The First Cell, and the Human Costs of Pursuing Cancer to the Last, by Azra Raza. Basic Books, New York 2019. Dr. Raza is professor of Medicine and MDS Center Director at Columbia
University. She also was an oncologist for several years at Roswell Park
Cancer Institute in Buffalo.
In this moving and complicated book, veteran oncologist Dr. Raza argues for shifting research and clinical resources to the prevention and early detection of cancer, as opposed to aggressive treatments for and research into advanced stage cancers. She explains that for many of the deadliest cancers (lung, pancreatic, leukemia), the outcomes for most patients today are barely better than they were fifty years ago. In many cases, patients have their lives prolonged by new and experimental treatments for a matter of only weeks or months (though some do achieve much longer remissions). But they often achieve these incremental improvements while in agony and pain from the treatment side effects.
She demonstrates the awful torments of advanced stage cancers with narratives of a handful of her own patients, as well as of her husband Harvey (himself an oncologist). All of these patients died. I was very moved by the plight of these patients. They of course reminded me of my wife Marilyn's painful treatment for Non-Hodgkin's Lymphoma, and her sudden death from the side effects of her chemotherapy.
Araz argues that mouse studies and other laboratory research for drugs development often fail produce drugs that have any useful effect on actual human patients. She wants to move money from the work on advanced-stage therapies, arguing that we may be fifty or more years away from truly dramatic advances or cures. And she wants that money shifted to prevention and early detection. She believes we may be close to being able to detect cancers in their earliest appearance in the body -- in the first cell (or group of cells) of the book's title. I found her detailed analysis of various therapies difficult to follow; there are lengthy passages where she seems to be addressing fellow oncologists and members of the medical establishment.
Yet, shifting resources in this way means cutting back on money and research for drug trials that hundreds of thousands of frightened and desperate terminal patients are clamoring for. She acknowledges that this won't be popular, and that is one of the major hurdles of her approach. Furthermore, we have a huge and profitable cancer drug industry that won't easily give up their stake in the way cancer is currently fought.
My knowledge of cancer research and treatments is not deep. Most of what I know I learned in the terrible months following my wife's diagnosis. As a non-expert, I appreciate Dr. Raza's approach. It makes sense to prevent and detect cancer in its earliest possible stages, and thus decrease the numbers of patients who suffer its physical, emotional, and financial consequences.
