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Special Event

Millennium 2000: Cancer

Aired January 2, 2000 - 4:16 p.m. ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.

RIZ KHAN, CNN ANCHOR: They survived cancer. You can, too.

(BEGIN VIDEO CLIP)

DR. WILLIAM HASELTINE, HUMAN GENOME SCIENCES: I think we're on the brink of a major breakthrough in cancer therapy.

(END VIDEO CLIP)

KHAN: Breakthroughs that can save your life and new treatments that are on the verge of helping: the latest from the battlefield on the war to fight cancer.

Well, medicine has made big strides in recent years in the battle against cancer, but the disease still claims hundreds of thousands of lives every year.

BOBBIE BATTISTA, CNN ANCHOR: Will the 21st century bring a cure for cancer?

Here's CNN medical correspondent Dr. Steve Salvatore.

(BEGIN VIDEOTAPE)

CROWD (singing): Happy birthday to you, happy birthday to you...

DR. STEVE SALVATORE, CNN MEDICAL CORRESPONDENT (voice-over): Peggy Orlando didn't think she'd be alive for her daughter's 28th birthday. She was diagnosed and treated for breast cancer 10 years ago -- but the disease came back.

PEGGY ORLANDO, BREAST CANCER PATIENT: There was a reoccurrence almost six years ago now. And at that time I had a radical mastectomy followed by a punishing round of chemotherapy. And there was a doctor who told me that I was most probably going to die.

SALVATORE: The cure for cancer has alluded humanity for centuries. The first documented cases of cancer go back as far as the ancient Egyptians. Millions have died from the dreaded disease. Nearly five million lives have been lost to cancer since 1990, and this past year more than half a million people died -- that's more than 1,500 people a day. Cancer continues to be the second-leading cause of death in the U.S., exceeded only by heart disease, and each year one in four Americans die from cancer. To be diagnosed with cancer has, for most of human history, been a death sentence. But in 1971, then-President Richard Nixon declared a war on cancer, pushing scientists and researchers to put an end to the suffering.

(BEGIN VIDEO CLIP)

RICHARD M. NIXON, PRESIDENT OF THE UNITED STATES: Everything that can be done by government, everything that can be done by voluntary agencies in this great, powerful, rich country now will be done.

(END VIDEO CLIP)

SALVATORE: Since that time, there have been incredible advances. Between 1990 and 1995, overall cancer deaths were down at a rate of 0.5 percent per year.

DR. LARRY NORTON, MEMORIAL SLOAN KETTERING CANCER CENTER: We've seen death rates drop, you know, in major diseases now. But mostly, you know, on top of what we've seen clinically, we're seeing extraordinary scientific advances that are laying the foundation for truly revolutionary changes in the way cancer is managed.

SALVATORE: Initially, scientists had only a crude understanding of what cancer was and how it worked. In simple terms, it's a cell that's dividing out of control, growing, replicating, devouring and invading everything in its path.

Today, although they have clues, scientists are still trying to understand how cancer cells grow and divide.

DR. ROBERT MATER, We've made enormous progress since the funding that emerged from Nixon's war on cancer. We now understand how the normal cell becomes malignant. Increasingly, we're able to determine which genes go awry and the most exciting opportunity to be able to correct those abnormalities and return an abnormal cell to its normal pattern.

SALVATORE: Early treatments were as primitive as our understanding.

DR. HARMON EYRE, AMERICAN CANCER SOCIETY: In 1971 we were doing major radical surgery as standard treatment. We were doing very primitive radiation therapy that carried a lot of toxicity to normal tissue, and our chemotherapy agents were highly toxic and minimally effective.

SALVATORE: Doctors simply don't know how cancer is triggered. Are we genetically predisposed to get cancer, or is it in the air, the water, the food that we eat? Scientists say it's both.

MAYER: The development of cancer undoubtedly represents a combination of exposure to some sort of cancer-causing agent, carcinogen, whatever one might like to say, plus familial susceptibility. We know that even women who don't have the very, very high-risk cancer gene for breast cancer, if mom and sister have had breast cancer, they have a higher risk.

SALVATORE: That genetic link has Peggy Orlando concerned for her daughter.

