杏吧原创

ONE woman in nine can expect to suffer from breast cancer in her lifetime. So the hunt for the so-called 鈥渂reast cancer gene鈥� BRCA1, attracted massive attention from its early stages until it was finally found last September.

Everyone hoped that the gene would help to unravel the molecular biology of breast cancer 鈥� not just in the minority of families with the inherited form, but also in the 95 per cent of cases where the disease strikes out of the blue. Well, it will help, in the end. But not for now.

The long-awaited gene has turned out to be a distinctly messy one and its role in noninherited breast cancer is not at all clear. Its discovery has raised many more questions than it answers. For example, there are enormous ethical difficulties ahead in deciding how to use the knowledge the gene has delivered. How do you make reliable tests for the faulty gene when it comes in the form of dozens of different mutations? What do you do if you test positive? Who should be tested? Who should make money out of the test?

Kevin Davies and Michael White are as well aware of these questions as anyone. But because they have chosen to tell us the story of BRCA1 in the form of a ripping yarn about scientists鈥� quest for a gene, they have scarcely been able to tackle them. Breakthrough is an absorbing and authoritative account of that quest, with an admirable grasp of the roles of the different scientists. But its formula straitjackets the authors into overdoing the tale of the race and underplaying the exploration of the tricky issues. It left me feeling frustrated.

Repeatedly, Davies and White raise the problems of understanding the molecular process of breast cancer, the patenting of genes, the ethics of testing and so on, with tantalising hints that they have given time and effort to researching these issues. But then, just as the argument is beginning to develop, they move swiftly on to the next breathless little scene in someone鈥檚 laboratory or clinic. A sound publishing strategy, perhaps, but disappointing if you want something that takes medical genetics beyond the naive excitement that characterised the early discoveries of disease genes in the late 1980s. For instance, I was hoping to learn more about the views of Mark Skolnick. It was Skolnick who won the race and whose Utah-based company, Myriad Genetics, immediately filed a controversial patent application on the gene. I wanted to know what uses he foresees for such a test and women鈥檚 responses to the idea, but I found little.

The strains that the 鈥渞ipping yarn鈥� formula creates in the book are most obvious at the beginning and the end. The authors begin by raising expectations, making the ritual bow to 鈥渨omen everywhere鈥�, the 鈥渢rue victors in this medical marathon鈥�, who 鈥渇inally have good reason to hope that modern medicine can at last offer them something tangible in the battle against a unique disease that strikes at the very core of womanhood鈥�. Er, sick bag, please.

But in the final chapter, almost as an afterthought, they are forced to admit rather flatly that, despite the isolation of BRCA1, 鈥渢he stark truth is that little will change in terms of treatment in the near future鈥�. Then we have just a very few pages on the choices women face following the discovery.

If it interests you that Donna Shattuck-Eidens, the scientist in Skolnick鈥檚 team who actually found the gene, was jogging at the time Skolnick offered her the job, then you will love this book. There鈥檚 a paragraph on Skolnick鈥檚 parents and a mention of Francis Collins鈥檚 bad parking habits. It鈥檚 full of such colour and detail. Sometimes the colour feels forced. The first paragraph breathes: 鈥淲ith the eyes of millions of obsessed sports fans glued to the baseball World Series about to begin at the Riverfront Stadium in the heart of downtown Cincinnati, scant attention was paid to the few thousand medical researchers arriving from around the country and overseas that night as they checked into their hotels in the city centre.鈥� Baseball or no, it鈥檚 hard to believe the authors really imagine that the people of Cincinnati would have lined the route for a bunch of geneticists at the best of times. My sense is that Davies and White could have taken the real, messier story much further than they did, and their book is good enough to make me wish they had.