More Resources Needed to Detect Cancer Earlier

Published On May 01, 2024

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JOHN WHYTE
Welcome, everyone. I'm Dr. John Whyte, the Chief Medical Officer at WebMD. And you're watching Cancer in Context.

Despite many advances in cancer, it remains a leading cause of death. Over 600,000 people die each year, but nearly 2 million people are diagnosed, many at late stages. My guest today, Bruce Ratner, says we aren't adequately addressing this. He has a new book out entitled Early Detection-- Catching Cancer When it's Curable. Bruce, welcome to Cancer in Context.

BRUCE RATNER
Well, thank you for having me.

JOHN WHYTE
Thanks for joining me.

BRUCE RATNER
I'm delighted to be here, really. Thank you. It's such an important topic. And so I'm so glad to be able to talk about it.

JOHN WHYTE
You dedicate your book to your older brother, Michael. Tell us his story.

BRUCE RATNER
I almost get tears in my eyes when I talk about it, but I want to talk about it.

JOHN WHYTE
You had a very close relationship.

BRUCE RATNER
So my brother and I were very close. We grew up together. He's a year and a half older-- he was a year and a half older than me and in perfect health.

And one day I was out of town, and he called me and said, I've been sick to my stomach. I'm going to go to the emergency room. He goes to the emergency room. They go and do an MRI or a CAT scan and they find he has metastatic brain cancer, meaning it came from somewhere else.

And he died within 8 months. And he was at MSK. And they did a great job of keeping him alive for 8 months. And I'm grateful for that. But that got me into thinking, wait a minute, how come we can't catch this earlier?

And then on top of that, my mother died of cancer when I was 28 years old. My sister-in-law died of cancer when she was 42. And my grandmother-- I had one grandparent-- died when I was 5. And I remember it like it was yesterday. I remember thinking to myself something really incredible. She goes, I was five. And I said, I'm not going to get this disease. In 50 years, it'll be cured. I was wrong.

JOHN WHYTE
Your brother, your mother, your grandmother-- there's a lot of good chapters in this book, but there's a particular sentence that I want to read back to you that you wrote. I even marked it for me.

BRUCE RATNER
Good for you. Great.

JOHN WHYTE
You say, "I write of my family history not because it's special or unique, but because it's not."

BRUCE RATNER
Correct. And that's exactly right. What I've just said to you has happened to so many families. It is unbelievable. Almost everybody has somebody either in their family or close friend, sibling, or could be father, mother, grandparent, who has died of cancer.

And it's going to get worse because we're aging. And by 2040 or so or 2050, we're going to have double the numbers. And so this is something that happens to every-- the story is not because it's about me. It's about everybody.

JOHN WHYTE
You spend a lot of time talking about disparities. And the viewers could say, you and John are Caucasian men, right? That's not what we're talking about here primarily. Why are you interested in issues of disparities when it comes to cancer prevention particularly?

BRUCE RATNER
So I had parents who cared a lot about human rights and civil rights. My brother was a very famous human rights lawyer. And all my life, right out of law school, instead of going to a big law firm, I went to work for the city on poverty law. And I cared deeply about everybody.

And African-Americans, the best example is African-American women get breast cancer at the same incidence numbers diagnosed with cancer, the same as white people, but 40% higher mortality. That's just crazy. That doesn't make any sense. And actually, I get upset by it and angry about it because that isn't right.

And that's throughout health care. But in the case of screening and cancer, it's particularly serious. Really, it's we have ignored early detection. And we've ignored early detection. And even when we do it, we are racist about it. I hate to use that word, but we are in the sense of we haven't corrected the problems of social determinants of African-Americans and lower income people.

JOHN WHYTE
Your book gives a lot of examples throughout. And one example you point out is screening for lung cancer. So we know it's the leading cause of cancer death in men and women. 19% of the population, roughly, still smokes. Only about 4 and 1/2% of people that would qualify for lung cancer screening get it. Horrible statistic.

Bruce, you put your money where your mouth is in many ways. And you've talked about efforts that you're funding to help raise lung cancer screening. Tell us about that.

BRUCE RATNER
The first thing is I can see you read the book-- thank you very much-- because you have the number exact. I'm going to repeat it. 4 and 1/2% percent of people who are heavy smokers or were heavy smokers get screened. And that is crazy.

If you compare it to breast cancer, 90% of people get screened, women get screened. Prostate cancer, same kind of numbers, but not lung cancer. And lung cancer is the number one killer. 160,000 people die of lung cancer a year. And yet it's a terribly low number. Why?

So there's a lot of different reasons. There's a lot of studies as to why there are different reasons. The important thing is not even the reasons. We can change that. And so we did a pilot project in which we tried using a van, going into sections of Brooklyn--

JOHN WHYTE
A mobile van.

BRUCE RATNER
Yeah, a mobile van. Went in. We did free lung cancer screening. We did about 250. And then along came COVID. So we had to stop. And we found cancers. And we found people who had to be retested.

JOHN WHYTE
But you brought a CT scanner into the community to the people rather than saying, they need to come to big hospital center and wait in line and get screened.

BRUCE RATNER
Here's the interesting thing. When we looked at the people who came, they were from all over the area-- some from Long Island, some from New Jersey, some from different parts of New York City. The local community didn't come very much. And yet we papered and went all over Brooklyn.

JOHN WHYTE
So why is that?

BRUCE RATNER
What has to happen is mass media. We think about colon cancer. The CDC spent $300 million of free advertising over a period of 15 to 20 years to advertise the idea that people have to get screened for colon cancer. And we got double the rate of screening.

And that has to happen in lung cancer screening. It has not been done. It's got to be done. This is a government thing. I wish I could do it all myself. We all wish we could. But you have to do mass media.

