imbalance of four cardinal fluids: blood, black bile, yellow bile, phlegm. Galen applied this idea to cancer, believing it to be an imbalance of black bile. In 440 BC, the Greek historian Herodotus recorded the first breast tumor excision of Atossa, the queen of Persia and the daughter of Cyrus, by a Greek slave named Democedes. The procedure was believed to have been successful temporarily. Galen's theory was later challenged by the work of Andreas Vaselius and Matthew Baille, whose dissections of human bodies failed to reveal black bile.
In the 19th century, surgeons devised various approaches to remove tumors, like William Halsted and the radical mastectomy. Additionally, Emil Grubbe used X-rays to treat cancer, thus identifying another treatment modality. Rudolph Virchow first observed leukemia, and Franz Ernst Christian Neumann localized the pathology to the bone marrow.
In the 20th century, cancer became the second most common cause of death after heart disease in the United States. Sidney Farber induced temporary remission in pediatric leukemia using antifolates developed by Yellapragada Subbarow. Louis Goodman and Alfred Gilman also used nitrogen mustard to treat lymphoma. The National Cancer Institute (NCI) introduced clinical trials to test the efficacy of chemotherapy. Recognizing the possibility for a cure, Farber sought funding for his efforts through The Jimmy Fund and Mary Lasker. Inspired by the Space Race, Farber and Lasker appealed to the nation and President Nixon to enact legislation for the war on cancer, resulting in the passage of the National Cancer Act of 1971 and increased funding for the NCI.
The book also reviews the origins of hospice and palliative medicine and cancer screening.
According to Mukherjee, the book was a response to the demand of a patient: "I'm willing to go on fighting, but I need to know what it is that I'm battling." Mukherjee states that two of his influences for the book were Randy Shilts' And the Band Played On and Richard Rhodes' The Making of the Atomic Bomb, but the defining moment for him was "when he conceived of his book as a biography".