The very forces that bring living species into existence --including us!-- also bring cancer into being. Specifically, the forces of chance (random occurrences) and necessity (law-like regularities) are required for human life, and they are also what make cancer possible. This unnerving finding from the biological sciences is the brutal fact explained and addressed head on by Chance, Necessity, Love: An Evolutionary Theology of Cancer.
 If, in fact, the conditions for cancer are inherent in our existence, then questions abound. Authors Hummel (practical theologian) and Woloschak (scientist/medical practitioner) address two of the most obvious with honesty, clarity, hope and too much, in my judgment, redundancy. They specify their questions as: 1) What exactly is cancer and, 2) Where is God and what is love amidst this evolutionary disease? They are dealing with big questions and just as the three words of the title are a rare combination, it is unlikely that you have read anything quite like this book before. Despite its value, though, it is fair to ask: why is this book being reviewed in a journal of ethics? Why should someone involved with morals and ethical reflections expend precious time on a book dedicated to scientific and medical explanation and to theological questions that barely touch anything directly ethical? Alongside the sketch of rich insights in this book, this review needs to answer that question.
 Clearly Chance is not focused on moral quandaries, but it also is not about pastoral care. The authors are attentive to the origins of their questions in pastoral settings and there is plenty for pastors to ponder, but this is a book of practical not pastoral theology. They define practical theology as bringing theological interpretation to bear on a situation, in this case, on cancer as a disease that arises from the very fiber of being human and through the very same process that generates human life.
 An outstanding contribution of this book is its truly genuine engagement at the intersection of theology and science. Following an introductory chapter that presents the book's roadmap, the first section is titled "Cancer: An Evolutionary Disease of Chance and Necessity." The reader takes a journey into science, medical research, and cancer medicine that unpacks how cancer is: 1) a disease of cells, the very fiber of our being; 2) a disease of genes, a result of the forces of chance and necessity (read mutation and selection) that enable life; and finally, 3) a disease of evolution.
 Unless one knows a great deal already about these topics, one will inevitably learn quite a bit new. For instance, it is eye-opening to learn that cancer is a disease of evolution in how it evolves its own defenses against treatment within a patient. These three chapters are helpfully informative but also explicate why what is known about cancer raises troubling intellectual questions about a God who creates and sustains a creation that opens up to the chance and necessity of cancer. Where is God's power and love in that?
 The second section provides theological probing of what we know about cancer and about the questions identified. It does not seek pat solutions through each of its three chapters but draws upon multiple theologians, theological themes, poignant personal cancer stories of theologians, and the author's judicious attempts to draw out faithful understanding and suggest wise responses. The list of theologians and philosophers engaged suggest the breadth and depth of the work done: Edward Farley, Arthur Peacocke, George Murphy, Deanna Thompson, Ted Peters, Karl Peters, Jacques Monad, Gabriel Marcel and Charles Sanders Peirce. (Such a list should also whet the appetite for many readers!)
 Refreshingly, the authors do not pretend that these thinkers and themes mesh into some grand harmony or that taken together they provide a reasoned solution that make the questions "go away." Theologies of acceptance and theologies of hope are engaged as two overarching faithful and wise responses, yet each is acknowledged as bearing some intellectual "softness" as well as strengths. A theology of hope that holds that somehow God's promised eschaton will be without cancer receives the strongest critique since cancer seems inherent to the creative process. Still the authors recognize the power and necessity of hope in the midst of mystery and point to present signs that a future without tears might indeed be possible.
 Significantly, the book's concluding chapter presents examples of the two means the authors believe divine and human love becomes evident amidst cancer's chance and necessity: 1) the employment of science to outflank cancer's development and, 2) the creation of meaning through symbols and stories, and in communities of support. The importance of community is evident throughout the work. The final words of the text encourage others to join a community of inquiry that crafts theological reflection regarding the evolution of cancers.
 For their part, the authors present a pragmatic, collage-like practical theology of cancer that holds in tension and openness a thesis (their words):
Our loving efforts, enacted in sympathy with God's love for the world and in empathy for the evolutionary nature of the world, may testify to divine love amidst the evolutionary chance and necessity of cancers. First, by using our scientific understanding of cancer in the world, we may bring about transformations in the world of cancers. Furthermore, we may bring theological interpretations to the chance and necessity of cancer that witness to the love of God in, with and under their evolutionary development. (135)
 In the face of the unnerving and ironic questions, is this thesis satisfactory, defensible, adequate, missing something? Whatever one's assessment of those questions, Chance, Necessity, and Love will challenge any reader with the candid reality and leave an appreciation for the outstanding contribution of this distinctive book.
 But why should an ethicist as ethicist, read this book? Granted, this is not a book dedicated to moral issues. The last page contains one of the few direct references to moral questions when it makes the surprising jump from fact to ought in claiming that each individual suffering from cancer is paying the price for humanity's evolution and therefore there is a responsibility of love and care due to all those who are suffering on behalf of all humanity.
 Yet that claim, though debatable, suggests the multiple and significant reasons, if tangential rather than direct, why this book bears critical import as an ethicist's read. The first section presents in a wonderfully accessible manner the science and medicine of cancer, along with comprehensive summaries about contemporary therapies and practice. It would be hard to find in another small package all the critical material offered here enabling an ethicist to teach, advise, or do better medical ethics, bioethics, and biotechnology.
 Second, it is crucial that ethics, like theology today, take into account the findings of science. Because this book accepts that kind of challenge for theology, it offers a model for grappling with the findings and implications of science. Let me be clear, I am not speaking about technology, which ethicists often engage, nor about an easy acceptance that "science is not the enemy." It is not the enemy for theological ethicists, but the findings of science, when well-established, present knotty challenges for ethical rethinking. The findings of science qua science challenge and change the parameters for engaging fundamental ethical questions. There is much to be learned from the method here, even though it is grappling as a practical theology.
 As an illustration, there is a whispered content question in this book for ethics. In the background of what one learns about cancer here is a particular ethical question from the fundamental dimension of ethics, that of the nature of evil. The findings of science about chance and necessity (read mutation and selection), which are so thoroughly explained, challenge standard ethical distinctions and accounts about natural evil. Cancer traditionally has been, like earthquakes and hurricanes, an example of natural evil, but if it is inherent to the celebrated gifts of life—growth, change, creativity, we need to rethink how we talk about it as natural evil and how we talk about natural evil on the whole. Other questions follow. For instance, what then is the relationship and character of natural and moral evil? Chance, Necessity, and Love, clearly, presents fodder for ethicists, too.
Rev. Dr. Roger Willer serves as Director for Theological Ethics in the Office of the Presiding Bishop, as well as Publisher of the Journal of Lutheran Ethics.