It's a campaign. You've got to do focus groups to determine what people care about. It's like the antismoking. We were successful. You correctly said 19%. It used to be 50% in 1950. And we've done it by publicity and so on.

There has to be mass advertising because it's too hard to do it community by community. It takes too much money. And look at the pharmaceutical companies. How do they sell all those drugs? They'd sell them a very simple way. They do mass media. There are very good ads.

And that's what we have to do. The government has to have to actually subsidize this and pay for it. It's going to save money at the end. It's going to save Medicare money, Medicaid money, and so on.

JOHN WHYTE
You have a chapter entitled-- it's actually your first chapter-- "Fighting a Losing War." But I mentioned the number of deaths at the beginning. Overall for cancer-- and you point out cancer is not a good term because it's many diseases. But overall, cancer deaths are decreasing. So how are we losing the war?

BRUCE RATNER
We are losing it so badly, and I'll tell you one thing. Why do you think it's gone down 27% or 30% over the last 10 or 15 years? Smoking. So you will hear doctors-- and there's somebody I know who's a very famous doctor. And he says exactly what you said. We've reduced cancer by 30% over the last 15 years. Most of it is smoking and some screening.

It is not because of therapeutics. The drugs, when you have stage IV cancer, there's a 9% to 10% survival rate on average. If you catch it early, there's a 95%, 90% chance you will live. And so that actually is really important. And we have failed, failed.

JOHN WHYTE
But why? I think we'd all agree, if we catch cancer earlier, no one will debate that's better. So what are we doing wrong?

BRUCE RATNER
See this? Money. So what do I mean by that? The NCI, which is the National Cancer Institute, spends $7 billion a year on cancer.

JOHN WHYTE
Sounds like a lot, but it's not, really.

BRUCE RATNER
Well, yeah, I'm going to compare that. Keytruda revenue is $30 billion. Now, Keytruda is an immunotherapy drug that supposedly used primarily for lung cancer. It extends life by 9.1 months.

$30 billion of revenue. NCI only has $7 billion. And only 600, 9% is spent on early detection. It should be exactly reversed. If we're talking about therapeutics here and we're talking about early detection here, it should be reversed.

I don't want to take away any money because I've seen scientists at Sloan-Kettering. I'm on the board there for a decade, two decades, rather. And the scientists are incredible. And that's why we have such a low mortality rate for early cancer, because of the great work that scientists have done.

However, late-stage cancer, we do not have any good solution, particularly for solid cancers. We have the same mortality rates that we've had since 1950.

JOHN WHYTE
I could argue that we should be spending more money in terms of research because there still are several cancers that we don't have adequate screening for in the general population-- brain cancer, as you talk about in your book, pancreatic cancer. What's the solution there, Bruce? Because we don't have adequate screening right now.

BRUCE RATNER
I agree with you wholeheartedly. So what I felt when I'm talking about money, we spend a ton of money on therapeutics for stage IV, stage III. We don't spend the money on early detection.

JOHN WHYTE
You're passionate about social justice. That's clear. You talk about your history in terms of your early career. We talk about these screening strategies.

But you also point out in your book about the role of vaccines and the research into vaccines. The best example is HPV, human papillomavirus, as we think about reducing cervical cancer. But let's be honest, Bruce. Now there are some challenges, that people don't want to say anything about vaccines. And we're not where we need to be.

So what's the obstacle there? You talk about it in your book. So tell our audience what needs to change.

BRUCE RATNER
For those cancers which are which can be cured or avoided with vaccines, we need to push to get people vaccinated more for HPV and any other types of cancers, which can be used with a vaccine. It's not going to be perfect. And that's just how you have to look at it. There's no way that we're going to eliminate cancer. There's no way we're going to get a 0% mortality.

JOHN WHYTE
Why isn't it? Why aren't we going to eliminate cancer?

BRUCE RATNER
Cancer is too tricky. That's the best word to use. It is a ferocious disease, which is unpredictable, which is very difficult to even handle.

Metastatic cancer, we still do not know why metastatic cancer occurs and why it goes here or there as opposed to some other place. So a lot of stuff we still don't know. And so it's just, it's a treacherous disease, period.

JOHN WHYTE
What's your hope in writing this book?

BRUCE RATNER
My hope was to use this as a platform. I am committed to it. I was commissioner of consumer affairs of the city for four years. I worked in consumer fighting as an advocate for seven. Let's say seven and five, twelve years. And so I think I have some sense of what it is to be an advocate. And it's very important.

JOHN WHYTE
Is that what we need, a fight to have early detection?

BRUCE RATNER
I don't like to use the word "fight," but we need to have real advocacy for early detection. And I'm not going to be the one. I don't pretend to be that. But that's what I want to do because I think it's important.

Now, the good news is that I'm associated with two incredible places, three incredible places. Sloan-Kettering, my association with there is very helpful for advocacy. Weill Cornell Medicine, I'm on that board for two decades, and also Cold Spring Harbor, which is a research Institute. So I'm hoping through those organizations and doctors that I know there that are very influential that we can make a big difference.

JOHN WHYTE
Well, Bruce, I want to thank you for sharing your brother's story. I want to thank you for raising awareness of the need for early detection and this awareness campaign that we need to be doing, as we're trying to do today, to make people more informed. I

BRUCE RATNER
Am optimistic. I'm very optimistic that we can get there. This is a book about optimism. It's not a book about badness. It's an optimistic book. And that's what's really important to understand.

You've got to read it. You've got to know about it. If you don't read it, at least know about it. And I would have two words-- get screened.

JOHN WHYTE
Early Detection-- Catching Cancer When it's Curable. Bruce Ratner, thank you so much.

BRUCE RATNER
Thank you for having me. I'm very appreciative.

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