Cover image for Cancer : the evolutionary legacy
Cancer : the evolutionary legacy
Greaves, M. F. (Melvyn F.), 1941-
Publication Information:
Oxford ; New York : Oxford University Press, [2000]

Physical Description:
x, 276 pages, 1 unnumbered leaf of plates : illustrations (some color) ; 25 cm
Format :


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RC268.48 .G74 2000 Adult Non-Fiction Central Closed Stacks

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Cancer is everywhere. Around one in three of us will at some time in our lives have an unwelcome diagnosis of cancer; every day 1500 Americans and vastly more non-Americans die of the disease. For Western societies relishing health, wealth, and longevity, its continued prominence is one of thegreatest challenges to our scientists. And the illness we call cancer is extraordinarily diverse in its causation, symptoms, likelihood of effective treatment - in some sense, every patient's cancer is unique, and that is part of the problem. In this important new book, Mel Greaves explains why theold paradigms of infectious diseases or genetic disorders have proved fruitless when trying to account for the complex and elusive puzzle that is cancer. Rather, he claims that looking at cancer in its evolutionary context, we can begin to answer some of the big questions in cancer that concern usall. Drawing on both ancient and more modern evolutionary legacies, he shows how human development has changed the rules of evolutionary games, trapping us in a nature-nurture mismatch. Compelling examples, from the King of Naples intestinal tumour in the 15th Century, through the epidemic ofscrotal skin cancer in 18th century chimney sweeps, to the current surge of cases of prostate cancer illustrate his thesis. And finally, he looks at the implications for research, prevention, and treatment of cancer that an evolutionary perspective provides. Drawing on all the most recentresearch, this is the first book to put cancer in its evolutionary framework. At a time when Darwinian perspectives on everything from language acquisition to economics are gaining ground, medicine seems to have much to gain from the insights provided by evolutionary biology. Written in anexceptionally lucid and entertaining style, this book will be of broad interest to all those who wish to understand the big C, the biggest killer of them all.

Author Notes

Mel Greaves is Professor of Cell Biology and Director of the Leukaemia Research Fund Centre for Cell and Molecular Biology at the Institute of Cancer Research in London

Reviews 4

Publisher's Weekly Review

Setting forth a novel Darwinian theory of the origin of cancer, Greaves contends that cancer's development is a bizarre yet remarkably close parody of species diversification in evolution, embodying the basic ground rules of random genetic diversification and selection for survival, as cells that are driven by mutant genes that ignore signals to restrain their aggressive growth take over and cannibalize bodily systems. Director of the Leukemia Research Fund Center at London's Institute of Cancer Research, Greaves rejects the widespread view that the 20th century's cancer epidemic is due to environmental pollutants, chemicals, pesticides and manmade radiation. Instead, he insists that all cancers arise from a mix of causes, such as naturally occurring and synthetic toxins, chronic stress, overexposure to sunlight, cigarette smoking, gamma rays, DNA-damaging viruses, poor diet and spontaneous physiological changes caused by aging. Pursuing his Darwinian tack, Greaves also comes up with some maverick hypotheses about the causes of breast and prostate cancer. The good news, he says, is that 90% of modern cancers are preventable. Besides recommending changes in diet and lifestyle, he envisions advances in genetic screening to allow identification of the mutant genes that signal escalating malignancy. Though technical at times, Greaves's clean prose and historical asides make this book accessible to the general reader. 20 illus. (Mar.) (c) Copyright PWxyz, LLC. All rights reserved

Choice Review

One does not generally think of discussions of cancer as having the potential for being entertaining. However, drawing on his experience at the Institute of Cancer Research in London, Greaves writes in an informative and engaging manner. His approach to the subject of cancer is Darwinian; i.e., humans are primed to develop cancers by the very fact that improvement of a species requires mutations. The ability to evolve through DNA mutations has the flip side of potentially leading to cancers. This unique book is very readable, beginning with an introduction to the biology cf cancer, chapters on the causes of specific cancers, and a conclusion with a guardedly optimistic discussion of future efforts that could reduce the incidence of cancer in society. Interesting historical data are presented suggesting that cancer is a disease that has plagued humankind for thousands of years. Rather than dryly presenting facts and figures, Greaves writes with wit and, at times, indignation (when discussing continuing deaths from tobacco-related cancers). His intriguing book will prompt readers to consider cancer in a new light, weighing the interplay of inherited genetic information, exposure to carcinogens, life style, and pure chance. Useful notes; section references. All levels. J. A. Kelly; University of Connecticut

