Conversation with Cancer Expert Siddhartha Mukherjee

Be it in the abstract or the real, the specter of cancer haunts us all. Live long enough and this ever lurking disease will arrive in your life, it’s bags packed full of fear and hard questions to answer for you and your loved ones. Cancer cares not about your riches or your responsibilities, your plans or your politics. It is an equal opportunity killer, well known yet still largely misunderstood.

My dance with the disease began at the ripe old age of 21 with a medium-sized melanoma on my left shoulder blade and took a turn toward the deadly serious with a pancreatic cancer diagnosis at the age of 34. It has been nearly 5 years since the latter was discovered and nothing has ever been the same and, in my heart of hearts, I know it never will. Such is my cancer story.

However, as the storms of life-threatening illness blew across the landscape of my life, I found both solace and strength at the intersection of science and storytelling. The more I could connect with fellow fighters and the more I could learn about this shape shifting and ubiquitous ages-old killer, the more I could begin to see my struggle in it’s proper context, the more I could understand how exactly I got there, and, above all, the more I could envision a path back from the brink.

It was early on in my journey that my father-in-law sent me a copy of Dr. Siddhartha Mukherjee’s book, The Emperor of All Maladies: A Biography of Cancer. A Pulitzer Prize-winning exploration into the origins and assorted causes of cancer, the book was literary liberation for me. It is rare when an author can be both world class in their knowledge of a topic and captivatingly colloquial in the way they talk about it but that is exactly what Mukherjee was able to accomplish in his book. For this once-upon-a-time investigative reporter, reading The Emperor of All Maladies was nothing less than good and strong medicine.

Now, on the heals of his new book, the New York Times bestselling The Gene: An Intimate History, Mukherjee is coming to Santa Barbara this week thanks to the folks from UCSB’s Arts and Lectures. Though the good doctor/Rhodes Scholar is beyond busy with his literary life and his ongoing cutting edge cancer research, I had the opportunity to email with him last week and talk a bit about his hard-earned views on cancer and the future of medicine. What follows is an expert from our correspondence.

Ethan Stewart: What do you feel is the biggest misconception about cancer?

Siddhartha Mukherjee: There are several, but I find that some misconceptions seem to persist over decades. One is that cancer is caused by an emotional state or by psychic trauma, which seems to reverse cause and effect. Cancer patients are often blamed or victimized by such myths: You have cancer because you brought it upon yourself via your psychic state. It’s a real disservice. And there’s a whole industry of quacks who try to take advantage of this. Another one is that oncologists use chemotherapy for cancer because we are suppressing some mysterious but secret cure.

In his final State of the Union, Obama, the now former President of the United States, called quite clearly for a cure to cancer in the years ahead. Is this even possible? Why or why not?

I certainly think that we will prevent many more cancers, learn to treat some, and learn to cure some additional ones over the next decades. However, cancer is such a diverse family of diseases that it’s hard to make predictions about it in one bucket.

It would seem that your work and writing is turning on new lights in the whole nature versus nurture debate. For the layperson, briefly explain the role genetics play in a person’s health story. What are the limits to this role?

The nature nurture debate has gone on for a long time but we now have powerful new tools to actually investigate this question. Most complex human features are not governed by single genes but by multiple gene variants, by gene-environment interactions, and by gene-chance interactions. Take height, for instance. We now know that multiple genes govern height. But is height all nature — or genes ? No, because if you have malnourishment, then it’s possible that these gene variants may not fully exert their influence. Is it all nurture? No, because if you remove malnourishment and other restricting features then genes become ascendant in the determination of height. It’s not an empty question. Whether nature predominates or nurture does depends on what feature one is examining and under what circumstances. One of the powers of genetics is to be able to answer this question on a feature-by-feature basis, and that’s more than we’ve been able to do ever before.

As a pancreatic cancer survivor, and someone who has refused chemo or radiation, I often describe cancer as “a call toward your better self that you either answer or die.” Thoughts?

Well, I think it depends on individual patients. For some patients, it could be a call to self. Others have a very different attitude toward a cancer diagnosis. Some take years to emerge from the depression. Some find themselves activated.

In your esteem, what is the next big frontier in medicine and what is keeping us from getting there?

I’m particularly intrigued by the idea of using cells to regenerate organs or tissues — it’s an area that my lab works on — but there are many fundamental scientific challenges. I’m also very interested in finding out how to detect cancer at the very earliest stages and use that information to prevent cancer.

411: Siddhartha Mukherjee will be presenting Cancer and the Gene: Past, Present, and the Future, Thursday, February 23, 7:30 p.m., at UCSB’s Campbell Hall. For more info and tickets call 805-893-3535 or go to www.ArtsandLectures.UCSB.edu