ORLANDO: As a matter of fact, right now Kimberly has been checked for a lump, and it is still there. And she is 28, and we're going in next week for a biopsy. I know that the probability is that it's nothing because of the statistics, but I know that she has -- she has a lot of my body build, so I think there's a possibility that there's a tendency there. So it's a worry.

SALVATORE: Genetic susceptibility to cancer is a worry, but it may also lead scientists to a cure. Human Genome Sciences is bio- pharmaceutical company using the understanding of genes to develop new treatments for many types of diseases, including cancer.

Dr. William Haseltine is the CEO.

HASELTINE: In a very real sense, genes are us. Genes are the instructions to build all of our parts. If we think of a human being as a set of parts, organs, tissues and cells, the fundamental parts of a human being are determined by our genes. Genes are an instructions to build the human being. They create small parts, which, when assembled into larger organs and tissues, create our bodies.

SALVATORE: That understanding is leading to better treatments for cancer.

HASELTINE: We may have two new things to add to the cancer repertoire: new classes of drugs that specifically attack cancer cells and powerful new ways to shield the body while killing the cancer. We'll see a major advance in curative chemotherapy, curative radiation therapy, and curative -- let me just say -- curative cancer therapy for the major cancers, such as colon cancer, lung cancer, liver cancer, head and neck cancer.

SALVATORE: Doctors have already made progress against prostate cancer, breast cancer and most childhood cancers.

(on camera): While researchers have made tremendous strides over the past 20 years, the battle is far from over. Cancer has proven to be a very complex disease. Though a cure has not yet been found, scientists are confident they'll soon be able to manage cancer as a chronic condition.

EYRE: This is a collection of diseases that we will control. Cancers will go away. They will be controlled in a chronic state in a very early phase, and people will be able to live normal lifespans and not have to worry about them.

SALVATORE (voice-over): Many people are living better, longer and healthier lives with cancer because of new drugs and therapies that use the body's immune system that normally fights infections to fight cancer.

HASELTINE: I think we're on the bridge of a major breakthrough in cancer therapy. First is the concept that we can now make human antibodies target cancer cells and kill cancer cells but not affect normal cells. We have the first effective drugs on the market for that purpose. The specific drug I'm thinking of is Herceptin for breast cancer, but that's the tip of a very big iceberg.

The second advance is one we're making here, which is to improve the ability to protect the body, the healthy body, from the devastating effects of cancer therapy.

SALVATORE: These new treatments are called bio-therapeutics, compounds made from proteins and genetic material. Some bio- therapeutic treatments include gene therapy, to replace or repair damaged genes or to boost the immune system; Angiogenesis inhibitors like angiostatin and endostatin, that cut off the blood supply to tumors, depriving them of the nourishment they need to grow; antisense therapy that blocks the formation of important proteins that keep cancer cells from growing and spreading; and monoclonal antibodies, biological smart bombs that target select portions of cancer cells, leaving healthy tissue alone.

There are also powerful new vaccines.

NORTON: We have developed that technology, so it's a real possibility that vaccines are going to make a real difference in therapy tied to early diagnosis and also in prevention.

SALVATORE: Experts say these bio-therapeutic treatments have led to an explosion of new therapies in the drug pipeline.

NORTON: There are 350 drugs, for example, right now in clinical trial for breast cancer. Never in history have there been that many drugs in clinical trial at any one moment in history, and they're all based on some solid scientific evidence that something's abnormal in the cancer that can be attacked.

SALVATORE: Surgical and radiation treatments have also changed dramatically.

EYRE: The radiation therapy that's given is dictated by a computerized design sparing normal tissues such that the toxicity is very minimal, and it's much more effective in controlling the cancer for doing breast-conserving surgery. We do colo-rectal cancer surgery and have very few people have colostomies that are permanent. And we're doing limb-preserving surgery for sarcomas so that the surgery is still equally effective but much less deforming.

SALVATORE: Even with major advances in treatment, experts believe the biggest hope is in early detection and prevention.

NORTON: My prediction is that in 10 years cancer doctors will be doing much more prevention than treatment. We already have available to us a medicine that can cut the risk of breast cancer in half, for example, and that's the drug Tamoxifen.

