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Azra Raza, The First Cell: and the Human Costs of Pursuing Cancer to the Last, New York, Basic Books, 2019.  ISBN 978-1-5416-9952-6
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Reviewer: Alan Lippman, MD
November 10, 2019

The history of cancer treatment during the past century—as pointed out by Azra Raza in this dynamic new book—has been characterized by therapeutic actions sometimes described as “slash, burn, and poison,” disparaging terms referring to the traditional triad of surgery, radiation, and chemotherapy.  And while up to about 60% of cancers can be cured in this manner, for the remaining 40% the clinical course of illness is typically marked by painful or perturbing symptoms, treatment toxicities, and ultimately, death. Moreover, as Raza emphasizes, recent newer innovations, such as immune therapy and stem cell transplant, have added yet little to overall survival, despite intriguing indications promising superior outcomes and massive expenditures of research dollars.  

The evolution of new cancer drugs has traditionally depended on tissue culture cell lines or animal models which, Raza tells the reader, seek to target a single genetic abnormality with a “magic bullet,” but fail to account for the complexity of a disease characterized by a myriad of confounding molecular events.  Rather, she pleads, it is time to abandon this strategy and focus instead on identifying the molecular “signatures” that precede the appearance of the “first cell” to herald cancer’s clinical appearance and thereby to develop more effective preventive techniques. To this end, Raza has personally banked tens of thousands of bone marrow specimens from her own patients, creating the world’s oldest and largest repository of its kind. 

However, beyond the scientific, technical, and intellectual challenges posed by the cancer conundrum, Raza reveals a profound sense of humanity that adds an important, if not essential, dimension to her thesis.  In seven absorbing chapters, she describes, in intimate fashion and with their gracious permission, the stories of actual patients and their families—Omar, Per, Lady N., Kitty C., JC, Andrew, and Harvey—who confronted their illness with courage and dispatch.  Not only that, but Raza displays how each patient and, by implication, all of the unmentioned ones, influenced her thinking and her beliefs and contributed to the concepts that have shaped her philosophy.

In one of the final chapters, “Give Sorrow Words,” Raza captures the caring devotion of family and close friends that helped sustain and inspire the afflicted as they faced their deaths.  In the concluding epilogue, “The Dawn Has Already Arrived,” the author illustrates the extraordinary insight that drives her demand for what she terms “a complete overhaul of the current cancer culture.” 

Eight pages of acknowledgements, containing many dozens of names, demonstrate Raza’s great appreciation for the cooperation of the numerous associates and collaborators who have influenced her epistemology and her worldview.  An extensive bibliography supplements and supports her argument.


Azra Raza is director of the MDS (Myelodysplastic Syndrome) Center at Columbia University and a widely recognized and highly acclaimed leading oncologist.  In this, her second book, she calls for a fundamental change in the approach toward a fuller understanding of the challenge of cancer and how to defeat it. From the standpoint of medical history, it may be a safe prediction that future oncologists will regard this book as a landmark volume marking an important turning point in the so-called war on cancer.

Alan J. Lippman, MD
November 10, 2019

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