Cancer: The Emperor of All Maladies (2015)

A three-part PBS documentary, two hours per episode, directed by Barak Goodman, executive produced by Ken Burns and narrated by Edward Herrmann, adapted from Siddhartha Mukherjee's Pulitzer-winning book. The first film, Magic Bullets, runs to 1970: Halsted's radical mastectomy, Grubbe and early radiation, Sidney Farber's first chemotherapy in children with leukaemia, nitrogen mustard, the VAMP combination, Mary Lasker's lobbying and the declaration of a war on cancer. The second, The Blind Men and the Elephant, covers 1970 to 2000: cancer cell biology, the studies that tied smoking to lung cancer, Ames and mutagens, the discovery of oncogenes including src and ras, tamoxifen, the bone-marrow transplant regimen that was widely adopted and later failed, and the work on chronic myeloid leukaemia. The third, Finding the Achilles Heel, reaches 2015 through tumour suppressor genes, the Cancer Genome Atlas, immunotherapy from Coley to Allison, and Mary-Claire King's BRCA1. Contemporary patients are followed through treatment; their outcomes differ, and the series does not resolve.

Spoilers throughout. Discussing the cancer storyline means discussing how this ends.

As history and as an explanation of why cancer is hard, this is unusually reliable. It rests on a carefully sourced book, and many of the scientists interviewed are the people who did the work. It resists the single-breakthrough story and is candid that the war on cancer oversold itself, that high-dose chemotherapy with bone marrow transplant was adopted enthusiastically before evidence supported it and later collapsed in trials, and that progress has been wildly uneven, transformative in childhood leukaemia and chronic myeloid leukaemia, far slower elsewhere. It does not sanitise chemotherapy, and it sits with the ethics of experimenting on desperately ill children. Patients filmed in the present are treated as people with lives rather than as illustrations of a thesis.

Being a documentary, its licence is mostly emphasis. The chronology is streamlined and credit simplified, so discoveries look more like individual triumphs than the messy multi-laboratory grind they were. The focus tilts strongly towards American research and towards molecular breakthroughs, leaving prevention, screening, palliative care and the steady unglamorous gains from surgery and radiotherapy underweighted. Filmed in 2014, the final hour's optimism about immunotherapy predates a decade of learning where it does and does not work. Cost, access and inequity get comparatively little time, and some patient stories are edited to land emotionally at the point the argument needs them.

This series covers cancer as a whole, so the useful anchor is which cancers can actually be screened for. NCI lists screening tests shown to reduce deaths: mammography for breast cancer; HPV testing and Pap tests for cervical cancer, which also prevent cancer by finding treatable pre-cancer; colonoscopy and stool-based tests for colorectal cancer; and low-dose CT for lung cancer in people with a heavy smoking history. The USPSTF currently recommends biennial mammography for women aged 40 to 74, and annual low-dose CT for adults aged 50 to 80 with a twenty pack-year history who smoke or quit within fifteen years. For most other cancers, including pancreatic, ovarian, brain and most blood cancers and sarcomas, there is no screening test recommended for people at average risk. They are found because somebody noticed a symptom and acted. Signs worth taking to a doctor if they persist include a lump, a sore that will not heal, unexplained bleeding, unexplained weight loss, a cough or hoarseness that lingers, a change in bowel or bladder habits, drenching night sweats, and a mole that changes. None of these means cancer; all of them mean get checked.

A film is not a diagnosis, and a dramatised illness is not a guide to your own. What a story like this is genuinely good for is lowering the barrier to a conversation you might otherwise put off.

If something in your body has changed and stayed changed for a few weeks, that is worth raising with a doctor — not because it is likely to be cancer, but because most of the time it will not be, and finding that out is the point. Where screening exists for a cancer, it is the one thing you can do before anything is wrong at all. See screening and possible warning signs.

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Cancer: The Emperor of All Maladies is worth watching as a film. It is not a guide to the disease it portrays. The gap between the two is what this page is for — and the thing worth carrying away is that a change which persists is worth a conversation, whatever a story led you to expect.

This page describes a work of film or television for education. It is not medical advice, and nothing here is a judgement of anyone's real medical care. Spotted an error? Please email [email protected].