HASELTINE: I think over the next five to 10 years, we will have a broad range of new early detection markers. You'll now give a drop of blood, or more than a drop of blood, when you visit your doctor for an annual health care check, and over the next five to 10 years, that blood will be checked for five, 10, as many as 15 different kinds of cancers.

SALVATORE: Doctors will also be able to assess the risk for developing cancer. But with all these advances, there are still a number of cancers that science is struggling with.

EYRE: There are some cancers in which we don't know the cause, and the cancer incidence and death rates are rising. Those present the most difficult dilemma to us at the present time. Brain cancer, non-Hodgkins lymphoma, in neither case have we made major progress.

SALVATORE: Other challenging cancers include esophagial cancer and pancreatic cancer. Still, scientists are optimistic.

MAYER: I think people need not be afraid of cancer. I think there's a tendency to think about the big "C" and to think that this is something to ignore, to hide from.

NORTON: I think it's very unlikely that a little girl born today is going to have to worry about breast cancer in her lifetime. By the time she's in a risk category, you know, 30 years, 35 years from now at the very, very earliest, I think that it's going to be a disease that's a historic disease at the rate that we're progressing.

HASELTINE: In the short range, we'll be able to treat cancers better, give people longer, healthier lives. In the long-term, as address the problem of aging, we can eventually address and eliminate most cancers.

SALVATORE: Peggy Orlando hopes they're right.

ORLANDO: I worry about it every day. Every ache and pain, you know, is it in the bone? You know, when my hip hurts, is it -- I had a headache which is probably a sinus headache -- oh, my god, is it a brain tumor? You now, if you could know that that would be treatable, that you wouldn't have to, that would be wonderful.

SALVATORE: Maybe in the next 20 years we won't have to.

Dr. Steve Salvatore, CNN, New York.

(END VIDEOTAPE)

KHAN: Experts around the world are racing to find a cure.

BATTISTA: In a moment, we'll speak to two of those experts: Dr. Steven Rosenberg of the National Institutes of Health, and cancer researcher Dr. John Potter.

KHAN: Plus, we'll find out if what you eat can keep you cancer free.

Stay with us. ANNOUNCER: The National Cancer Institute estimates that 8.2 million Americans alive today have either been cured of cancer or are undergoing treatment.

(COMMERCIAL BREAK)

ANNOUNCER: An estimated 1,221,800 new cancer cases were diagnosed in the U.S. in 1999.

KHAN: Well as we've seen, medical researchers entered the year 2000 still searching for a cure for cancer.

BATTISTA: Joining us now to talk about the progress that has been made in the battle against the disease, Dr. Steven Rosenberg, in Potomac, Maryland. He is the chief of surgery at the National Institutes of Health.

KHAN: And in Seattle, Dr. John Potter. He's the head of cancer prevention for the renowned Fred Hutchinson Cancer Research Center.

We thank you both for joining us.

Dr. Steve Rosenberg, I want to start with you. And let ask you, we've walked on the moon, we've sent things to Mars, we've entered the year 2000 without a cure for cancer -- have we failed?

DR. STEVEN ROSENBERG, NIH, CHIEF OF SURGERY: We can cure many patients who develop cancer today. It's very important to realize that cancer is a curable disease. If someone develops a diagnosis of cancer in the year 2000, then they have a 50 percent chance of being cured. And when I say cured, I don't mean five or 10 years, but I mean live out their normal lifespan. And so in many ways, cancer is among the most curable of our chronic diseases.

But the problem, of course, is that the incidence of cancer is so high -- over one-million two-hundred thousand cases of invasive cancer in the United States last year -- that the half of people that cannot be cured last year resulted in over 520,000 thousand deaths in America alone, and so...

KHAN: So, sir, what types of cancer do we know more about? And what better treatments have been provided perhaps or have been developed in the last 10 years?

ROSENBERG: Well, we have three effective ways to treat cancer: surgery, radiation therapy and chemotherapy. And we're slow improvements in the development of each of those three types of cancers.

