The Cancer Chronicles

Several years ago, for reasons that will become clear in these pages, I was driven to learn everything I could about the science of cancer. How much could I as an outsider, a longtime science writer more com- fortable with the sharp edges of cosmology and physics, grasp of this wet, amorphous, and ever-changing terrain? I imagined the expanse before me as a boundless rain forest whose breadth and diversity could never be captured within a single book or even a single mind. I would find an opening at one of the borders and enter, cutting my own path, exploring where my curiosity led—until I emerged years later at the other side, with a better understanding of what we know and don’t know about cancer. I was in for some remarkable surprises.

Many people helped along the way. First I thank the scientists who devoted so much time—sitting for interviews, answering e-mails, reviewing parts or all of the manuscript: David Agus, Arthur Aufderheide, Robert Austin, John Baron, José Baselga, Ron Blakey, Timothy Bromage, Dan Chure, Tom Curran, Paul Davies, Amanda Nickles Fader, William Field, Andy Futreal, Rebecca Goldin, Anne Grauer, Mel Greaves, Seymour Grufferman, Brian Henderson, Richard Hill, Daniel Hillis, Elizabeth Jacobs, Scott Kern, Robert Kruszinsky, Mitchell Lazar, Jay Lubin, David Lyden, Franziska Michor, Jeremy Nicholson, Elio Riboli, Kenneth Rothman, Bruce Rothschild, Chris Stringer, Bert Vogelstein, Robert Weinberg, Tim White, and Michael Zimmerman. In addition I consulted more than five hundred papers and books about cancer and sat in on dozens of
lectures. Most of these sources are listed as references in my endnotes along with interesting information that didn’t make it into the main text. George Demetri and Margaret Foti kindly allowed me to sit in on a private workshop in Boston organized by the American Association for Cancer Research. Thanks to them and the staff of AACR, including Mark Mendenhall and Jeremy Moore, who welcomed me to the organization’s fascinating annual meeting in Florida. I am also grateful to the Keystone Symposia and the Society for Developmental Biology for accommodating me at some of their events.

Just as I was getting my boots wet, David Corcoran at
The New York Times
enthusiastically commissioned and published two of my early reports. Thanks to him and other colleagues—Christie Aschwanden, Siri Carpenter, Jennie Dusheck, Jeanne Erdmann, Dan Fagin, Louisa Gilder, Amy Harmon, Erika Check Hayden, Kendall Powell, Julie Rehmeyer, Lara Santoro, Gary Taubes, and Margaret Wertheim—for their reactions and advice on the manuscript.

Several recent alumni of the Santa Fe Science Writing Workshop read early versions, offering their good sense and expertise: April Gocha, Cristina Russo, Natalie Webb, Shannon Weiman, and Celerino Abad-Zapatero. Bonnie Lee La Madeleine and Mara Vatz helped with library research and the endless checking of facts. The manuscript was in constant flux and any errors that survive are my own. This will be the seventh book I have done with Jon Segal, my editor at Knopf, and the fourth with Will Sulkin of Jonathan Cape and Bodley Head in London. Thanks to them and their colleagues—including Victoria Pearson, Joey McGarvey, Meghan Houser, and Amy Ryan, a superb copyeditor—and to Esther Newberg, my agent almost from the start.

Special thanks to Cormac McCarthy, who read an early version of the book, and to Jessica Reed, whose literary sensibility and encouragement were an inspiration. More than once my friend Lisa Chong read through the book sentence by sentence, page by page, helping to apply the finishing touch.

Finally my deep thanks to Nancy Maret and the family of my brother, Joe Johnson, who allowed me to tell their stories.

As I crossed a dry, lonesome stretch of
the
Dinosaur Diamond
Prehistoric Highway, I tried to picture what western
Colorado—a wilderness of sage-covered mesas and rocky canyons—looked like 150 million years ago, in Late Jurassic time. North America was breaking away from Europe and Asia—all three had formed a primordial supercontinent called
Laurasia. The huge land mass, flatter than it is today, was drifting northward a few centimeters per year and was passing like a ship through the waters of what geographers would come to call the Tropic of Cancer. Mile-high Denver was near sea level and lay about as far south as where the Bahamas are today. Though the climate was fairly dry, webs of rivulets connecting shallow lakes and swamps covered part of the land, and vegetation abounded. There were no grasses or flowers—they had yet to evolve—just a weird mix of conifers commingling with ginkgos, tree ferns, cycads, and horsetails.
Giant termite nests soared as much as thirty feet high. Splashing and stomping through this Seuss-like world were
Stegosaurus,
Allosaurus, Brachiosaurus,
Barosaurus, Seismosaurus
—their bones buried far below me as I made my way from Grand Junction to a town called Dinosaur.

Occasionally one can glimpse outcroppings of the Jurassic past, exposed by erosion, seismological uplift, or a highway department road cut—colorful bands of sediment that form a paleontological treasure house called the
Morrison Formation. I knew what to look for from photographs: crumbling layers of reddish, grayish, purplish, sometimes greenish sediment—geological debris piled up over some 7 million years.

Just south of the town of Fruita on the Colorado River, I hiked to the top of
Dinosaur Hill, stopping for a moment to pick up a pinch of purplish Morrison mudstone that had fallen near the trail. As I rolled it in my fingers it crumbled like dry cookie dough. On the far side of the hill, I came to a shaft where in 1901 a paleontologist named
Elmer Riggs extracted 6 tons of bones that had belonged to an
Apatosaurus
(the proper name for what most of us call a
Brontosaurus
). Alive and fully hydrated, the 70-foot-long reptile would have weighed 30 tons. Riggs encased the bones in plaster of paris for protection, ferried them across the Colorado on a flat-bottom boat, and then shipped them by train to the Field Museum in Chicago, where they were reassembled and put on display.