Booklist Review

Greaves, director of the Leukemia Research Fund Center at the Institute of Cancer Research in London, is also a member of Greenpeace, a man of remarkably broad interests, and a skillful writer; he also has a good sense of humor. For instance, he entitles the first chapter "Perplexed? You Should Be." His book provides a feast of information about cancer that, like most banquets, is best consumed slowly: savor each course, enjoy relationships among the courses, become aware of the cook's creativity and skill. Throughout, Greaves shows how the Darwinian perspective is a plausible framework within which to look at all the big questions--those that have answers and those that don't, yet. How have the various kinds of cancer developed? Why does each affect each person differently? Why do the many and varied therapies have such broad ranges of success and failure? In answering such questions, Greaves punctures myths, examines theories, and successfully sets the whole field of cancer research in perspective. --William Beatty

Library Journal Review

Despite his somber subject matter, Greaves, director of the Leukemia Research Fund Center at the Institute of Cancer Research, London, has written an entertaining and highly readable account of the "Darwinian" view of cancer. There are general books for the lay reader on Darwinian medicine, such as Randolph M. Nesse and George C. Williams's Why We Get Sick (Vintage, 1996), but this is the first to look specifically at cancer. Greaves starts by explaining the numerous changes that must occur to a cell's DNA before cancer can develop. The evolutionary need to recombine genes and the need for cells to divide throughout life conflict with the way these events make our cells susceptible to DNA damage that can lead to cancer. There are excellent chapters on specific cancers, including breast, prostate, and skin cancers, and on how the changes in our lifestyle from the earliest humans has contributed to the growth or decline of certain cancers. Highly recommended for all public and academic libraries.--Margaret Henderson, Cold Spring Harbor Academics, NY (c) Copyright 2010. Library Journals LLC, a wholly owned subsidiary of Media Source, Inc. No redistribution permitted.