But we have for the first time now the availability of totally new approaches to treating cancer that are being developed, biologic approaches that take advantage of the body's own immune system. And the opportunity for the first time ever to actually change the genetic makeup of humans to enable them to either prevent disease or fight the cancer in a better way. And so there are many new opportunities available in the last decade that haven't been available before. KHAN: There are some who say that cancer is really a result of a modern lifestyle -- you know, unhealthy eating, perhaps fumes, cigarettes, and goodness knows what else. How long has cancer been a part of mankind's presence on this planet, if you like?

ROSENBERG: We have evidence of cancers occurring in the dinosaurs. The first creature on the planet that was ever known to have an invasive cancer was a cave bear in the Pleistocene era. The distal femurs, the leg bones of that cave bear actually showed the typical erosive of a cancer very similar to that we might see in a young person today.

So cancer has probably been with us as long as living things have been on planet Earth.

BATTISTA: Dr. Potter, let's talk a little bit about that high incidence of cancer that we see. And for that, we have to talk a little bit about prevention. Is it possible to live a clean life and to eat the right foods? If you do that, can you prevent cancer?

JOHN POTTER, CANCER PREVENTION RESEARCHER: I think we've got another way of preventing cancer, that interestingly enough in your entire segment to this it point we haven't even talked about, and that's the prevention of smoking. We know that tobacco accounts for something like 30 percent of all the cancers that we see. And that's the fastest rising cancer in the developing world, cancer of the lung, but also other cancers that are related to smoking. So that's one of the important things that we can do to reduce cancer risk.

The second certainly does have to do with the way we live our lives in other ways. And the dietary side of the story -- in 1994 through 1997, I chaired an international panel that examined all of the information that was available, on diet and cancer, on alcohol and cancer, on physical ability, on obesity and so on, and during that work, we probably reviewed 4,000-plus scientific papers from the literature. We prepared a report that was published in '97, and we concluded that the dietary change probably would account for a similar proportion of prevention if simple steps were taken, as would result from lowering or eliminating tobacco consumption.

So yes, there is a way to do this, and it does involve lifestyle changes, but the sort of lifestyle changes that people can make without huge difficultly.

This is a sort of low-tech approach to cancer prevention, and I certainly think that we will see, built upon some of these findings, very specific chemo-preventive ways of reducing the risk of cancer in high-risk individuals particularly. But for the population in general, both tobacco and diet, and physical activity and body weight are all going to be really important considerations as we move toward the prevention of cancer..

BATTISTA: But you know, this is what confused people, because they feel that if they do all of these things, and they're genetically predisposed to get cancer, that it may be for naught?

POTTER: Yes, and I think that's a question we do don't know the answer to yet. Indeed, for some of the studies that we've done, it does look like for those with the very high risk genes, genes like the RCA 1 and 2 genes, perhaps the dietary prevention and the other sorts of the things that we might do are not enough. And certainly then we will be moving I imagine toward more specific chemo- preventives and specific chemotherapies.

But for some large portion of the population, the question is not that you will be able to prevent every cancer in everybody. Dr. Rosenberg's already mentioned that cancer has been with us as long as we've had certainly vertebrate bodies anyway, and certainly you'd imagine that cancer is actually one of the side effects we have from simply having a genome that can evolve. And so certainly, prevention is only a part of the story, but it's a serious part that is fairly low-tech and fairly low cost.

KHAN: That leads me back to Dr. Steven Rosenberg, and let me ask you, sir, about the Interleuken 2, the gene therapy you're developing. You feel that's the future. What kind of progress is being made in trying to take that approach?

ROSENBERG: Conventional approaches that we've had -- surgery, radiation, chemotherapy -- apply external forces to the body -- scalpels, radiation beam, drugs. In this new approach of biologic therapy -- and perhaps this Interleuken 2 therapy is the prime successful example of it today -- we don't apply an external force to the body, but rather attempt to develop new cancer treatments by altering the body's own natural defense mechanisms. After all, the body recognizes a cancer as a foreign invader and reacts against it. And the challenge of the biological therapies is to determine ways to increase the body's natural immune response against the cancer. The body is probably a lot smarter than any doctor or scientist. And the more we can take advantage of the body's own naturally defenses, the more likely we are to develop effective treatments with minimal side effects.

Interleuken 2 administration and natural hormone can stimulate the body's immune system and represents today the best treatments we have available for two particular kinds of metastatic cancers. Those kind of cancers, called melanomas, that start in black moles in the skin or cancers that arise in the kidney.

