The evolution of Man is also the story of the diseases that he has endured. And this evolutionary process has taken a particularly fast pace in the case of cancer.
Cancer was rare in prehistory, when the ravages of communicable disease and violence held sway, but traces of it are sometimes seen in the fossil remains of long-gone bones. The disease was described and defined in Ancient Greece, where the word oncus, meaning “tumour”, was first spoken. In its modern iterations, the word tumour litters our conversations, blights our dark moments and dazzles in the media spotlight .
We move from ancient times to the late Victorian era, which was morbidly preoccupied with tuberculosis, the mysterious and predominant killer. TB was cancer’s antique cousin, and the Victorians puzzled about its origins. Depression and lifestyle were thought to be its cause, with homeopathic cures the only redoubt. This view persisted until the great scientist Robert Koch discovered the TB bacillus under the lens of his microscope in 1882.
In late Victorian times, nothing could be done for the cancer patient. In his autobiography, Mark Twain, observing the passing of his beloved father-in-law, noted that his only treatment was the froth of champagne. Some would say a fine way to go, but . . .
In modern industrialised society, prosperity has brought longevity. But this freedom to live our three score and ten has brought with it a poisoned gift: it has extended the period of time that we are exposed to the environmental carcinogens that cause cancer. Cancer is the endowment of affluence.
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It was not so long ago that cancer was in the closet: spoken of in muted mumblings, treated by paternalistic physicians and suffered in silence. When I first started life as a cancer doctor, the patients were hidden from us by the nurses; they did not want them to suffer from treatments that brought such minimal advantage. But 30 years on, the opposite is the rule: cancer patients are not hidden away and they demand treatment.
The feminist movement in the 1960s transformed attitudes: women’s breasts were no longer the property of doctors, but belonged to their owners. Radical voices ensured treatment patterns were overhauled and breast conservation became standard practice. Men followed this lead, as men do follow women, and 15 years ago male patients started to form their own pressure groups.
Perhaps what we do not see is the incredible change that academic cancer research and drug companies have given us. Surgery, radiotherapy and chemotherapy have a short history as cancer treatments. Surgical techniques for cancer entered the modern era in the 1930s with breast conservation, which was pioneered by Geoffrey Keynes, John Maynard Keynes’s brother.
It was only in the past 60 years that radiotherapy became widely available. Chemotherapy creaked into action just after the Second World War, but it was not until the late 1960s that it became effective, and lymphoma, testicular cancer and leukaemia could be cured.
We live in exciting times and the past decade has brought us incredible molecular therapies for cancer that have made what was incurable curable. Research has given us vaccine treatments that at last give us some prospect that cancer can be prevented by mass immunisation and that the rigours of surgery, radiotherapy and chemotherapy may be avoided.
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In current times, the parallel with TB is evident and we puzzle over the causes of cancer. But there have been many Koch moments and scientists have brought extraordinary hope to patients who have no need to resort to the anodyne cures of Victorian times or internet miracles, yours for just £4.99 a bottle plus postage.
And with these changes, cancer itself now has celebrity. The cancer diaries, the cancer column: what was unspoken has become the stuff of TV, film and books. Cancer has become the star.
But is this prioritisation fair and reasonable? Cancer has been moved into a radiant spotlight with treatment guided by two-week-wait rules. With the wave of a magic wand, a prime minister makes cancer treatment available where it apparently was unavailable. The celebrity of cancer has led to other illnesses being sidelined, even though the prospects for these conditions may be as bad as the worst of all cancers.
But looking at the bottom line, this spotlight on cancer has undoubtedly been good. We do not want cancer patients to live in darkness. Let us hope now that for the next generation, surgical wounds will leave no scar, radiotherapy will be an archaic technological curiosity and that immunisation and molecular medicine will do for cancer what antibiotics did for TB.
Jonathan Waxman is Professor of Oncology at Imperial College London. His book about cancer, The Elephant in the Room, is to be published this year