Cancer: The Evolutionary Legacy

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Overview


Every day, 1500 Americans die of cancer, and yet for most of us this deadly disease remains mysterious. Why is it so common? Why are there so many different causes? Why does treatment so often fail? What, ultimately, is cancer? In this fascinating new book, a leading cancer researcher offers general readers clear and convincing answers to these and many other questions.
Mel Greaves places cancer in its evolutionary context, arguing that we can best answer the big questions about cancer by looking through a Darwinian lens. Drawing on both ancient and more modern evolutionary legacies, he shows how human development has changed the rules of evolutionary games, trapping us in a nature-nurture mismatch. Compelling examples, from the King of Naples intestinal tumor in the 15th century, through the epidemic of scrotal skin cancer in 18th-century chimney sweeps, to the current surge of cases of prostate cancer illustrate his thesis. He also shows why the old paradigms of infectious diseases or genetic disorders have proved fruitless when trying to explain this complex and elusive disease. And finally, he looks at the implications for research, prevention, and treatment of cancer that an evolutionary perspective provides.
Drawing on the most recent research, this is the first book to put cancer in its evolutionary framework. At a time when Darwinian perspectives on everything from language acquisition to economics are providing new breakthroughs in understanding, medicine seems to have much to gain from the insights provided by evolutionary biology. Written in an exceptionally lucid and entertaining style, this book will be of broad interest to all those who wish to know more about this dread disease.

Presents a systematic Darwinian explanation for cancer; incl. historical anecdotes & scientific findings.

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Editorial Reviews

Nick Owchar
But his book's greatest contribution to the body of cancer literature is in its discussion of cancer's genetic mechanism and the role of DNA...what they don't explain, and what Greaves shows, is how this difference works to a cancer cell's advantage, making it "deaf" to the body's regulatory chemical commands, and how this supposed defect, following a remarkable chain of events obeying the Darwinian rules of natural selection, enables it to survive and multiply steathily.

"Will cancer patients benefit from reading this book? Greaves certainly supplies them with enough technical information to keep up with any oncologist. But there is an even more basic consolation here: that cancer has long been a part of human development, it isn't "bad luck or an act of God" that has singled out any individual, Greaves assures us. Whenever science can be used to rescue patients from blaming themselves for their condition, there is reason to celebrate.
—(L.A. Times 9/25/00)

From the Publisher

"Provides a feast of information about cancer that, like most banquets, is best consumed slowly: savor each course, enjoy relationships among the courses, become aware of the cook's creativity and skill...Greaves puctures myths, examines theories, and successfully sets the whole field of cancer research in perspective."--Booklist

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Product Details

  • ISBN-13: 9780192628343
  • Publisher: Oxford University Press
  • Publication date: 3/21/2002
  • Edition description: New Edition
  • Pages: 288
  • Product dimensions: 9.10 (w) x 6.10 (h) x 0.70 (d)

Meet the Author

Mel Greaves is Director of the Leukemia Research Fund Center at the Institute of Cancer Research, in London. The winner of several awards for cancer research, he lives in London.

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Read an Excerpt




Chapter One

PERPLEXED? YOU SHOULD BE


Allow me to start with the bad news will you? Statistics. Around one in three of us will at some time have an unwelcomed diagnosis of cancer, providing common ground between presidents, movie stars, bishops, athletes, Nobel prize winners, Jew and gentile, black and white, wealthy and destitute. Every day, around 1500 Americans die of the disease and, needless to say, vastly more non-Americans. Worldwide, over eight million new cancer diagnoses are delivered each year. It's geographically and ethnically ubiquitous, and it's a big problem. Something of an acute problem in Western societies relishing wealth, health, and longevity, anticipating the quick fix and perplexed by the lack of it. In the developed world, with the eradication of infection and malnutrition as major causes of mortality, cancer has, largely by default, become more prominent as a life-threatening illness in children, although its frequency in the young remains very low.

    The illness we call cancer has extraordinarily diverse features including its causation, underlying pathology, clinical symptoms, therapeutic response, and outcome or chance of cure. In a sense, every patient's cancer is unique, which is part of the difficulty. In so far as it is a disease, it is a collection of very many (a thousand or so) disorders of cell and tissue function that have one special biological property in common — the territorial expansion of a mutant clone.

    Cancer can be a thoroughly horrible illness. Capricious and insidious it may bebut our perception of the problem is in no small measure distorted by the label itself — `cancer' (a gift from the Greeks). The name is, for a medical condition, uniquely evocative and has helped engender a pervasive and frightening notion of what it means to have the illness. It's a shame we cannot deinvent the word. As Susan Sontag vividly described in her book Illness As Metaphor, cancer has become enshrined in its own mythology as an obscene and demonic predator, an invincible grim reaper. It is no surprise that a diagnosis of cancer can so easily promote exaggerated fear. A fear of inevitable outcome. A fear exacerbated either by guilt that one's own habits, some life-enhancing and pleasurable, may be to blame or by anger that some filthy and unregulated industrial enterprise is the villain. And, as if that wasn't bad enough, cancer may hijack parts of our anatomy that we would rather not talk about, at least when they are not in perfect working order. Pain, shame, and a dash of anger make a rotten cocktail.