KHAN: Dr. Rosenberg, Dr. Potter, don't go away. We're going to pause here for a short break.

When we come back, more questions for our doctors here on the issue of cancer, and development and research on that subject, including perhaps where the world of alternative medicine fits in.

Stay with us. We'll be right back.

(COMMERCIAL BREAK)

ANNOUNCER: The National Institutes of Health estimate overall annual medical costs for cancer at $37 billion. Treatment of breast, lung and prostate cancers account for more than half of those costs. KHAN: We are talking about the issues concerning cancer research, as we go into the year 2000. Joining us, we have Dr. Steve Rosenberg, of the National Institutes of Health, and Dr. John Potter, who is with the Fred Hutchinson Cancer Research Center.

Dr. Steve Rosenberg, let me get back to you and ask you about the costs of the kind of funding needed for the kind of research you're doing, because surely it has gotten to the stage where perhaps there isn't enough money to take the kind of steps you need to?

DR. STEVEN ROSENBERG, NATIONAL INSTITUTES OF HEALTH: We have opportunities available today that we have not had available in prior decades. There has been an explosion of information of basic biology, as well as molecular biology, the development of the biotechnology industry. All of these have increased our understanding of natural biologic processes.

We have probably learned more about the basic biology of cancer in the last 20 years than we did in the 200 years that preceded that. And that information is now struggling to be translated into effective treatments, and certainly the more funding that is available for that kind of basic, as well as translational research, I think the more rapidly we'll develop a more effective means for treating patients with cancer.

BATTISTA: Dr. Potter, what sort of impact does psychology have on cancer? How important is it for the patient to deal with the diagnosis and in many instances the cost?

DR. JOHN POTTER, CANCER PREVENTION RESEARCHER: Well, I think you know that there is an extremely high cost in the -- to be paid for individuals with the diagnosis. But as your piece earlier suggested, we are getting better at treatment, we are getting better at reducing that cost to individuals. I think also more importantly we are setting up systems whereby we can do earlier detection and screening, and that too, while it doesn't lower the incidence of the disease, it lowers its mobility and mortality.

For instance, if you catch cancer early -- in very early stages, you have better than 90 percent survival over five years. If you catch it late in the process, you're down to 20 percent. Knowing that should provoke people to go for screening tests and it should provoke us to improve the capacity to develop screening tests.

BATTISTA: We talked a few moments ago, Dr. Rosenberg talked about the three main ways to fight cancer. What sort of success are you having with alternative means?

POTTER: This isn't an area that I'm particularly involved in, unless you regard thinking about dietary prevention as it were an alternative. But there are some people who claim certain things for this area. I think we need to do clinical trials. If there are claims to be made that are worth what people say they are, then we should be able to prove these using clinical trials in the same way that we've taken a drug like Tamoxifen and shown that indeed it does lower the likelihood of developing breast cancer. KHAN: Dr. Steven Rosenberg, let me ask you, as you do your research looking at genetic links, and so on, to cancers, what have you learned from looking at different societies around the world. Is there anything you can see as a common trait, or perhaps there might be a nugget of information you can use?

ROSENBERG: The incidents of cancer differs in different populations and that can provide often clues as to the causes of cancer. For example, breast cancer and colon cancer incidents are much lower in many Asian countries. And so, as we study populations and how they migrate and how the incidents of cancer changes as they migrate from one environment to another, we can learn a lot about what potentially is involved in the cause of cancer.

BATTISTA: Dr. Potter, in the research that I had, I thought the one thing that stood out said that in the years to come we would probably be treating cancer more as a condition rather than a disease, and possibly something that a cancer victim has to just live with the rest of his life like, say, diabetes?

POTTER: I think that's a question you might more reasonably ask the people involved in treatment. Certainly, our improvement in survival is enormous. Certainly, our capacity to prevent and detect early is enormous. But how this will effect individual therapies for individuals is still, I think, speculative.

KHAN: But, Dr. Potter, when you talk about the affects of diet on cancer and the development of cancer, are you able to see an improvement overall in -- certainly, in developed nations -- in the way our diets are heading?

