Soon after publication of The Emperor of All Maladies: A Biography of Cancer (Scribner) in 2010, the book’s author Siddhartha Mukherjee, MD, PhD, received a call from Laura Ziskin, a film producer and cofounder of Stand Up To Cancer, who was interested in obtaining the film rights to Dr. Mukherjee’s Pulitzer Prize–winning book. Ms. Ziskin, a breast cancer survivor, later teamed with Sharon Percy Rockefeller, the President and CEO of WETA, a PBS station in Washington, DC, and a colorectal cancer survivor, to produce the film. Ms. Rockefeller then put Dr. Mukherjee together with acclaimed documentarian Ken Burns to adapt the book to film.

“Laura had been looking to produce a film about cancer that gave an honest appraisal of where we are on the ‘War on Cancer’ and a history of how we got here and said the book provides the perfect template for that,” said Dr. Mukherjee. “After discussing the film adaption with Ken Burns, I thought teaming up with Stand Up To Cancer and Ken’s production company provided the perfect match to bring the book to film, and that’s how the documentary got started.” (Ms. Ziskin died of metastatic breast cancer in 2011, before production on the film began.)

The ASCO Post talked with Dr. Mukherjee, Assistant Professor of Medicine in the Division of Medical Oncology at Columbia University Medical Center in New York, about the translation of his book to film, his hope that it will start an ongoing national dialogue on the progress being made in cancer therapy, and the need for increased research funding.

Similar but Different

The Emperor of All Maladies: A Biography of Cancer was so enormously popular, garnering every major award, including the Pulitzer Prize for General Nonfiction. How well do you think it translates to film?

I think the book translates incredibly well into film. We thought about the film very, very deeply, and it was clear that telling the story of cancer in the film was going to be more complicated in some ways than in the book. For example, we picked up new characters from real life, including researchers and patients, and we followed the patients throughout their disease. Obviously, the stories are not the same as in the book, but they are very similar. Also, the way they intersect and are interspersed with history is very similar, so you get the feel of the book but in a different form.

The other incredible thing is that the film is exciting to watch. You can convey excitement in a different way in a film than in a book. Viewers will see how the pace picks up around the discovery of the oncogene in the early 1980s, and suddenly you realize what a monumentally important discovery that was, how it was so counterintuitive, and how everyone came into that discovery thinking a completely different thing.

There are so many little devices in the film that bring the book to life. There is a lovely piece—I don’t even know how they got this archival footage—with four different cancer wards and four different ways of thinking of cancer. The match between the narration and the archival footage is so incredible and seamless.

Executive Summary

Despite great advances in cancer therapy, nearly 600,000 people die of the disease each year, and the word “cancer” is still very frightening to people. Why do you think the film will be appealing to a large, general audience?

The way the film is made makes learning about cancer exciting. It reminds us that there has been enormous progress in cancer treatment and how much has changed over the past century. We haven’t had this kind of executive summary on cancer with so many of the world’s greatest authorities on film in the history of cancer. In 1971, Congress declared a “War on Cancer,” and 40-odd years later, we have a chance to go back and ask where we are today, in the most authoritative way.

Making an Impact

What are you hoping happens as a result of this documentary? Do you think it might change people’s perceptions of cancer, get them to recognize the importance of participating in clinical trials, or increase federal funding for research?

I would say all of those things. I think they deserve to be changed and will be changed. Telling people honestly where we are in cancer research without pushing the message on them is the greatest form of advocacy and creates a kind of platform to fully answer the question, how did we get here?

We got here because of basic science, because of physicians, because of the enormous dedication of patients, because of the immense wisdom of funding cancer research both at the basic science and clinical science level, because patients participated in trials, and because we learned from our past mistakes and were able to make strides in cancer advances. So presenting that information is the best form of advocacy.

The film doesn’t tell you to fund basic science at the National Institutes of Health; you reach that conclusion by yourself. You see why understanding the biology of leukemia at the National Cancer Institute in the 1950s and 1960s was critical to curing patients with leukemia for the first time. If that doesn’t motivate viewers to become advocates of basic and clinical scientific research, I don’t know what will.

Transformative Process

You have said that you wrote the book because one of your patients asked you, “What is this disease I’m fighting?” And you were compelled to learn about the history of cancer, the current state of cancer research, and what happens next. What stage is cancer research in today?

We are in the middle of a transformative process in which we know more about the cancer cell than we ever have before, and we are trying to convert all that knowledge into more effective therapies. The cancer cell, the physiology of cancer, the physiology of cancer patients, and understanding the role of the immune system are all pieces that we are going to fit into the cancer puzzle, and that knowledge didn’t exist 10 or even 5 years ago. Now the question is, can the knowledge we have gained be made into medicines, effective prevention strategies, and cures? ■