Published on Aug 25, 2022

Video Transcript

[MUSIC PLAYING] Hi, everyone. I'm Dr. John Whyte, the Chief Medical Officer at WebMD. And you're watching Cancer in Context. Have you heard the phrase, we need to cure cancer? Maybe you yourself have used that phrase. But my guest today says, hey, we need to stop saying that. It's not helping us get a cure for cancer.

To explain why he thinks that, I've invited him to chat today. Joining me is Dr. Sanjay Juneja. He's chief of oncology at Baton Rouge General Hospital in Baton Rouge, Louisiana. Dr. Juneja, thanks for joining me.

SANJAY JUNEJA: Thanks so much for having me, and I really appreciate the attention that we're putting into cancer and really its treatments, and I think some of the stuff that lingers from years past is just not applicable for good reasons today. One of those being what you said, was a cure for cancer.

JOHN WHYTE: That's not what I said, it's what you said. And you said in our conversation, you said on social media. And at first it seems like, why would he say that? So help explain to our audience what you mean by that and really what we should be saying.

SANJAY JUNEJA: The only issue with a cure for cancer makes it sound like it's one entity we can tackle, when in fact, any cell in our body any, one of them, that's been behaving and doing everything it's supposed to do suddenly stops behaving.

And that specific cancer cell in that person is different than the same breast cancer in somebody else. And so the challenge becomes, how do we cure all cancers, or how do we control or just make them disappear in all of the different cancers?

And that's this whole concept of precision medicine, that's in primary care, but also in cancer. Precision cancer means, what about you specifically? How can I tackle that, because there's a lot of areas.

JOHN WHYTE: I want to simplify it in some ways saying cure for cancer makes it sound like, oh, we could just find one solution, but you're suggesting rightfully so that it's many strategies that we need to develop, including sometimes for the same type of cancer, whether it's breast cancer or pancreatic cancer or colon cancer.

I want to talk about treatment, and even back to this issue of cure. Are we closer today for a cure for some types of cancers than we were 10 years ago? Are we curing cancer or are we just putting it in remission?

SANJAY JUNEJA: Well, if it's really early, people go decades and decades and decades until they pass and hopefully a totally long average lifespan without that cancer coming back.

So the key to that, by far, and we'll touch on it, is did you catch it early when that cell, that rogue cell, started to multiply? Could you remove it all before it went anywhere? In your blood and your lymph nodes before it spread? And that's the entire concept of screening and catching things early. So that's number 1.

If there's one cancer people say should not exist in the Western world it's cervical cancer. And the reason for that is a very large percentage of them, 90% plus, by some estimates, are due to, number 1, HPV. That's a virus that's very common, unfortunately, but we know that it's very uncommon to get cervical cancer without HPV infection in the past. So that's number 1, and we have vaccines for that.

And number 2, there are cancers that go slowly where we can say, aha, that annoying term, precancer. But with pap smears is super important and the reasons experts say it should not exist is because we get a heads up way before it turns into that ugly thing. These abnormal cells or I'm going to get an extra procedure.

These intervals that are defined by your primary doctor, say, this is how often you should get it, at what age, they are defined such that we the evolution takes about that long and we want to be ahead of it, and you want to get that colony out before it even gets there.

The same concept is in colon cancer. You want to get a precancerous polish. That's why you get your screening. Not to say, oh, you have cancer. I'm sorry. This is a bad news. It's like, well, we found this guy tubular villous adenocarcinoma. 6% to 8% times become cancer, but it's out. It's out now.

JOHN WHYTE: So screening is important. But you've been out there to say that not all screenings have the same degree of efficacy in finding cancer early on. And one that is highly effective but also underutilized is screening for lung cancer. Tell us what you mean by that.

SANJAY JUNEJA: Gosh, John. I'm so glad you brought that up. And this is something I'm very passionate about, because people are pretty good, 75% to 80%, about getting the mammograms, getting the colonoscopies, but for some reason-- and those are pretty effective at stopping something, but we have something that we know can save one out of five people from dying, 20%.

JOHN WHYTE: That's pretty good.

