Review of The First Cell

Published Feb 7, 2020

1 Article; 142 Posts

Azra Raza has many excellent points to drive home in her book, The First Cell, particularly about the lack of relevance to patient care of animal models in current and ongoing cancer research, as well as the reductionist approach in general, in research. Her own work as the director of the Myelodysplastic Syndrome Center at Columbia University and as a doctor to many patients with MDS and AML, though, relies heavily on chasing DNA and mutations, which to my mind is a somewhat reductionist approach. What was lacking and therefore frustrating for me personally was any discussion or acknowledgement in the book about the role of diet or lifestyle in cancer prevention. She would allude to it here and there but to my mind never gave it its full due and in fact at some points dismissed it. She described the nature of carcinogenesis as “unsolvable.”

Let me quickly point out that the crux of her book, repeated throughout, is that the solution to our current cancer misery is to detect cancer when it first appears. Prevention, of sorts, in other words.

But the question to that answer is: and then what do we do?

In terms of where it all starts, Dr Raza says: “One side argues that aneuploidy [chromosomal abnormality] comes first, and genetic mutations arise because of the chromosome breaks, while the other suggests a driver role for genetic mutations with aneuploidy as the downstream consequence."

She states:

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“There are several questions that arise from the above conclusions. The first relates to prevention. If cancer always results from a cell’s intrinsic typo and has nothing to do with factors outside of the cell, such as the environment, then no amount of lifestyle changes would make a difference. However, this is not the case since we do see lifestyles affecting cancer incidence. For lung tumors, for example, DNA copying errors accounted for only 35 percent of the mutations while environmental factors accounted for 65 percent.”

Near the beginning of the book she does briefly mention lifestyle.

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“Deadly breast cancers in women, prostate cancers in men, as well as mortality from cancers of the pancreas, colon, and rectum escalated among low socioeconomic groups and in impoverished regions with a high incidence of obesity.”

So, it’s just impoverishment and obesity?

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“To begin the ending, we must end the beginning. Prevention will be the only compassionate, universally applicable cure. It is not prevention through lifestyle changes. Individuals with pristine eating and exercising habits get cancer because cancer-causing mutations accumulate as natural consequences of reproduction and aging of cells.”

So hold up. Let me understand. If you are from an “impoverished region,” and are obese, your cancer is lifestyle-related, but if not – your lifestyle will not be questioned, for, as a cancer doctor she knows that her (usually well-off patients) have had “pristine eating and exercise habits.” Not that I know what’s going on, but something is off there.

And so begins and ends the main issue I had with this otherwise very excellent and highly recommended book. Here is a doctor all healthcare workers should both admire and envy - admire for her boldness, originality and creativity, and envy for the way she carves out a very personalized space for herself to have meaningful relationships with her memorable patients. She writes beautifully and her work is meaningful for all concerned, and has a lot of promise for the future. Definitely worth paying attention to and following.

As a nurse, I learned some new things about blood cancers that will have applicability for my work, as well as appreciating her accounts of patient centered care in action.