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The Emperor of All Maladies

Image of The Emperor of All Maladies: A Biography of Cancer
There’s no doubt that Siddhartha Mukherjee absolutely deserved the 2011 Pulitzer Prize for general non-fiction. The Emperor of All Maladies: A Biography of Cancer is a brilliant history of cancer, and a book that will change the way you think about a far-too-common disease.

But oh my gosh, it’s long and complicated — and I have spent a fair amount of time reading or writing about cancer.

Still, what Mukherjee has going for him is his ability, in most chapters, to spin a tale. You feel like you KNOW Sidney Farber or William Halstead as they make strides in leukemia or breast cancer surgery. It’s a skill to balance history and biology in a nonfiction work. You feel like Mukherjee is there saying to you “isn’t this interesting?!” whether it’s the rise of scrotal cancer in London chimney sweeps circa 1775, or the wife of the inventor of the Pap smear giving up cervical smears every day.  

A physician who divides his time between patients and the lab (who somehow found the time to write an award-winning book), Mukherjee has wisely chosen to include some real-life patient stories, which drive home his points about cancer research. What’s even more impressive is he explains some common aspects of cancer – such as risk and survival — in an innovative way. An example is of two women who develop breast cancer at the same time and die the same year, although they have different years of diagnosis.

Hope’s physicians insist that she had a five-year survival: her tumor was detected in 1995 and she died in 2000. Prudence’s doctors insist that her survival was one year: Prudence’s tumor was detected in 1999 and she died in 2000. Yet both cannot be right: the twins died from the same tumor at the exact same time. The solution to this seeming paradox—called lead-time bias— is immediately obvious. Using survival as an end point for a screening test is flawed because early detection pushes the clock of diagnosis backward.”

Seriously, for someone who has been on the early-detection bandwagon for years, this rocked my world.

But then we start to get into cancer and genes. This is not material that is easy to grasp. Mukherjee does a yeoman’s job of trying to keep us up with where he’s going, but the last fourth of the book takes intense concentration. That said, this is a book that everyone should read, and probably means to read, and may feel guilty about skimming. But it's okay: even in small doses, it’s a masterful work that's well worth your time.