SANJAY JUNEJA: That's huge. In a deadly cancer, that is deadly because it's not too late. Lung cancer originates in two balloons. How are you going to know if you have lung cancer until it's actually hitting something that's a problem? You want to get it early, again, that whole concept of getting it out before it ever goes anywhere.

6% to 8% of people get a low dose CT lung screening scan that is appropriate for that 100%. Meaning that 95% of people don't get it ordered that can save their lives across the country.

JOHN WHYTE: Why is that?

SANJAY JUNEJA: The CT lung cancer screening only applies to smokers. So you have to smoke over 25 pack years. What does that mean? It means like if it's one pack a day, it's 25 years, if it's two packs a day, it's 12 years. Even if you quit within the last 15 years and you're over 50.

JOHN WHYTE: So you get screened every year if you meet those criteria?

SANJAY JUNEJA: Correct. And that's because it saves 20% of people from having an advanced cancer and passing away from it. But 6% of people get it ordered. 95% don't ever have it appropriate, and it breaks my heart as an oncologist, breaks my heart when somebody is showing up that met all of the criteria this thing has been around for over 10 years.

And I just have to think to myself, how did you never get once the screening to see if we could have got this thing early? So that's extremely important. And to answer your question, some of the things I've read they say, well, there may be some subconscious bias to people that have habits like smoking, which is just something you just don't want to believe in medicine but could be the case, others is the demographics of people that smoke and stuff.

And the truth is whatever it is, it shouldn't be happening. And I think we live in a time where there does need to be patient advocacy, some patients in some places in the country just need to advocate for themselves.

JOHN WHYTE: What about this talk of liquid biopsies? We're going to get a blood test or some other type of test where we're going to see fragments of cancer cells. So we're going to be able to detect cancer at 10, 20, 50 cells before it reaches 600,000 cells, which is what we would see on imaging. Where are we on that, Dr. Juneja?

SANJAY JUNEJA: Yeah, that's huge. And I'm so glad you said that, is to see a tumor, if you're told, oh, it's clear. Or if you had therapy and it says it's clear, we also have to recognize.

That means that it takes 400,000 or 600,000 cells in one place to see it on an average CT in the country. So that means if you have 100,000 or 50,000 cancers there, we just don't know about it. But what if we could know about it sooner? That's what the liquid biopsy is.

It's trying to detect basically the shedding, the stuff. If you go into someone's house and they live there a while and don't clean up, you see dust, that's hair products, skin products, you know somebody's been there. That's what tumor DNA or liquid biopsies do.

They say, I know that there has to be some dust from the tumor specifically if it's there, and can I find it before I get my imaging, and the answer is, it's amazing, that's being looked at heavily over the last two years. You've heard a couple of the companies, one's GRAIL, and there's these companies out there that are looking to find cancers sooner, because as we said, catching it earlier is what is the biggest insurance for you to be cancer free.

I mean, a lot of people believe that it could be as quickly as in a year or two. If the test can be affordably done, and one large study of 800 people had very pretty low criteria. Just basically weight loss don't feel right physicians suspect something might be going on. That was very sensitive at finding cancers, 85% to 90%.

And so if you could have an affordable test that can obviously reduce the burdens of health care costs with a metastatic or stage 4 cancer that requires all kinds of therapies for now years, fortunately, because people will live years nowadays, compared to 20 years ago, with most stage four cancers, you can do that. Everyone wins. It's cheaper, people live longer, and you control the disease better.

JOHN WHYTE: Let's go back to this concept of cure. A component of cure is effective treatment. And we do know, as you referenced, that in cancer care, we often want it to be personalized precision medicine, and what that means is targeted therapy.

But everyone doesn't get offered the same therapies in some situations. And you would think that cancer care is largely routinized. You get the same thing no matter where you go. But that may not be the case, is it, Dr. Juneja?

SANJAY JUNEJA: That's correct. I mean, for the first couple of decades with treating cancer, there were all what people think of as chemotherapy, cytotoxic chemotherapy. What does that mean? It's like you're poisoning the cell and same process systemically poisoning the body.

