In learning about his father's illness, a son came to terms with his own fears and misunderstandings about cancer. Sylvia Thompson reports
When Adam Wishart's 72-year old father was diagnosed with cancer, the London-based science journalist and television director went in search of a book that would answer his questions on what caused cancer and the various approaches to treatment.
"I knew nothing about cancer and I expected to find hundreds of books that would describe the science, the biology of the disease and how treatments work. I was surprised to discover that there weren't any books like that," says Wishart.
So, he decided to write one himself and One in Three - a son's journey into the history and science of cancer (Profile Books) is both a poignant memoir of his father's last year of life and a historical overview of the developments in cancer treatment over the past 250 years.
"My father [ a retired lecturer of statistics at the University of Birmingham] was fascinated by the history of science and I began to work on the book to help me be strong in relation to Dad's doctors and also as a way of entertaining him when he was ill," says Wishart.
A further aim was to dissipate his own personal terror of cancer by informing himself in detail about how a tumour grows, why it is so difficult to detect sometimes and how radiation and chemotherapy work.
"When I started work on the book, I thought humanity had failed us in that we hadn't succeeded in curing cancer but by the end of the book, I realised that once you really understand the biology of the disease and how closely related it is to the fundamentals of life and how cells work, you realise science has made huge progress."
In One in Three (and yes, the book's title refers to the fact that one in three people will develop cancer), Adam Wishart acknowledges that cancer has always existed among humans but, with an average lifespan of about 30 years, few people in ancient civilisations lived long enough to develop a life-threatening tumour.
Yet he writes of how the "false but surprisingly pervasive notion that cancer is caused by sadness has its roots in the idea that the melancholic humour was a determining factor" as propounded by the ancient Greek doctor, Claudius Galen.
Throughout the book, Wishart pays homage to scientists and medical doctors who went against the thrust of medical knowledge at the time to develop what are now mainstream approaches to cancer treatment - surgery, radiation therapy and chemotherapy.
The origins of chemotherapy treatment for childhood leukaemia in the early 1950s and the huge advances in success of such treatments are particularly interesting.
He also devotes a chapter to causes of cancer, starting with a section on Silent Spring by biologist Rachel Carson, the highly influential 1960s book about how modern chemicals were poisoning rivers, polluting the air and destroying wildlife.
Wishart argues that while Carson's theories on the environmental causes of cancer resonate to this day, the triggers of cancer are as diverse as the forms of the disease itself (ranging from bacteria, Helicobacter pylori as a cause of stomach cancer to naturally occurring female hormone, oestrogen, which encourages breast tumours to grow).
"Paradoxically, because we suffer less from other diseases and we live richer lives we are more likely to develop cancer," he writes.
He also examines how alternative therapies arose out of a backlash against the toxic side effects of orthodox treatments and how over time, some of these therapies have now become integrated into orthodox treatment approaches at such places as Sloan Kettering's new Integrative Medicine Centre in New York City, US.
Wishart is, however, perhaps at his scientific best where he explains gene therapy - from the first evidence in 1980 that sections of DNA could trigger cancer to the development of new targeted drug treatments which are showing high levels of success with fewer side effects.
Alongside this historical account of cancer, Wishart charts the course of his father's illness with great sensitivity and love - from the initial back pain through neck surgery to hospitalisation and his last calm pain-free days in a Birmingham hospice.
"I have come to understand how the hospice movement is a profoundly important part of our lives. And, how for us, the hospice was a hugely important place of calm, rest and where family events could take place which would have been impossible in a hospital.
"It's interesting to see how what happens in the last few weeks of a person's life has been embraced by orthodox medicine."
And in what he describes as a tone of "measured optimism", Wishart concludes that the rising rates of cancer don't necessarily point to a greater prevalence of the disease (in some cases, they are due to increased numbers diagnosed through voluntary or targeted screening programmes).
In fact, since 1993, he says that "the age standardised rates of all cancers taken together has been in decline" and that, in total, there has been a 10 per cent reduction in deaths from cancer in the past decade.
Quoting Karol Sikora, the professor of cancer medicine at the Imperial College of Medicine in London, he writes: "Cancer will be considered a chronic disease, joining conditions such as diabetes, heart disease and asthma. These conditions impact on the way people live but do not inexorably lead to death."
He adds: "The message that cancer is a disease that more and more people will live with rather than die from is an essential one.
"People are still so fearful of cancer and it disturbs them to talk about it. What I hope this book will do is to bring understanding of the disease and hope for the future."