A collective of bibliophiles talking about books. Book Fox (vulpes libris): small bibliovorous mammal of overactive imagination and uncommonly large bookshop expenses. Habitat: anywhere the rustle of pages can be heard.
In real life, when I’m not reading books, reviewing books, arguing about books and tunnelling out from under my collapsed pile of ‘to-be-read’ books, I’m the manager of a small healthcare charity in the Lake District. A sizeable percentage of our clients are people who either have cancer, are in remission from cancer or who have had cancer and are now free from it. I’ve known people who have stuck two fingers up to medical wisdom and lived decades beyond their allotted ‘six months’ and those who – as soon as they heard the word ‘terminal’ – simply withered and died. I know cancer, in other words, as a complex and fickle illness that refuses to be buttonholed and never seems to behave the same way twice.
I asked for a copy of Pecorino’s book wondering if I could recommend it to people as a way of demystifying an illness that terrifies so many and to help get the message across that a diagnosis of cancer is no longer an automatic death sentence.
Pecorino’s stated aim is to explain cancer and its treatment in simple, layman’s terms: what it is, where it comes from, how and why it develops, how it spreads and what science is doing to combat it – and to a great extent, she succeeds. She writes with enthusiasm and conviction, deploying simple analogies to explain complex scientific ideas, but the science underlying the whole subject is – genetics – is complicated and there are places in the book where the science swamps the message.
At its most straightforward, the book is beautifully transparent:
Cancer occurs because of alterations that lead to permanent changes (mutations) of specific genes. The reason that there are so many types of cancer is that genes are found in every type of cell in the body and so every cell can be a candidate for the origin of cancer.
However, when the author starts to grapple with the actual science of gene mutation, the going gets a bit heavier. I grasped the basic idea, but by the time she got to …
Activated RAS passes the signal from the membrane to signal carriers in the cytoplasm. The first signal carrier, RAF, also a kinase, adds an accessory phosphate to the next signal carrier, MEK. Phosphorylation causes a change in shape and activation of MEK. Upon activation, MEK, also a kinase, adds an accessory phosphate to the next signal carrier, MAPK. Phosphorylation of MAPK causes a change in protein shape and activation of MAPK …
… she’d completely lost me, which may well say more about me than about the book, but I don’t think I’m exactly slow on the uptake
In fairness, Pecorino never launches a term like ‘phosphorylation’ on you without explaining it, and a good part of the problem is that I was being bombarded with so many new ideas and so much information that my basically non-scientific brain got to a point where it couldn’t absorb any more.
Happily, you don’t HAVE to understand the finer details of the science to get something worthwhile from this book. There is, for instance, an excellent chart listing the major cancers and indicating to what extent such factors as weight, breastfeeding, exercise, various foods and general lifestyle are believed to affect them – either adversely or advantageously – and the chapter entitled “You are what you eat (and do)” should be required reading.
Where Pecorino’s book really starts to come into its own however is in recent advances in the understanding and treatment of cancer, and I found myself wishing she’d dumped some of the more opaque stuff to expand upon her fascinating explanations of subjects like personalized medicine – tailoring the treatment to fit the patient. Because no two people are genetically identical, no two people respond to either cancer or cancer treatments in the same way (witness my two examples at the beginning of this review) and we are – thankfully – now rapidly approaching the time when the blunt instrument of chemotherapy (which kills healthily multiplying cells along with cancerous ones) will be, if not a thing of the past, at least a very much more finely tuned instrument.
Then there’s the recent discovery that some cancers are actually caused by viruses – the most startling of which is the human papilloma virus, or HPV. Did you know that 100% of cervical cancers are caused by HPV?
Where she really got my attention though was right at the end, when she touches – all too briefly – on stem cell research, which offers the very real hope that one day cancer may become a completely treatable illness.
So, would I recommend this book to clients? I think so – at least to selected clients who wouldn’t be fazed by the technical passages – because the over-riding message is that we are, contrary to what many may believe, truly beginning to win the battle and in that battle, knowledge is power.
Oxford University Press. 2011. ISBN-13: 978-0199580552. 256pp. Also available as a digital download.
When she’s not doing all the afore-mentioned stuff with books, Moira is the Manager of The Centre for Complementary Care – a small healthcare charity in the Western Lake District in Cumbria.