Cancer: The Evolutionary Legacy.

Mel Greaves. Oxford University Press, Oxford. 2000. Pp. 271. Price £19.99, hardback. ISBN 0 19 262835 6.

Everyone (including geneticists) should know about cancer. After all, as our society becomes better at curing the really big current killers, such as heart disease and infectious diseases, cancer is much more likely to kill us in our old age. The problem is that cancer is now such a terribly complicated set of diseases that simplistic thinking and analysis are no longer enough. It needs a good and lucid intellect to explain it, even to geneticists, and in Professor Greaves an able communicator has been found. I have read many ‘popular’ cancer books, some with a multitude of colour illustrations to make their point (and to relieve the complexities), but rarely have I actually enjoyed the read.

This small and sparsely illustrated volume held my attention, and actually demanded a re-read to check on the bits I missed first time through. There was even humour to lighten the load. The account of increased cancer risk from smoking was considerably enhanced (without losing the serious message) by quotations from Bob Newhart’s sketch on tobacco (or ‘civilisation’ as it was known at the time!). We are even presented with a glowing example of Bernard Levin’s prose on the subject of smoking. I hope that the contemporary writings of John Diamond, also of The Times, (who is under treatment in Professor Greaves’ own Institute) could be included in a second edition.

But there is a serious side to it all. This erudite text explores cancer as a genetic disease and ultimately as an example of natural selection. This could descend, as it often does in plenary lectures, into an extensive list of cancer-associated genes and/or an account (suitably neutral in tone of course) of the lecturer’s own area of research. Not so. This book is a balanced and selective account, using common examples, rather than an overwhelming encyclopaedic approach. True, the nit picker may find omissions, but as a whole the subject is conveyed with wit, fluency and authority.

The concept that our uncoupling (to coin a phrase) of sex for reproduction from sex for pleasure lies at the heart of the two biggest gender-specific cancers (breast and prostate) is a particular theme. Man’s foolishness in other areas such as his ‘modern’ diet and treatment of the environment rightly do not escape the caustic treatment of Professor Greaves’ pen. The comparison between cancer incidences past, present and future should give us plenty of food for thought.

Although not a text book, I would rate Cancer: The Evolutionary Legacy an essential read for new graduate students, undergraduates in a specialist cancer option, medical practitioners wanting to update their medical school oncology … and even tired old geneticists. In these days of information overload and deep specialisation, the next generation of cancer researchers frequently become obsessed with the leaves on the trees, while never glimpsing the wood or the forest! Here is the problem in 271 pages. It is not until page 218, that the cause of cancer is defined in the following two sentences: ‘So no, it isn’t your job, your stressful lifestyle, your genes, your diet, just bad luck, or an act of God that’s to blame: a multi-layered web of exposures and modifiers is involved. And, by and large, this network is a construct of very long-running evolutionary contests and problem solving, human history and social engineering – heavily garnished in more recent centuries and decades with commercial and political imperatives, and pervaded throughout by chance.’

Yes it’s complex, and although the disease has been with us for a very long time (here beautifully put into historical context), it can rarely have been described with such aplomb.