The King Of Naples's disease

In the 15 years I have been fortunate to practice medicine, I have been constantly reminded of the apparent lottery of cancer affliction. Sure, some of the patients I have looked after have had a predictable history of excessive smoking or an occupational exposure to a noxious substance, which, in part at least, helps to put some vaguely scientific explanation on their misfortune. But many of those struck down by this modern scourge appear to have been plucked indiscriminately from the ranks of their fellows.

Mel Greaves has a straightforward and transparent agenda: he sets out to explore the extent to which an evolutionary and historical look over our shoulders can confirm the key issues we face in cancer.

As a disciple of "Darwinian Medicine", Greaves's day job as Professor of Cell Biology at the Institute of Cancer Research in London is rooted in the field of molecular genetics. The strength of the book lies in his ability to move beyond the narrow confines of cell biology, both in content and in literary style.

Cancer is often seen as a new illness, emerging along with AIDS and Alzheimer's Disease as an integral part of the 21st century. But it is not a new disease. The King of Naples died in 1494. His body was mummified by embalming and placed in a wooden sarcophagus in the Abbey of San Dominico Maggiore. Five centuries later it was exhumed and an autopsy performed. A well preserved tumour in the pelvis turned out to be a type of cancer called adenocarcinoma, possibly from the large intestine. By applying a modern molecular test for a gene mutation commonly found today in this type of cancer, scientists from Pisa University were able to identify the precise mutation seen in present day cancers.

"May we then infer that, cancer, like insanity, follows in the wake of civilisation?" So asked Walter Hayle Walshe, Professor of Anatomy at University College London, in 1846. He was one of the first to articulate the commonly held view that cancer is a product of industrialised society. It is an idea espoused by Rousseau and other philosophers - the notion that humans have lost touch with nature and are paying a price with "modern" diseases.

"It seems to me reasonable to conclude that a small but significant minority of cancers are directly attributable to industrial activities or the chemical products of our advanced technology in both developed and developing countries." This is Greaves's response to the "civilisation causes cancer" hypothesis. However, he acknowledges the fact that, by greatly reducing the number of competing causes of death, a healthier society was now at an increased risk of cancer. Material progress certainly provides the paradoxical context within which some cancer rates rise while others fall.

The Darwinian view of disease is eloquently explained in the following lines. "Man has always inadvertently helped orchestrate the ecology of his diseases by his insatiable curiosity, migrating explorations and dietary experiments. There is a sense in which all our ailments and particularly our modern chronic disorders are reflections of design limitations, delayed trade offs, and nature - nurture mismatches. They are part of the natural scheme of things even if we would like to believe that we have been sculptured to perfection."

Mel Greaves does not pretend to have all the answers but he does challenge W.H. Auden's view of cancer, whose 1937 poem `Miss Gee' has the following:

"Nobody knows what the cause is, though some pretend they do. It's like some hidden assassin, waiting to strike at you".

I dare say the poet would have appreciated this witty and wise book which weaves science, art and history with a literary flourish.

Dr Muiris Houston is Medical Correspondent of The Irish Times.