In the latest round of debates and lectures Fronteiras do Pensamento (Frontiers of Thought), in São Paulo, doctor-writer Siddhartha Mukherjee led a lecture on cancer history, its causes and potential treatments.  Ana Claudia Quintana Arantes, a geriatrician, palliative care and grief support specialist, mediated the event. The main topic of the events promoted by Frontiers of Thought is: “world in disagreement – democracy and culture wars.” Siddhartha’s lecture’s goal was to translate into a straightforward language the variables of the disease.

Born in New Delhi, capital of India, Siddhartha studied biology at Stanford University, immunology at Oxford and graduated in medicine at Harvard. A specialist in oncology, he is a physician and assistant professor at the Columbia University Medical Center. His book The Emperor of All Maladies: A Biography of Cancer won the 2011 Pulitzer Prize. He also wrote The Laws of Medicine (TED Books, 2015) and The Gene: An Intimate History.

“Many people know someone who underwent chemotherapy. All of you who have experienced this, you know everyone asks the same question: why me? Or why my mother or why my son?”, said Siddhartha, opening his lecture. “We’re starting to understand this answer at a cellular, molecular and more detailed level. What we already understand is that there is a wide range of possible cancers: there aren’t two exact ones in the world, every type of cancer is unique.”

Fear of cancer and widespread of previvors

“In 1986, I was at an audience where we were asked which were the two words that scared people the most. Shark and cancer came on top”, reminds Siddhartha. To him, fear of cancer and all feelings related may become commonplace in our culture. And this phenomenon effect is ambiguous.

Siddhartha suggests that, in the near future, everyone may become cancer previvors. In medical language, that is a word associated with cancer jargon for a survivor of a disease which has not occurred yet. This term usually refers to patients who survived the first cancer and, therefore, are at the risk of an onset of a second version of the disease.

A possible excessive care towards cancer risks may represent emotional overload; however, it is a great ally to fight the disease. Siddhartha explains that the ideal model to fight cancer has to be thought as a pyramid, in which prevention is at the bottom, that is, by identifying carcinogenic status, such obesity and smoking. At the top and center of this pyramid are, respectively, early detection (possible due to the use of new technologies) and treatment precision (which combines the use of knowledge of genetics and physiology to create new action paradigms).” The barrier for treatment is that some societies simply can’t afford costs. In the US, the amount can go as high as US$ 400,000,” says the doctor. “Therefore, the focus should be on the bottom of the pyramid.”

Disease origin – in body and history

“Many people think cancer is a new, modern disease, but it’s one of the oldest known to humanity,” states the Indian. He argues that today we see more cancer incidence because our species lives longer and; therefore, we learned to eliminate other forms of death.

The writer pointed out that there were historical records showing the existence of a disease with similar characteristics 2.5 thousand years before Christ. Thus, the malady was named cancer by Greek philosopher Hippocrates (460 b.C to 370 b.C), who associated the tumor images to images of crabs on the skin.

For centuries, according to Siddhartha, physicians believed that the cause of cancer was solely connected to external factors. Only in the XIX century, physicians noted that it was in fact an abnormal growth of cells. “It was clear that the tumor comes from a normal cell that suddenly doesn’t know when to stop growing and becomes cancerous,” explains the doctor.

“What are the signs a cell notices to stop growing? And why doesn’t a cancerous cell perceive these signs? We still don’t know why, but it’s something vital for cell physiological studies, which are growing,” he adds.

Contemporary theses partially suggest that cancer had the Brazilian ophthalmologist Hilário Gouveia as one of its leading figures. Hilário noted that, in certain families, cancer was a disease that went through generations, and he claimed that one of its factors was heredity.

Other elements were added to heredity issues. Firstly, external elements were noted to contribute for the disease’s onset – an English physician noted cancer relapsed among children who cleaned chimneys in London. Later, the randomness factor and even correlation to some types of virus were added to the equation.

“Today, there’s a strong evidence that the determinant factor are genes, but all other factors help: randomness works to create genetic mutations, viruses may go into cells and change their genetic descriptions – and behaviors such as smoking also contribute,” he adds.

Which path is science showing for cancer treatment?

Siddhartha believes that medicine should follow a holistic approach to the treatment, totally dedicated to prevention and early detection in patients.” Today, supercomputers can read our genomes and, just by using genetic information, they can estimate our height. Supposedly, more sophisticated questions can be asked to those computers, such as the risk of diseases,” he states.

The doctor was cautious when asked about the impact of positive thoughts and religion on the treatment. “Based on my experience, I can say yes, it makes a difference in the patient’s quality of life to face the disease in an optimistic way. But it’s not fair, nor right, to say that it would extend their lives. Saying it so is to say that the patients are guilty for their suffering. That’s wrong,” he says.

Content published in September 27, 2018