We have come a long way from the days in which cancer was embarrassedly referred to as “the Big C”, and then dropped totally from conversation. Since those days many new diagnostic and therapeutic measures have evolved, but only lately has the realization that many predispositions to cancer development have their bases in mutant genes which ordinarily protect the body from malignancy. Scientists and clinicians are now working on identifying, classifying and detailing the cancer-provoking risks of a host of mutant genes with known linkage to many types of cancer, and involving patients and entire families with prevalent histories of certain cancers to seek genetic counselling and possible testing for presence or absence of mutant genes which are “bad actors”.
“A Cancer in the Family”, by Theodora Ross, M.D. Ph. D., is a remarkably lucid and sympathetic voyage through the genetics of cancers, and the role of mutant genes in the inherited DNA of individuals with a high percentage of such cancers. Using her own personal knowledge of a mutant gene, BRCA1,
predisposing to a high likelihood of breast and ovarian cancer as a nodal focus, Dr. Ross, a researcher and clinician who treats cancer patients, gently, patiently discusses in understandable terms the molecular biology of inheritance, the transformation of part of the DNA strand into a potentially harmful mutation, and the reason that this mutation affects the ability of one’s body to identify and eradicate the resulting malignant cells. She stresses the importance of gathering a thorough collection of family pedigree of presumed cancer and taking this to a qualified genetic counselor, who, in turn, will advise whether specific testing of specimens be done to identify likely mutant genes. She walks the reader through the difficulties in obtaining reliable information from family members, choosing and interviewing with a counselor and even where testing is best performed. Best of all, she provides constant reassurance and comfort to the person undergoing this process, with the upbeat message that the knowledge of one’s possessing a mutant gene will be ultimately a positive step in assuring better health for oneself and one’s entire family.
In later chapters she details therapeutic options, including surgery, radiotherapy, and the burgeoning host of currently used chemotherapeutic interventions (hormonal, kinase and PARP-inhibiting, therapeutic antibodies, and immune therapies, alone and in combination). Concluding chapters stress the importance of ongoing involvement in research, and the pathway which new drugs must take before approval by the FDA. In appendixes, there is an exhaustive compilation of inherited cancer syndromes, and of risk management strategies for these syndromes. There is a sizable bibliography, and, helpfully, an index.
The author’s recounting of the many personally experienced conflicts, both external and internal, the warmth and buoyant attitude with which she retells her own family’s story and the multiple mini-histories of patients she has treated mark the book as utterly different from the coldly scientific literature about the same subject, and make it a pleasure to read.
Given the long-recognized barriers in physicians’ abilities to conducting meaningful dialogue with patients at risk for, or with known malignancy “A Cancer in the Family” should be required reading for all physicians with interactions with patients, whether medical students, residents or established clinicians. It would be a valuable resource for nurses and other caregivers interacting with the same population. For the general reader, and most particularly for the reader with questions about possibly inherited predisposition to cancer, this is the Go-To volume to begin the long journey to understanding and ultimately well-informed actions.
Laurence J. Krenis, M.D.
Wellesley Hills, MA