Targeted therapy means something different. That means we go way deeper and see what are the switches that are on and off that allows that tumor to grow. So that's a newer concept. There are some drugs that have just changed everything with targeted therapy, CLL, for leukemia, CML, those have targeted therapies now that have completely revolutionized how a lot of people live years and years and years with an oral pill.

We're trying to do that with everything else too, lung cancers, ovarian cancers, colorectal. And the important thing and the only way to know if you qualify for those things is to get what's called sequencing. You want to basically look the genomic sequencing at what are those on and off switches.

But that is a volitional thing that at first when it came out in the last couple of years, and it was available everywhere that people thought, oh, you only do that for a trial or if it's the last ditch effort. But the volume of stuff that's coming out month to month showing that, hey, this oral pill seems to have efficacy here or there, it's very important that everyone gets a clear message that that is the way we live in a world where people can have targeted therapies, oral therapies, and non-chemo options and control their tumors.

Now, what bothers me, and you mentioned it, was there's about a 15% lower molecular sequencing rate in African-Americans and up to 23% to 25% in Latinos. And some of that, again, it's multifactorial but there's some resistance against trials in certain minority groups.

JOHN WHYTE: But Dr. Juneja, what's the practical aspect here? So you're saying 15%. 20% of people are not even having their tumors sequenced to know what targeted therapies they may or may not benefit from.

And I should point out it's a greater percentage in minority populations, but it's not solely minority populations. Sometimes it depends on where you go. Isn't that a problem? And how do we address it? It's not just as part of a clinical trial, it's also part of a therapy.

SANJAY JUNEJA: The key is just to educate across the board. Patients need to know, physicians need to know. And as the world of cancer accelerates so fast, a multibillion dollar industry on the therapy side, but you're not pushing out as many oncologists out of the medical schools or residency fellowships. We just have to educate across the board.

And I think the more we can do that, and that's the goal of my social media presence, I guess, is to say, hey, I'm sure your care is optimized. I know everyone's working super hard, but this stuff is coming out week to week, this is what's available for you. If you have this tumor type, this is something you should know and inquire about.

JOHN WHYTE: Should a patient with cancer get a second opinion?

SANJAY JUNEJA: I think if anyone feels uncomfortable more than anything, having the security with your oncologist and the care is always the most important thing. It sounds silly and unscientific, but a gut feeling at the end of the day, since we're all finite at the end of the day, we all terminal, having a gut feeling and carrying that gut feeling unsatisfied is something I really try to avoid. I always encourage second opinion.

So if you're doing well with your cancer and you feel good about it, then you steer the course. But if you're not doing well or the options don't feel great or you're hearing stuff that suggests, well, does that apply to me? One, talk to your oncologist about it for sure, and two, if you still have that feeling or concern, then definitely that gut feeling is invaluable. And I tell all my patients to do so if they feel that way too.

JOHN WHYTE: Well, Dr. Juneja, how can people learn more about what you're doing?

SANJAY JUNEJA: So do my handles. It was very serendipitous how I ended up on social media, was only two years ago. But I try to educate a lot on my podcast, which is called Target Cancer Podcast. It's on YouTube and Spotify.

And I myself have learned so much about what's right here. It's extremely encouraging. And I think anyone that's scared of the term cancer, we need to desensitize that, and then I think these phrases with the cure and this and that the more we desensitize and realize it is a disease that person to person can actually be controlled much differently and more forgiving than it used to be, then I think things will spread, and people will be more optimistic.

They'll go get something checked out that they were concerned about, because the big thing is people come in late because they're scared. But if you know that things going to happen and the treatments are different, then you come in sooner. And then what does that mean? Then hopefully things are more curable.

So Target Cancer Podcast, I do that. I try to educate on that platform and then on TikTok and Instagram, theoncdoc. I just want to continually put out these big indications that are game changers so that everyone's up to speed.

JOHN WHYTE: Dr. Juneja, thanks for taking time today.

SANJAY JUNEJA: Thank you so much. And for everything that WebMD and Medscape too has taught me a lot in my training. And I know it's just really accelerated medical care across the board.

JOHN WHYTE: If you have a question about cancer care, drop me a line. You can email me at [email protected] Thanks for watching. [MUSIC PLAYING]