Piqued my interest when I heard the author on a podcast say cancer was a fundamental phenomenon in the universe. By which she means in any population of cooperating individuals, there will be a tendency for cheaters to evolve, and a tendency to suppress cheating. Cool main idea. I learned lots of interesting specifics. What I really didn’t like about the book was the style. Each new point is repeated over and over in slightly different ways.

Raw Notes:

• Evolution favors cancer suppression AND cancer. Multilevel selection. So cancer evolves in our bodies (somatic evolution), but our bodies have evolved to suppress cancer. Limits: cancer suppression often limits fertility. We were not evolved for modern environments (like smoking).
• Ironically, aggressive cancer treatment puts evolutionary pressure in cancer, making it stronger. Like fighting a hydra.
• Cancer is fundamental to multicellular life because we are a population of cells that reproduces with variation.
• More cellular evolution happens in one lifetime than human evolution has happened in all history.
• Cancer is an example of evolutionary suicide (life evolving in a way that leads to its own extinction)
• Tasmanian devils (and dogs!) have transmissible cancer
• Variation comes from copying errors, sun or chemical damage, epigenetic variation.
• Decisive victory available sometimes if early, young, genetically homogeneous. Otherwise, stronger treatments lead to more drastic mutations.
• Multicellular cooperation is possible because of genetic relatedness. Like kin altruism, but moreso.
• Multi level selection. Cancer evolves anew in each new organism. Organisms with better cancer suppression proliferate.
• TP53 is the main cancer suppressor gene. Detect cancer activity and active cancer suppression.
• We don’t suppress cancer entirely because suppression causes premature aging via killing healthy cells from false alarms. Also necessary for fertility, healing, fighting infection. Placenta is invasive. Cells grow and move to heal wound. Immune cells mutate.
• Competing interests of maternal and paternal genes blew my mind. Paternal favors more growth. Maternal favors less growth.
• Telomeres protect against cancer by limiting cell division. Tradeoff between cancer and aging.
• Peto’s paradox: larger species have less cancer, but larger animals within same species have more cancer.
• There’s a bit about cooperation among cancer cells to aid metastasis.
• Integrated pest management and adaptive therapy: Treat only until below a harmful threshold, to avoid killing all individuals that are sensitive to treatment.
• Change the fitness landscape to favor less aggressive cells.
• Constant but low levels of resources favor slow growth. Reminds me of placating the masses to avoid revolution.

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