“biography” of cancer, showing how our conception of the disease has changed with our understanding of the body. Ancient Romans blamed an excess of “black bile.” At the dawn of modern surgery, physicians relied on procedures like radical mastectomies. The atomic age birthed supertoxic chemo cocktails. And now that we’re plumbing the mysteries of the genome, we aim to crack the codes that hijack our cells. “Every era,” Mukherjee writes, “casts illness in its own image.”

One of the recurring motifs in your book is that cancer is like an exaggerated version of ourselves—a caricature of our own cells’ imperatives for growth and evolution. Nearly every one of the genes that turns out to be a key player in cancer has a vital role in the normal physiology of an organism. The genes that enable our brains and blood cells to develop are implicated in cancer. The gene that enables birds to learn songs can become cancer-causing. There is no normal physiological process that can’t be bastardized by the disease.

How have genomics research and personalized medicine changed the way we think about cancer? In the book, I paraphrase Tolstoy and say that normal cells are identically happy, but cancer cells are unhappy in their own unique ways. If you take 100 breast-cancer samples, 100 types of cancer have 100 different hallmarks of mutated genes. You could be nihilistic and say, “Oh, God, we’ll never be able to tackle this!” But there are deep, systematic, organizational principles at work in all that diversity. The most promising direction in cancer R&D is to understand those principles at the genetic level.

You call your book a biography of cancer. How do you visualize the lead character in the story? Because I work on leukemia, the image of cancer I carry in my mind is that of blood. I imagine that doctors who work on breast cancer or pancreatic cancer have very different visualizations. About a month ago, I changed the color of the crab on the cover of my book from black to red to match my image of the disease.

Authors: Steve Silberman

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