The Cigarette Duet & The Emperor of All Maladies

The Cigarette Duet - Princess Chelsea

I am reading my way (I am about halfway at this point) through an incredibly interesting and riveting, very educational, superlong book called The Emperor of All Maladies: A Biography of Cancer by Siddbartha Mukherjee. I love long, well-written, scientific-type books aimed at ordinary people like me. This is the story of cancer, a chronicle of an ancient disease, writes the author, a history of humankind's involvement with the disease, and a biography of this awesome illness. In fact, cancer is not just one disease but many and in the past scientists have sought "the cure" for cancer seemingly like a search for the holy grail.

And one knows that in a book like this one is going to come up against one's demons. Such as cancer in children. The reader is confronted with heartbreaking histories of the attempts of doctors attempting to cure very sick children, in the past it seems more like madness, trying to find cures at any price, on the bodies of very sick people including children. For the greater good? Something we can only decide in our own minds as we read but this author manages a difficult balancing act in the writing. Not ghoulish, not over-emotive, but not overly distanced from the realities being portrayed either.  I was impressed.

More personally for me is when we get to the smoking/cancer correlations. It seems to have taken a long time before doctors, scientists, and politicians accepted the correlation between smoking and cancer. Many of us older folk will remember that dawning awareness through the sixties and the seventies. I remember my father stopping smoking in the early seventies even as I, fool that I was, began the habit. I think my father had watched a programme on the telly which showed smokers lungs blackened with tar. I didn't see that programme, I was out somewhere, probably getting up to no good.

What he may have seen on the telly would have been something like this description detailed in the book.

"A man of careful words, Auerbach was a widely respected lung pathologist who had recently completed a monumental study comparing lung specimens from 1,522 autopsies of smokers and non-smokers.

Auerbach's paper describing the lesions he had found was a landmark in the understanding of carcinogenesis. Rather than initiating his studies with cancer in its full-blown for, Auerbach had tried to understand the genesis of cancer. He had begun not with cancer but with its past incantation, its precursor lesion - precancer. Long before lung cancer grew overtly and symptomatically out of a smoker's lung, Auerbach found, the lung contained layer upon layer of precancerous lesions in various states of evolution - like a prehistoric shale of carcinogenesis. The changes began in the bronchial airways. As smoke travelled through the lung, the outermost layers, exposed to the highest concentrations of tar, began to thicken and swell. Within these thickened layers, Auerbach found the next stage of malignant evolution: atypical cells with ruffled or dark nuclei in irregular patches. In a yet smaller fraction of patients, these atypical cells began to show the characteristic cytological changes of cancer, with bloated, abnormal nuclei often caught dividing furiously. In the final stage, these cell clusters broke through the thin lining of the basement membranes and transformed into frankly invasive carcinoma. Cancer, Auerbach argued, was a disease unfolded slowly in time. It did not run but rather slouched to its birth." (p258,259)

After 33 years of smoking, my lungs are probably looking pretty sick.