CHEMO FOR ALGERNON--Galaxy Online.com Column #4

Copyright (c) 2000 by Mike Resnick.
Reprinted with permission

Like most people, I grew up in a household where cancer was considered the deadliest killer of all, and where the word itself was uttered only in hushed whispers. I suspect if we'd been Catholics we'd have crossed ourselves every time we mentioned it.

So when Carol, my wife, was diagnosed with breast cancer last summer, it looked an awful lot like the end of the world.

Just goes to show how out of touch with science even a science fiction writer can be.

First of all, they didn't have mammograms when I was growing up; they do now. The cancer showed up on a routine mammogram. It was still microscopic. 25 years ago it would have gone undetected until it formed a discernable lump, at which point the very best Carol might have hoped for was a mastectomy, and the likelihood of it killing her was better than 50-50.

But this cancer was only two cells wide. Cells, not inches or centimeters.

The first step was to cut it out. It wasn't a mastectomy. It wasn't even a lumpectomy. It was a one-inch incision that removed an area about the size of a golf ball -- considerably larger than the affected area. Outpatient surgery. She was home an hour after they finished.

They did some more mammograms, and determined that they'd cut it all out. We thought they were done -- and ten years ago they would have been -- but they then suggested to Carol that she undergo radiation treatments and start taking the medication tamoxifen citrate. Why, we asked, if the cancer was gone? Because, they explained, the radiation treatments -- there would be 33 of them -- would catch any stray cancer cells they might have missed, and the tamoxifen (she would take one pill daily for the next five years with absolutely no side effects) would just about guarantee hat the cancer would never recur.

Just about? Right. The odds of recurrence were 20%

without the radiation and the tamoxifen, and less than 1/2 of 1% with them. Carol can count as well as the next person, and liked 200- to-1 odds better than 4-to-1, so she agreed to the treatments.

That's when our friends decided to warn us off. Her hair will fall out. She'll be vomiting day and night. She'll lose 40 pounds. I'm surprised that they didn't suggest that the enamel on her teeth might melt.

Turns out they were as uninformed as I was. Yes, 20 and 30 years ago radiologists bombarded a cancer patient rather indiscriminately with cobalt, which often did as much harm as the cancer itself...but 20 years in the field of medicine is like 2,000 years in the field of archaeology -- ancient history.

They still use cobalt, but they were able to pinpoint the radiation so it hit only the target, nothing else; the trunk of her body was never radiated. The treatments took about a minute each; she'd enter the hospital's radiation lab at 1:00 every afternoon, and be done ten minutes later. She never got sick. She never lost her hair. She never vomited. The only side effect was a slight "sunburn" after about 25 treatments.

In short, the appearance and cure of this dread disease was pretty much of a non-event.

The oncologist seemed resigned to the fact that people didn't know about the enormous steps that have been made in the treatment of cancer. I was sure it was the Number One killer of Americans; I discovered it was Number Four, and moving down the list rapidly.

Early detection is the key, of course, and thanks to the CATskan and the mammogram they can detect things much earlier than they used to. But it's not just those two remarkable machines. For example, any man over 50 can -- and should -- get a PSA blood test every year, and they can tell from it whether or not he has (or is likely to soon have) prostate cancer.

The greatest weapon, once cancer is found, is no longer the scalpel, but chemotherapy. Chemo, like radiation, used to make the patient horribly sick on its own. I remember that my mother, who died of cancer 20 years ago, would go into the hospital once a month for her chemo dose; they'd hook her up to a drip overnight and it would run a month's supply into her. She'd be too sick and too weak to stand up for three or four days; then the hospital would release her for another four weeks, and she had to smoke pot the rest of the month to avoid the constant nausea brought on by the chemo.

No longer. Not only has the science of chemotherapy improved to the point where it only attacks the cancerous cells, rather than all suspect and non-suspect cells in a given area, but you no longer need a month's dose all at once. These days you can walk around with a small device discreetly attached to you that will slowly but constantly inject the chemo into you, a drop at a time, around the clock, so you're never sickened and overwhelmed by too powerful a dose.

Think back to the dawn of the last century -- 1900. What could we do about cancer then? Not much. There is a memorable line in John Wayne's last movie, The Shootist, when he discovers (in 1899) that he has cancer. He asks James Stewart, the doctor, if he can operate. Stewart sadly shakes his head and replies, "I'd have to gut you like a fish." That, alas, was the state of the art back then.

Now, a century later, if we can find it early enough, we can cure 80% of the cases. (Finding it early enough is the problem. Most people, unbelievable as it seems to me, don't want to hear bad news from their doctor -- so if something is wrong, like a small lump, they wait until is it a large lump before reporting it, thereby assuring they it isn't caught early enough.)

Nonetheless, medical science marches on. Are they building a better mousetrap?

Nope. They're building a better mouse.

Honest.

The National Cancer Institute has just funded 19 groups of scientists for what has come to be known as the Mouse Models of Human Cancers Consortium. (Too bad they didn't come up with a name that would lend itself to a snappy acronym.)

And what is this all about?

We've learned enough about genetics and DNA, and enough about cancer, to create a subspecies of mouse that can actually mimic human cancers. Such an animal has never existed before, so almost all meaningful cancer treatments have been tried out on exceptionally small groups of human guinea pigs, and progress, though it seems amazingly fast, has actually been quite slow.

Now, however, we have the ability to reproduce breast cancer, brain tumors, lung cancer, colon cancer, any kind of carcinoma you want, in hundreds of thousands of mice, which will then be subjected to every conceivable type of cure. If you lose a few hundred along the way, it's not like losing a few hundred human patients, so everything, no matter how radical, will be tried. By mid-21st century, I would imagine that even highly-developed cancers will be treatable with undreamed-of approaches that make radiation and chemotherapy and drugs such as tamoxifen seem crude and primitive.

Will it work? Absolutely. The University of Cincinnati, one of the 19 groups, has already produced an asthma-resistant breed of mouse that can breathe massive amounts of smog without suffering asthma attacks.

I suppose by the 22nd century this will all be moot, that we'll have found a way to clone our various internal organs so that when you come down with heart disease or lung cancer you simply stop by the lab and trade your diseased organ in ("trade it in" is probably not the right expression, is it?) for the genetically identical heart or lung that's been waiting on ice (no, it won't really be sitting in a meat freezer) for you.

But in the meantime, medical science uses what it has and keeps performing its daily miracles. I think our best hope in the war against cancer is the new species of mouse.

Every new species needs a name. I think we should call these the Algernon Mice.

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