This past Sunday, most professional football players wore pink cleats, pink mouthpieces, or pink chin straps as they ran around their respective gridirons. The color was delicately included to heighten awareness about the scourge of breast cancer, a disease that until the 1970s — like many forms of cancer — was not discussed in polite society in tones above a hushed whisper. “There was a lot of stigma until then. It was seen as a disease you brought on yourself, either by stress or hysteria. And for women with breast cancer, there was the sexual shame of it. And I wouldn’t say that stigma is all gone by any means,” said nationally acclaimed writer and oncologist Siddhartha Mukherjee, who won a Pulitzer Prize this year for writing the definitive medical biography of cancer in his book, The Emperor of All Maladies: A Biography of Cancer.
Thanks to an anonymous donor working in conjunction with the Cancer Center of Santa Barbara and UCSB, Mukherjee will be giving a public address this Saturday afternoon, October 22, and then afterward, at 5:30 p.m., will be meeting with a panel of Santa Barbara cancer specialists intent on talking some serious shop. As Americans began living longer, Mukherjee wrote, more and more got cancer. The disease now ranks number two as cause of death. “Much of the stigma fell away when the numbers changed. It’s hard to stigmatize something that one out of two or three people will come into contact with.”
In his book, Mukherjee traced cancer as far back as the Egyptians and examined how they dealt with it. It was the Greek medical investigator Galen, he found, who first concluded that a host of out-of-control growths on various body parts should be regarded as a single, unified disease. Graced with movie-star good looks, Mukherjee managed to synthesize a massive quantity of highly technical and potentially intimidating medical information into a compelling and dramatic read. The book provides a comprehensive exploration of how cancer treatment has evolved from a belief in “the humors” to the combination of high-tech biochemistry and genetics it is today. Mukherjee sought to make this palatable to lay readers by writing a biography of the disease. “I tried hard not to overly personalize cancer,” he said. “When you read Lord of the Rings, you never actually see the Lord of the Rings. You get to know him only through the struggles against him and the perseverance and determination of the people fighting him,” he said. “I was striving for that.”
Mukherjee’s talk has been billed as his assessment of where we are in the “War on Cancer,” which is ironic given his criticism of the “war” approach. “The metaphor of war is inappropriate,” he said. “Cancer isn’t a war as much as it’s a puzzle. You don’t win or lose a puzzle. You solve it.” The War on Cancer was officially declared during the presidency of Richard Nixon in the 1970s. While it funneled and focused vast sums of federal money on cancer research, Mukherjee said Nixon sought to use the war to discipline scientists, forcing them to pursue work that promised immediate results as opposed to basic research that might prove more valuable in the long term. In his book, Mukherjee described at length the statistical difficulties involved in assessing with any precision the extent to which cancer research and treatment has actually saved and extended the lives of people diagnosed. “In general, there’s been steady progress in reducing mortality,” he said, “but much of that’s been undone by smoking and lung cancer.”
In a list of questions prepared for Mukherjee, Dr. Fred Kass, director of medical oncology at the Cancer Center of S.B., noted that the American Cancer Society estimated 220,000 new cases of lung cancer will be diagnosed in 2011, with 150,000 cancer deaths. “Approximately 90 percent of these will be attributable to tobacco use,” he wrote. “Will the War on Cancer ever be winnable if we cannot alter behavior?” Kass said he and other cancer specialists hope to explore issues, like prevention and access to health care, that fell outside the scope of Mukherjee’s book. According to one estimate, 43 percent of all cancer deaths in males — and 30 percent for women — are attributable to educational and racial differences. In addition, Kass and his fellow practitioners hope to engage Mukherjee on the medical implications of “the immortality” of cancer cells. “One of the hot questions right now is whether cancer cells have stem cells and how they function,” he said. Mukherjee said from the leukemia research he’s now doing, he has been able to “tease out” stem cells from the blood cancer. “The idea that cancer contains stem cells and that they exist in every tumor and that they can re-create the entire cancer is hotly debated,” he said. “If we’re not killing these stem cells, then the cancer will come back.”
Mukherjee’s appearance comes at a busy, if uncertain, time for the Cancer Center. This past week, the center hosted a health fare at the Eastside Neighborhood Clinic, providing free screenings for 80 people, most of whom either had no insurance or were grossly under-insured. The center also conducted its annual cancer walk/run benefit, drawing more than 850 participants, ranging in age from 3 to 80 years old. With Santa Barbara’s institutional medical landscape experiencing intense flux, the Cancer Center’s efforts to chart a new and more financially secure course has been beset with fits and starts. Although the center secured the necessary planning permits to rebuild a larger and unified campus three blocks away from Cottage Hospital last year, the center abandoned the fundraising effort to make that happen in order to pursue a possible merger with Cottage. But the merger idea — initiated by center executives — was subsequently shot down when doctors there voted against it, arguing their exclusive focus of mission would be become watered down. Center officials are currently exploring possible options with both Cottage and Sansum.