    This state of alarm is, in many respects, understandable but it is unquestionably fuelled by ignorance, ill-conceived claims, and inconsistent but striking anecdotes, and is reinforced by what is perceived to be a startling lack of progress in control or eradication. Breakthroughs are forever `just around the corner' and an increasingly more sceptical public is tempted to turn to alternative medicine. The national cost of treatment, research, and lost income, as well as the physical and emotional burden to patients and their families is enormous.

    The reality is that treatment for cancer can be nasty and toxic, and doctors and scientists have overall done a rather poor job in explaining why this is so and what the underlying problems are. And yet, there have been real improvements in clinical management, a revolution in our understanding of the underlying biology of cancer, and a much more sophisticated appreciation of the multiple factors involved in causation. At last we have some understanding of what it really is, why the complexity exists. This new knowledge explains past failures and, in the longer term, offers a plausible route to control through earlier detection and intervention, more efficacious, less toxic treatment, and, last but not least, prevention. The demon is ripe for exorcism.

    We now know from advances in molecular genetics of the past 25 years that cancer develops as a chromosomal gene disorder in single cells. But it is different and more complex than the 5000 or so other human genetic diseases that arise as inherited, single-gene traits. It is also different from the disease paradigm the public most readily understands, or rather misunderstands, of common infectious illnesses, caused by individual culprit micro-organisms and that are, on the whole, amenable to treatment or prevention. The simple formula, infection with X = disease Y: treat with Z is an illusion that disguises a more complex aetiology. Susan Sontag in castigating the mystification of cancer also indulges in inappropriate or superficial analogies (with tuberculosis) and wishful thinking — in supposing that the escape from this dilemma must lie in simple, singular, and exclusive explanations of cause and cure. But she is not alone in anticipating a straightforward relationship between cause and effect. The notion is pervasive, especially in Western societies. What has engendered it? Potential explanations include the philosophical determinism of Descartes, Leibniz, and Newtonian physics, and, at a more influential level perhaps, Hollywood movies. These provide the rationale and precedents for one-dimensional thinking: linear, all or none relationships between causes and effects, villains and victims and seduction by simple explanations and solutions, however illusory.

    But cancer and indeed most other diseases are inherently more complex. And this complexity is not just an oddity of our ailments, it's an essential feature of the biological worlds that our genes, cells, and bodies inhabit — of the way living things work. This inevitable but frequently ignored difficulty has frustrated both sustained attempts at eradication and efforts to explain the nature of cancer without resorting to superficiality. Simple explanations won't wash. Worse still, erroneous perceptions of the existence of a cause and the possibility of a cure have fuelled unrealistic expectations. There is no singular cause. Ionizing radiation is the only known cause of breast cancer and was similarly indicted for leukaemia. But it clearly isn't the cause of these cancers or even involved in anything but a small minority of them. Of course it's confusing. But we have a need to pin the blame on somebody, to nail something. Nobody knows and everyone knows. It's bad bile. It's bad habits. It's bad bosses. It's bad genes. It's bad luck. It certainly is bad luck. It's the air we breathe, the water we drink, the food we eat. All of these and none of these.

    The painful reality is that there is no holy grail, no magic cure-all bullet, and no quick fix. And the paradox is that all the complexity, now that the fog is lifting, has a coherent pattern and makes a great deal of sense. And, as often when seen in retrospect, it is difficult to imagine how it could have been otherwise. Demystifying the disease is to travel over a new and more realistic landscape. It's not the easiest of journeys but it's the only ticket worth having.

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Table of Contents

Figure acknowledgements xi
Part 1 Cancer: ancient legacies and modern myths
1 Perplexed? You should be 3
2 The King of Naples and other silent witnesses 7
3 Soot, civilization, and neuroses 13
4 An evolutionary view 21
Notes to Part One 28
Part 2 Evolving cancer
5 Pundit's progress 33
6 Clones, clones, clones 35
7 The way we are: risks and restraints 43
8 How cancer cells play the winning game 53
9 St Peregrine's progress 69
10 Green-eyed mutations? 77
11 Off to a shaky start 85
12 Blind chance - and ultimate extinction? 93
Notes to Part Two 102
Part 3 Paradox of progress: indecent exposures
13 Is cancer an evolutionary inevitability? 111
14 And then you set fire to it? 121
15 Women's troubles 139
16 Men's troubles 161
17 Cancer a deux 167
18 Other ways of getting bugged 171
19 Travelling light 175
20 The great glut 185
21 Dying for a living 195
22 Collateral damage 205
23 Finale: cause, complexity, and the evolutionary rub 213
Notes to Part Three 221
Part 4 Finessing the clone
24 Treatment: the blindfolded marksman 235
25 Epilogue: cancer in the twenty-first century 247
Notes to Part Four 264
General facts, figures, help, and advice 267
Glossary 268
Index 273
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  • Anonymous

    Posted December 2, 2002

    excellent - highly recommended

    This book is a fascinating survey of the suspected causes and proposed cures for cancer. The book is engagingly written at the perfect level of detail for the inquisitive layman.

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