Found this book pedantic and really much of a downer... Had been expecting some breakthroughs or insights about cancer and its treatments, but it was all about how dire and impossible to treat cancer really is, and you can't prevent it, no matter what you do, and everyone who gets it dies from it... Not the message anyone, let alone I, really want to hear (and I'm a 2x survivor of breast cancer!)
It just felt like a rant and a self-aggrandizing play on words to not end up saying much, except that medical oncologists are angels and anyone working in the cancer research field and about is just twiddling their thumbs and not doing anything...
Really, a waste of time and also of optimism to read this book! Will not recommend at all (if I could rate it negatively, I would!)

Azra Raza in THE FIRST CELL considers cancer from both the personal and the scientific perspective--focussing on how far we need to go before we have any real way to end its spread. The book serves as an introduction to oncology as well as a call for new approaches. The text will be accessible and meaningful to new patients due to Raza's personal stories.

An oncologist shares her views about present state of cancer treatment. Her husband has lymphoma. She is an expert in myelodysplastic syndrome. She is very goo at it. But she questions if we are going in right direction as far as cancer therapies are concerned. She raises valid questions with great dose of knowledge and her biography.

An excellent, informative and heartbreaking book. Dr. Raza uses real patients and good science to explain why cancer research must change and expand.

Azra Raza is a professor of medicine at Columbia University and a practising oncologist. She specializes in and researches myelodysplastic syndromes (MDS), which the Canadian Cancer Society describes as “a group of diseases in which the bone marrow doesn’t make enough healthy mature blood cells.” Immature blood cells—blasts—don’t function properly, and they build up in the bone marrow and blood. Healthy red blood cells, white blood cells, and platelets are crowded out; there are fewer of them to do their vital work. MDS patients, who are usually older, often have debilitating anemia and require frequent blood transfusions, though some can be successfully treated with thalidomide. MDS used to be thought of as disease of low malignant potential, pre-leukaemia, but the syndrome is now considered blood cancer. One third of MDS patients go on to develop acute myeloid leukaemia (AML), another disease researched and treated by the author.

In over three decades of practice, Dr. Raza has cared for thousands of people with blood cancers. In her book, she tells the stories of several of these patients, as well as providing accounts of bright young people with other cancers—one, an intellectually gifted family acquaintance diagnosed with an aggressive sarcoma of the shoulder; the other, her daughter’s close friend, a young man in his early twenties, stricken with a lethal glioblastoma of the spinal cord. In a tender touch, she provides photographs of these patients, making them even more real and present for the reader. She documents how they negotiated their illness, made medical decisions, and confronted their end.

The author notes that over the years the billions of dollars directed towards cancer research have yielded valuable knowledge about its biology, but medicine has frustratingly little to show for this enormous investment in terms of actual treatments. Most of what is offered to the AML patients she sees (as well as to those with the most common types of cancer) has changed very little over the last forty to fifty years. Raza’s husband, cancer researcher Dr. Harvey Preisler—who himself succumbed to lymphoma in the early 2000s and whose suffering she describes in one chapter of her book—received the same combination of drugs that was used in 1977. Only about five percent of new cancer drugs are actually approved, and 70 percent of those provide no improvement in survival rates and are even harmful to patients. (America’s FDA is willing to approve an agent if it can prolong survival by 2.5 months over existing treatments—even if that additional couple of months is a living hell.) Treatments that are deemed “successful” employ the same old “slash-poison-burn approach” to cancer that’s always been used. While some novel immune therapies for lung cancer, lymphoma, and melanoma have come on the scene in recent years, they benefit only a few, and their cost is prohibitive. Even families with insurance plans frequently lose their life savings pursuing treatment for an afflicted loved one. Recent declines in cancer mortality rates are due to early detection—as is seen with colon and cervical cancer, for example—and smoking cessation. Given these realities, it’s not at all surprising that Raza’s impassioned main argument in the book is that cancer research needs to radically change.

The author aptly describes cancer as an example of malevolent “intelligence at a molecular level”. Perceiving its environment, it “takes actions that maximize its chances of survival,” becoming “stronger, smarter, and more dangerous with each successive cell division.” Many cancers are are still only diagnosed when they are quite advanced and extremely complex, having quickly transformed themselves, eliminating genes and entire chromosomes and acquiring multiple mutations. At this point, they are next-to-impossible to successfully treat. What is needed, says the author, is a commitment “to stop chasing after the last cancer cell and focus on eliminating the first” or, even better, “prevent the appearance of the first cancer cell by finding its earliest footprints.” She points out that oncologists and researchers are “already using sophisticated technologies to detect residues of disease that linger after treatment.” Why not harness and redirect these technologies to discover cancer early before it has laid waste to the body, she asks, pointing to the work of Bert Vogelstein’s team at Johns Hopkins, whose members are looking for the earliest markers (mutations, molecules, and metabolites) of breast, colon, lung, and pancreatic cancers in body fluids.

Early in her career, Dr. Raza treated a woman her age, a young mother in her thirties, who was terminally ill with acute myeloid leukaemia. Heartbroken that she could do little for a patient she had quickly grown to love, she took a decisive step in 1984: She began to build an MDS-AML tissue repository, banking samples from bone-marrow biopsies in order to study how these blood cancers evolve. Her tissue bank, which contains over 60,000 samples from thousands of patients, is the world’s oldest one created by a single doctor. A great challenge for Dr. Raza is actually gaining the research funds to carry out her work. She often has to court celebrities and hold benefits to get the financial backing needed to keep her project going.

