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Space to Think, a new book celebrating ten years of the Dublin Review of Books More Information 

The Cancer Chronicles

Unlocking Medicine's Deepest Mystery
George Johnson
Bodley Head


When a tumor finds a workaround, other drugs will be ready to go after the new mutation. Pursuing a different strategy, a new class of pharmaceuticals will switch back on apoptosis. Immune system boosters will learn to cleanly distinguish between what is a tumor and what is healthy flesh. A cocktail of these advanced treatments will stop cancer—even advanced metastatic cancer—in its tracks or manage it indefinitely as a chronic disease. Or maybe in ten years we will be reading how these approaches too are falling behind in the cellular arms race and we will be forced to look at cancer in an entirely different way.

About a year after he showed me his lab in Princeton, Austin was invited to Davies's domain at Arizona State University to give a talk called "Ten Crazy Ideas About Cancer." In the end he came up with five, and one in particular has stuck in my mind. It was about mitochondria. I remembered my surprise when I learned years ago that the mitochondria, these tiny things inside our cells, might once have been bacteria—individual creatures that became trapped some­how. The mitochondria have their own DNA and can replicate inde­pendently within the cytoplasm. With their ability to burn glucose and power the Krebs cycle—the chemical dynamo that energizes the cell—these symbionts provided their hosts with an evolution­ary advantage. They have also long been suspected of playing a part in cancer. Mutations to the mitochondrial DNA are found in many different tumors. That might just be collateral damage from the havoc of a cell careening toward malignancy. But there are rea­sons to think the mitochondria are more directly involved. For one thing they help initiate apoptosis, the cellular suicide routine. In his crazy ideas talk, Austin speculated that cancer might begin when the mitochondrial symbionts rebel. From the wear and tear of generat­ing energy, they become damaged and spew out free radicals that eat at other parts of the cell, including the genome. The cell gets sicker and the only recourse is to destroy itself. But the mitochondria refuse to cooperate. They don't want to die. More mutations follow and the cell becomes malignant.