Mel Greaves
Oxford University Press, £19.99, pp 272 
ISBN 0 19 262835 6
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Rating: ★★★
Have you ever wondered about the lottery of cancer? I do not mean the much discussed variation in availability of treatment, but rather the random way in which carcinoma picks its casualties. While some of my patients have had an explanatory history of excessive smoking or an occupational exposure to a noxious substance, many of those struck down by this modern scourge seem to have been “chosen” indiscriminately.
As a disciple of Darwinian medicine, Greaves's day job as professor of cell biology at the Institute of Cancer Research in London is rooted in the field of molecular genetics. The strength of his book lies in his ability to move beyond the narrow confines of cell biology, both in content and in literary style.
Cancer is often seen as a new illness, emerging along with AIDs and Alzheimer's disease as an integral part of the 21st century. But it is not a new disease. When the king of Naples died in 1494 his body was mummified by embalming and placed in a wooden sarcophagus in the Abbey of San Dominico Maggiore. Five centuries later it was exhumed, and an autopsy was performed. A well preserved tumour in the pelvis turned out to be an adenocarcinoma, possibly from the large intestine. By applying a molecular test for a gene mutation commonly found in this type of cancer, scientists from Pisa University were able to identify precisely the same mutation as that seen in present day cancers.
Greaves gives his response to the hypothesis that modern civilisation causes cancer: “It seems to me reasonable to conclude that a small but significant minority of cancers are directly attributable to industrial activities or the chemical products of our advanced technology in both developed and developing countries.” But he also acknowledges the fact that, by greatly reducing the number of competing causes of death, a healthier society has an increased risk of cancer. Material progress certainly provides the paradoxical context within which some cancer rates rise while others fall.
The Darwinian view of disease is eloquently explained in the following lines: “Man has always inadvertently helped orchestrate the ecology of his diseases by his insatiable curiosity, migrating explorations and dietary experiments. There is a sense in which all our ailments and particularly our modern chronic disorders are reflections of design limitations, delayed trade offs, and nature-nurture mismatches. They are part of the natural scheme of things even if we would like to believe that we have been sculptured to perfection.”
Mel Greaves does not pretend to have all the answers, but he does challenge W H Auden's view of cancer. In his 1937 poem “Miss Gee,” Auden wrote: “Nobody knows what the cause is, though some pretend they do. It's like some hidden assassin, waiting to strike at you.”