1. Cancer is often described as a "modern" disease—yet its first description dates from 2500 B.C. In what sense, then, is cancer a disease of modern times? How does knowing its ancient history affect your notion of cancer?
2. Mukherjee frames the book around the story of his patient, Carla Reed, a teacher who is diagnosed with leukemia. What did you find interesting or important about Carla's experience? How do you think she shaped the author's life and thoughts?
3. Mukherjee writes how in the early 1950s The New York Times
refused to print the word "cancer" (or "breast"). Compare this to how we view cancer today. Is there any difference in the way you discuss cancer as a political or news topic and how you discuss a cancer diagnosis among family and friends?
4. Looked at one way, Sidney Farber's early clinical trials with antifolates in 1947 and 1948 were a failure, with all of his young leukemia patients eventually dying of the disease. But with the results of these trials, Mukherjee writes, Farber "saw a door open—briefly, seductively" (page 36). How so? Why do Farber's trials mark a turning point in the history of cancer research?
5. "The stories of my patients consumed me, and the decisions that I made haunted me," Mukherjee says about working in a cancer clinic (page 5). But in the 1970s, during the height of aggressive combination chemotherapy trials, Mukherjee paints a different picture of doctor-patient interaction: "The language of suffering had parted, with the 'smiling oncologist' on one side and his patients on the other." How have the relationships between doctors and patients evolved along with cancer treatments? What could be done to restore some of the lapses in this relationship?
6. "'Li was accused of experimenting on people,' Freireich said. 'But of course all of us were experimenting... To not experiment would mean to follow the old rules—to do absolutely nothing.'" Review the case of Min Chiu Li (pages 135–138), and explain Emil Freireich's quote. Do you think Li's actions were ethical? How can doctors and scientists draw the line between reckless, unproven treatment and necessary experimentation for drug development?
7. How did Mary Lasker borrow from the worlds of business, advertising and even the military to build a nationwide effort to combat cancer? How might Lasker's vision be invoked today to generate funding and national attention for breast or ovarian cancer?
8. So many of the scientific breakthroughs that impacted cancer research, such as Wilhelm Röntgen's discovery of the X-Ray in 1895, occurred by accident. What other "chance" discoveries appear in the text?
9. Numerous advances in cancer research would have been impossible without patients willing to submit themselves to grueling experimental trials—experiences from which they did not benefit, but future cancer patients might. How would you counsel a friend or relative about submitting themselves to such experiments?
10. How is the early history of chemotherapy linked to the histories of colonialism, the Industrial Revolution, and World War Two?
11. Was the War on Cancer a failure? Why or why not?
12. How did the tobacco industry react to studies in the 1950s about the link between cigarettes and lung cancer? How did the industry's reaction differ to that of the general public? Do you think cigarette companies should be legally liable for cancer and other health problems likely caused by smoking?
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