Cancer: The Emperor of All Maladies (2015)

This is a three-part PBS documentary, two hours per episode, adapted from Siddhartha Mukherjee's Pulitzer-winning book. Barak Goodman directed it, Ken Burns was an executive producer, and Edward Herrmann narrates. It aired over three consecutive nights, 30 March to 1 April 2015.

"Magic Bullets" covers the long search for a cure that led to chemotherapy and to a declared war on cancer. Here are Halsted and the radical mastectomy, Emil Grubbe and early radiation, and Sidney Farber giving the first chemotherapy to children with leukaemia.

"The Blind Men and the Elephant" turns to cancer cell biology and to cause. It takes in the studies that tied smoking to lung cancer, work on chemicals that damage DNA, and the discovery of oncogenes.

"Finding the Achilles Heel" reaches 2015. Tumour suppressor genes, the Cancer Genome Atlas begun in 2005, and immunotherapy, including the approval of ipilimumab for melanoma.

Throughout, the series follows patients being treated in the present. Their outcomes differ, and it does not resolve them into a single message.

Patient outcomes are discussed below.

Two things make this unusually reliable for a documentary about medicine.

It rests on a carefully sourced book by a working oncologist. And many of the people interviewed are the scientists who did the work, talking about their own results rather than being summarised by a narrator.

It also resists the shape television usually imposes. There is no single breakthrough. It is candid that the war on cancer oversold itself, and candid that treatments have sometimes been adopted with enthusiasm before the evidence supported them.

Above all it is candid that progress has been wildly uneven. Childhood leukaemia and chronic myeloid leukaemia were transformed. Many other cancers were not, and the series does not paper over that.

It does not sanitise chemotherapy either. It sits with the ethics of experimenting on desperately ill children, which is where modern paediatric oncology actually came from. Patients filmed in the present are people with lives, not illustrations of an argument.

Edward Herrmann narrates all six hours. He died of brain cancer on 31 December 2014, three months before the series aired.

It is not mentioned on screen, and there is no reason it should be. But it is worth knowing before you watch, because the voice guiding you through a history of cancer belonged to someone who was dying of one while recording it.

Being a documentary, the licence here is a matter of emphasis rather than invention.

The chronology is streamlined and the credit is simplified. Discoveries look like individual triumphs, when in reality most were slow, contested and shared across many laboratories.

The focus tilts hard towards American research and towards molecular science. That leaves prevention, screening, palliative care and the unglamorous gains from better surgery and radiotherapy underweighted. If you watched only this, you would think most lives are saved in laboratories.

It was filmed before 2015, so the final hour's optimism about immunotherapy predates a decade of learning where it works and where it does not. Cost, access and inequity get very little time.

Since the series covers cancer as a whole, the most useful anchor is which cancers can actually be looked for before symptoms.

NCI lists four kinds of screening as effective and recommended:

• Mammography for breast cancer, shown to reduce deaths in women aged 40 to 74.
• HPV testing and Pap tests for cervical cancer, which also prevent cancer by finding abnormal cells that can be treated before they become cancer.
• Colonoscopy, sigmoidoscopy and stool-based tests for colorectal cancer, which likewise remove precancerous polyps.
• Low-dose CT for lung cancer in people with a heavy smoking history.

The US Preventive Services Task Force sets the ages. Mammography every two years from 40 to 74. Colorectal screening from 45 to 75. Annual low-dose CT from 50 to 80 for people with a 20 pack-year history who smoke now or quit within 15 years. Cervical screening generally from 21 to 65.

Two of those tests do something the series barely mentions and the others cannot: cervical and colorectal screening stop cancers from forming at all.

For most cancers there is no recommended screening for people at average risk. That includes pancreatic, ovarian and brain cancers, most blood cancers, and sarcomas.

They are found because somebody noticed something and acted on it. Which makes the everyday list matter more than any laboratory in the series:

• A lump that does not go away.
• A sore that will not heal.
• Unexplained bleeding.
• Weight loss you did not intend.
• A cough or hoarseness that lingers.
• A change in bowel or bladder habits.
• Drenching night sweats.
• A mole that is changing.

None of these means cancer. All of them mean get checked, and get checked again if the first answer does not fit.

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This is the rare film on this site that is accurate and still worth approaching carefully. Six hours of cancer history is a lot to take in the week of a diagnosis, and the patient stories do not all end well.

If you are in treatment, the most useful thing it offers is context for a question. Your treatment came from somewhere, and it either has trial evidence behind it or it does not. Asking which is a reasonable thing to do.

If you are not, the more useful takeaway is the shorter one. Find out which of the four screening tests apply to you at your age, and get the one you are overdue for. Cancer: The Emperor of All Maladies cannot tell you what to watch for, but screening and possible warning signs can.

This page discusses Cancer: The Emperor of All Maladies for education. It is not medical advice, and nothing here is a judgement of anyone's real medical care. Spotted an error? Please email corrections@cancerexplained.org.