Thanks to Tom Stoppard

From kottke.org, shared there by a UK reader...

A Line in a Tom Stoppard Play Inspired a New Breast Cancer Treatment

In a letter to the Times of London, Dr. Michael Baum tells how a line in Arcadia by Tom Stoppard sparked an idea which resulted in adjuvant systemic chemotherapy, a therapy Baum helped pioneer which greatly increased the survivability of breast cancer.

Sir, In 1993 my wife and I went to see the first production of Arcadia by Tom Stoppard (obituary, Dec 1), and in the interval I experienced a Damascene conversion. As a clinical scientist I was trying to understand the enigma of the behaviour of breast cancer, the assumption being that it grew in a linear trajectory spitting off metastases on its way. In the first act of Arcadia, Thomasina asks her tutor, Septimus: “If there is an equation for a curve like a bell, there must be an equation for one like a bluebell, and if a bluebell, why not a rose?” With that Stoppard explains chaos theory, which better explains the behaviour of breast cancer. At the point of diagnosis, the cancer must have already scattered cancer cells into the circulation that nest latent in distant organs. The consequence of that hypothesis was the birth of “adjuvant systemic chemotherapy”, and rapidly we saw a striking fall of the curve that illustrated patients’ survival.

Stoppard never learnt how many lives he saved by writing Arcadia.

Michael Baum
Professor emeritus of surgery; visiting professor of medical humanities, UCL

Certainly drives home the value of a robust and diverse culture of humanities in contradiction to the current backlash.

As I said back in April this year, cancer research — particularly the Trump regime's recent funding cuts to it — have become more personal to me. 

This doctor's letter sheds some light on the improvement in breast cancer survival rates after 1990 that were mentioned in my April post.

For those who don't know, adjuvant chemotherapy (or neoadjuvant, which is administered before surgery) — which are most of the chemotherapies people undergo if they are in earlier stages of breast cancer — are meant to eliminate cancer cells that may have escaped the main tumor site, but are not detectable yet. I had never heard the term before I had cancer.

Its purpose is not to eliminate or even shrink the known tumor, though it also often has that effect. And how much it shrinks the tumor is considered to be an indication of how effective the treatment is on a particular patient's cancer cells generally.

Thanks to Dr. Baum for the Damascene conversion, as much as he thanks Tom Stoppard.