Chapter One PERPLEXED? YOU SHOULD BE Allow me to start with the bad news will you? Statistics. Around one in three of us will at some time have an unwelcomed diagnosis of cancer, providing common ground between presidents, movie stars, bishops, athletes, Nobel prize winners, Jew and gentile, black and white, wealthy and destitute. Every day, around 1500 Americans die of the disease and, needless to say, vastly more non-Americans. Worldwide, over eight million new cancer diagnoses are delivered each year. It's geographically and ethnically ubiquitous, and it's a big problem. Something of an acute problem in Western societies relishing wealth, health, and longevity, anticipating the quick fix and perplexed by the lack of it. In the developed world, with the eradication of infection and malnutrition as major causes of mortality, cancer has, largely by default, become more prominent as a life-threatening illness in children, although its frequency in the young remains very low.     The illness we call cancer has extraordinarily diverse features including its causation, underlying pathology, clinical symptoms, therapeutic response, and outcome or chance of cure. In a sense, every patient's cancer is unique, which is part of the difficulty. In so far as it is a disease, it is a collection of very many (a thousand or so) disorders of cell and tissue function that have one special biological property in common -- the territorial expansion of a mutant clone .     Cancer can be a thoroughly horrible illness. Capricious and insidious it may be but our perception of the problem is in no small measure distorted by the label itself -- `cancer' (a gift from the Greeks). The name is, for a medical condition, uniquely evocative and has helped engender a pervasive and frightening notion of what it means to have the illness. It's a shame we cannot deinvent the word. As Susan Sontag vividly described in her book Illness As Metaphor , cancer has become enshrined in its own mythology as an obscene and demonic predator, an invincible grim reaper. It is no surprise that a diagnosis of cancer can so easily promote exaggerated fear. A fear of inevitable outcome. A fear exacerbated either by guilt that one's own habits, some life-enhancing and pleasurable, may be to blame or by anger that some filthy and unregulated industrial enterprise is the villain. And, as if that wasn't bad enough, cancer may hijack parts of our anatomy that we would rather not talk about, at least when they are not in perfect working order. Pain, shame, and a dash of anger make a rotten cocktail.     This state of alarm is, in many respects, understandable but it is unquestionably fuelled by ignorance, ill-conceived claims, and inconsistent but striking anecdotes, and is reinforced by what is perceived to be a startling lack of progress in control or eradication. Breakthroughs are forever `just around the corner' and an increasingly more sceptical public is tempted to turn to alternative medicine. The national cost of treatment, research, and lost income, as well as the physical and emotional burden to patients and their families is enormous.     The reality is that treatment for cancer can be nasty and toxic, and doctors and scientists have overall done a rather poor job in explaining why this is so and what the underlying problems are. And yet, there have been real improvements in clinical management, a revolution in our understanding of the underlying biology of cancer, and a much more sophisticated appreciation of the multiple factors involved in causation. At last we have some understanding of what it really is, why the complexity exists. This new knowledge explains past failures and, in the longer term, offers a plausible route to control through earlier detection and intervention, more efficacious, less toxic treatment, and, last but not least, prevention. The demon is ripe for exorcism.     We now know from advances in molecular genetics of the past 25 years that cancer develops as a chromosomal gene disorder in single cells. But it is different and more complex than the 5000 or so other human genetic diseases that arise as inherited, single-gene traits. It is also different from the disease paradigm the public most readily understands, or rather misunderstands, of common infectious illnesses, caused by individual culprit micro-organisms and that are, on the whole, amenable to treatment or prevention. The simple formula, infection with X = disease Y: treat with Z is an illusion that disguises a more complex aetiology. Susan Sontag in castigating the mystification of cancer also indulges in inappropriate or superficial analogies (with tuberculosis) and wishful thinking -- in supposing that the escape from this dilemma must lie in simple, singular, and exclusive explanations of cause and cure. But she is not alone in anticipating a straightforward relationship between cause and effect. The notion is pervasive, especially in Western societies. What has engendered it? Potential explanations include the philosophical determinism of Descartes, Leibniz, and Newtonian physics, and, at a more influential level perhaps, Hollywood movies. These provide the rationale and precedents for one-dimensional thinking: linear, all or none relationships between causes and effects, villains and victims and seduction by simple explanations and solutions, however illusory.     But cancer and indeed most other diseases are inherently more complex. And this complexity is not just an oddity of our ailments, it's an essential feature of the biological worlds that our genes, cells, and bodies inhabit -- of the way living things work. This inevitable but frequently ignored difficulty has frustrated both sustained attempts at eradication and efforts to explain the nature of cancer without resorting to superficiality. Simple explanations won't wash. Worse still, erroneous perceptions of the existence of a cause and the possibility of a cure have fuelled unrealistic expectations. There is no singular cause. Ionizing radiation is the only known cause of breast cancer and was similarly indicted for leukaemia. But it clearly isn't the cause of these cancers or even involved in anything but a small minority of them. Of course it's confusing. But we have a need to pin the blame on somebody, to nail something. Nobody knows and everyone knows. It's bad bile. It's bad habits. It's bad bosses. It's bad genes. It's bad luck. It certainly is bad luck. It's the air we breathe, the water we drink, the food we eat. All of these and none of these.     The painful reality is that there is no holy grail, no magic cure-all bullet, and no quick fix. And the paradox is that all the complexity, now that the fog is lifting, has a coherent pattern and makes a great deal of sense. And, as often when seen in retrospect, it is difficult to imagine how it could have been otherwise. Demystifying the disease is to travel over a new and more realistic landscape. It's not the easiest of journeys but it's the only ticket worth having.

Table of Contents

Figure acknowledgementsp. xi
Part 1 Cancer: ancient legacies and modern myths
1 Perplexed? You should bep. 3
2 The King of Naples and other silent witnessesp. 7
3 Soot, civilization, and neurosesp. 13
4 An evolutionary viewp. 21
Notes to Part Onep. 28
Part 2 Evolving cancer
5 Pundit's progressp. 33
6 Clones, clones, clonesp. 35
7 The way we are: risks and restraintsp. 43
8 How cancer cells play the winning gamep. 53
9 St Peregrine's progressp. 69
10 Green-eyed mutations?p. 77
11 Off to a shaky startp. 85
12 Blind chance - and ultimate extinction?p. 93
Notes to Part Twop. 102
Part 3 Paradox of progress: indecent exposures
13 Is cancer an evolutionary inevitability?p. 111
14 And then you set fire to it?p. 121
15 Women's troublesp. 139
16 Men's troublesp. 161
17 Cancer a deuxp. 167
18 Other ways of getting buggedp. 171
19 Travelling lightp. 175
20 The great glutp. 185
21 Dying for a livingp. 195
22 Collateral damagep. 205
23 Finale: cause, complexity, and the evolutionary rubp. 213
Notes to Part Threep. 221
Part 4 Finessing the clone
24 Treatment: the blindfolded marksmanp. 235
25 Epilogue: cancer in the twenty-first centuryp. 247
Notes to Part Fourp. 264
General facts, figures, help, and advicep. 267
Glossaryp. 268
Indexp. 273