The idea of actually harnessing new technology to look at “disease-caused perturbations” years ahead of their clinical appearance is not yet widely embraced by a “sclerotic” cancer industry. Over the years a huge bureaucracy and byzantine funding process has developed around in vitro and animal studies, even though these have yielded little of practical value to patients with cancer. Raza does not advocate for the abandonment of these studies, but she does offer an illuminating explanation of their limitations. Cultured cells are grown in controlled environments, quite unlike their natural ones, and the cells are forced to adapt to this hostile habitat. In time, they diverge wildly from their parents, genetically and in form and structure. Their doubling time is also much faster. While animal models may offer cell lines an environment more comparable to a human’s than petri dishes do, the complexity of the human environment is not fully understood and consequently can’t be replicated. Mice and human lineages diverged approximately 85 million years ago, and human and mice genomes are only about 50 percent identical. The life cycle of a mouse is short (three years), and the animal reaches sexual maturity at six to eight weeks. Furthermore, its metabolic rate is seven times faster than a human’s, so drugs are very rapidly metabolized in mice. Doses for clinical trials have to be drastically reduced because of the much slower metabolism of humans. Perhaps most critically, the immune system of mice evolved to be very different from that of humans. Ours developed to combat airborne pathogens and mice’s to handle earth-borne ones. A target lab mouse is healthy—not debilitated, as a human cancer patient is. Its immune system would naturally reject transplanted human cells; therefore, its immune system has to be destroyed before human cells are introduced. Needless to say, the tiny bodies of immunocompromised creatures hardly resemble the ones in which human cancer cells thrive. Yet, writes Raza, scientists have expected these transplanted cells to help them identify useful drugs for cancer patients.

<i><b>The First Cell</i></b> is an ambitious, rich, and informative book. It is also a demanding one at times. It will reward the persistent and motivated lay reader. My chief criticism is that it is occasionally repetitive. I believe some judicious cuts would have served the book well. As a lover of literature, Dr. Raza includes passages from great novelists and poets, but I’ll admit to having struggled at times with their pertinence. However, these are relatively minor complaints about an illuminating book that I’m glad to have read—one with a message that deserves to be heard.

Thanks to the publisher and to Net Galley for providing me with a digital copy for review purposes.

The first cell accurately and accessibly charts the several innovations that have happened in the field of cancer medicine. Highlighting the issues of accessibility and efficacy of each and showing why we are yet to cure the deadly disease.

This oncologist is on a crusade to cure cancer by detecting the very first cancerous cell when it first appears. Great idea but so far impossible to do. One gets the feeling that this doctor would halt almost all research into later-stage cancers and shift all of these resources to finding the onset of cancer. This is a great idea if one is willing to ignore the suffering of millions of people for the next 50 or 100 years. In my view, this is a non-starter.

This is a soulful, honest look at cancer by Dr. Azra Raza. Her husband died of Lymphoma. She writes a call to action that is told in an easy to read, data backed, focused book that suggests: Focusing on treating cancer by discovering the first cell and eliminating it before it is able to do any damage.

The Myth Of (Cancer) Experience. This book actually does a phenomenal job of using both hard data and anecdotal case studies to show what the current state of cancer research and treatment is - and why it is costing us far too much in both lives and dollars. This is a cancer doc/ researcher who has been in the field longer than this reader has been alive, and yet she attacks the problem in a way that genuinely makes sense: if cancer is effectively a group of cells that begin replicating uncontrollably, the best way to eliminate this phenomenon is to detect these cells as early as possible and eliminate them before they become problematic. Using several patient case studies - including her husband, who apparently started out as her boss, and her daughter's best friend among them - Raza does an excellent job of providing names and faces (yes, the book has pictures of the patients as well) to go along with the alarming yet decently documented data. (Roughly 18% of the book is bibliography, which is perhaps a touch low - 25-30% is more typical - but is better than one might expect from such a case study driven narrative.) Ultimately this book actually makes the case for The Myth of Experience better than the authors of the book by that title did, which is actually fairly interesting to this reader. :) And the Urdu poetry (with English translations as well) was a nice touch to lighten a text that could otherwise be a bit dreary. Very much recommended.

In her passionate and gut-wrenching book on cancer, doctor Azra Raza makes a desperate call to action to the scientific world, sponsors and community at large. Her point is simple: Why do we keep focusing on treating cancer instead of focusing on discovering the first cell and eliminating it before it is able to do any damage?

It is difficult to resist getting sucked in doctor Raza’s book right from the start due to a combination of her eloquent and poignant writing and her undying passion for this subject oozing on every page. She also has an interesting story to tell, or rather many. Doctor Raza gives a grand tour of several patient cases that have meant a lot to her over her years treating acute myeloid leukemia and have taught her how to be a better doctor and a more compassionate human. These cases include her husband, an oncologist as well, who died of cancer and one of her daughter’s best friend, a young man full of dreams who suffered terribly due to his cancer diagnosis. At the same time, this book is a simple introduction to oncology and the development and treatment of cancer.

Nobody is immune to cancer and cancer can be merciless. Doctor Raza is also often merciless in her descriptions of the sufferings of patients who were also her friends. This must be one of the most difficult books I have ever read and yet I could not stop myself. I kept reading well through the night, often feeling incredibly sad and even strangely burdened. This burden is what the author bore for years and is expressed so powerfully in this book. In a sence foctor Raza is lucky because she has found her passion and she works doing what she loves everyday. The cost seems unbearable to many of us, but it is this passion that keeps her moving and always trying to do better. In this bleak landscape of death and suffering we must do better.