Cancer is an emotive business. It's the modern equivalent of the Black Death in today's society. We are all as frightened of the disease as medieval villagers were when rats died in the gutter, heralding an epidemic of plague. One in three of us will get cancer, and one in four die from it. It fills space avidly in the media. The key features that make a cancer story sell to newspaper editors are conspiracy, fraud, inequity, official incompetence and an interview with someone who has suffered - preferably young, good-looking and with small children.
Here we have a wonderful collection of such stories focusing on the discovery of the various causes of cancer in the 20th century. The conspiracy bit is about the covert operations carried out by industry, governments, the military and individuals to play down and even completely hide the risks. From cigarettes to mobile phones to all sorts of chemicals - it's all here. The bottom line of our current knowledge base is that 30 per cent of cancers are caused by tobacco, 30 per cent by faulty diet and 15 per cent by infection - the wart virus causing cervical cancer, hepatitis B causing hepatoma and HIV causing a range of lymphomas and other tumours. The causes of the remaining 25 per cent are a mystery. Cancer, of course, has two other correlates about which we can do absolutely nothing - our genetic make-up and our age. It's a disease mainly for the over-sixties. So any clue as to more potentially reversible causes for cancer would be welcome. But as we are shown here, sometimes the messenger is not always welcome.
The title of this book is just great. I couldn't wait to open it. But I immediately began to worry. Any science book that starts with a story about the author's great-grandmother and ends with a poem is probably best avoided. But I persevered. It is a catalogue of mostly familiar stories about various causes of cancer that have been identified over the past 100 years written in a chatty, American, "female-friendly" style.
My first disappointment was with the "secret" in the title. I was expecting great revelations of momentous significance. In reality, there was nothing new but a rehash of the familiar conspiracy theories. Nowhere is the concept of risk discussed. Devra Davis is not a physician and therefore has never had to explain to someone that he or she has a diagnosis of cancer or about the benefits and drawbacks of the suggested treatment plan. That probably explains her lack of insight into the public understanding of risk, especially among those with minimal education. All cancer conspiracies have a purpose - usually to make somebody a lot of money or to gain political superiority. The reasons behind them, if they can be uncovered, are fascinating. This book goes some way to do this.
Industrial chemicals of various types are now known to be carcinogenic. So much has been known since the classical observations of the London surgeon Percival Pott, who, in the 18th century, noted the increased risk of cancer in the scrotal skin of chimney sweeps caused by coal tar and soot.
All sorts of industries are affected by occupational cancer - the luminous dial painters, tyre-makers, uranium miners, dye workers and asbestos removers. But developing safe working practices costs money, time and systems that inevitably add to the costs of the finished goods. According to Davis, there was much sweeping under the carpet of information about carcinogens in the 1930s, which inevitably led to many people dying unnecessarily.
Love Canal was a very sad story. In 1978 it was discovered that a housing estate in upstate New York had been built on a huge amount of industrial waste. This eventually led to the evacuation of 225 people. The enormous repercussions drastically changed the acceptable level of risks from effluent. But the actual relationship to cancer still remains hazy. Little hard evidence exists that pollution anywhere results in increased cancer incidence. No recommendations are found on how we should deal with the large volumes of waste produced to keep our modern lifestyle going.
Do mobile phones cause brain tumours? Dealing with such extremely low risks is very difficult and cannot really be rigorously explored by academic analysis. Mobile phone technology has changed dramatically since its introduction. So inevitably have patterns of use and the availability of hands-free systems. The real answer is that we have no idea, but if they do the risk is immeasurable. This doesn't stop the media from producing the occasional new headline to grab our attention.
One of my medical heroes, Sir Richard Doll, gets some special mention and vitriol. He is blamed for not introducing cervical screening in the UK, for working secretly for the chemical industry and for being persuaded by a company to change the text on a key paper on the relationship between mesothelioma and asbestos - all a bit sad when he has clearly saved more lives from cancer than any other person in history.
I eagerly read the chapter on Nixon's War on Cancer. The injection of huge amounts of funding into the US cancer establishment was amazing. It led to huge infrastructural growth and yet few useful discoveries. As Davis points out, it did little more than build some fine buildings and shunt a few careers into the fast lane. It demonstrated the need for changes in technology to occur before the injection of massive investment.
The real endgame in the war is never addressed. Personalised messages based on our age, lifestyle and genetics will one day be used to tailor a specific prevention programme for an individual. Blanket public health interventions just don't work very well. The great weakness in human mentality is that it's too easy to believe unfavourable events happen only to other people. We all have some sort of belief system to ignore our own mortality.
Altogether, this is an interesting collection of anecdotes showing clearly how a democracy deals with the incompatibilities between government, industry and the people. It would be interesting to compare how countries other than the US have dealt with the same problems. I don't think they ever existed in the old Soviet bloc countries, where risk is to this day viewed rather differently. Life is, of course, a terminal disease with only one possible outcome. Risk is often impossible to measure, difficult to communicate and even more difficult to eliminate. However much money we spend, it simply won't go away. The Secret History of the War on Cancer reflects the complex interaction of science, politics and society in the 20th century. I am left wondering how it will change in the 21st.
Karol Sikora is professor of cancer medicine, dean, University of Buckingham Medical School and medical director of CancerPartnersUK. He is senior editor of Treatment of Cancer , Britain's leading postgraduate text, which is now in its fifth edition.
The Secret History of the War on Cancer
Author - Devra Davis
Publisher - Basic Books
Pages - 506
Price - £16.99
ISBN - 9780465015665