POTTER: Well, if you have a look, one of the interesting things that has happened in the U.S. is that we now have longer lives than ever before, and yet some of the risk factors for chronic disease have grown quite dramatically. Forgive the pun, but obesity is a serious problem in the U.S., and obesity is associated both with higher risks of specific cancers and with higher risk of other chronic diseases. So it is interesting to see that nonetheless overall longevity is actually going up.

So not all of our understanding of diet is entirely clear, but certainly increases in vegetable and fruit consumption are associated with lower risk. People with higher consumptions of vegetables and fruit are known to have lower risks of almost every epithereal cancer we have. That's the cancers that line the various organs, lungs gastrointestinal tract, et cetera. So those links are quite clear. Whether or not that can be translated into a full program is another question.

KHAN: Dr. Steven Rosenberg, before we take a short break, let me just ask you about the kinds of cancers that are becoming more predominant. You referred to melanoma, for example. Is that, again, a result of a lack of care on society -- on the part of society for preventing in the first place?

ROSENBERG: Certainly, melanoma is. That is cancers that start in black moles of the skin represent the most rapidly increasing cancers in incidence of any that we know about. And we are not sure of the exact mechanisms. There certainly is a relationship between sun exposure and the incidence of melanoma. There has been some thought that perhaps decreases in the ozone layer may be increasing the incidence of melanoma. But many of these changes in incidence are not quite understood.

BATTISTA: We have to take a short break. When we come back, we'll talk about miracle cures and how they effect cancer research.

(COMMERCIAL BREAK)

BATTISTA: We're back, and we are talking about the potential for a cure for cancer in the 21st century.

KHAN: Joining us, we have Dr. Steven Rosenberg of the National Institutes of Health, and we have Dr. John Potter, the Fred Hutchinson Cancer Research Center, head of cancer prevention program there.

Dr. Steven Rosenberg, gene therapy, we touched on that, your special -- specialist field, if you like. Can you give us an example of where you've seen a big step taken forward in the research you've done, the kind of progress you've seen specifically?

ROSENBERG: For the first time ever in history, we're able to actually manipulate the genes of a human being. It's important to realize there are only 50,000 to 100,000 genes that control all of the proteins, all of the body processes that we contain. And even tiny modifications of those genes can make enormous differences.

For the first time in 1989, foreign genes were inserted into humans, into lymphocites that were being used to treat patients with cancer. And one of the developments I see as very exciting in the near future is the ability to manipulate the genes in humans that affect not only their susceptibility to disease but also their ability to fight the disease.

For example, one of the kinds of research that are now ongoing at the National Institute here in Bethesda are attempts to put new genes into human lymphocites, which are the immune warriors that fight cancer inside the body, to make those immune cells more potent in their ability to recognize and destroy a cancer, and I think this whole area of gene manipulation is one that will result in a great deal of progress in the years to come.

KHAN: Dr. Rosenberg, when you said gene manipulation, I heard distance alarm bells from those in society who say perhaps there's an ethics question being raised here. Do you face any kind of battle, any kind of moral battle there?

ROSENBERG: Whenever one develops a new technology, one needs to be aware of the fact that it can be used for benefit or it can be abused. We need to realize that last year in the United States, over 520,000 innocent Americans were died of cancer. We need to use every weapon we can in a reasonable, thoughtful way to try to improve the lot of those patients. Gene manipulation, as it's being performed now, is gene manipulation of what we call somatic cells. It doesn't go into the germ line. These are not genes that will be transmitted to offspring. They're genes that are introduced into a cancer patient to help them successfully fight their disease. I have no problem with that at all.

BATTISTA: Let me ask you both this, as I'm sure you've both witnessed this in your tenure. When you see someone recover from cancer against all odds, someone whom you thought had a terminal case of this disease and perhaps you're not even sure how they were able to do that, what does that teach you?

ROSENBERG: Well, every time a patient is cured of cancer there are mechanisms that have taken place to increase the bodies own ability to fight that disease. And one of the major things we do in cancer research as we deal with patients is to study the reactions of patients to different treatments. We can now, with immune manipulations, for example, cure about 10 percent of patients that have even widespread metastatic melanoma and kidney cancer. And if we can understand what happens in those patients, we can learn how to apply that information to others. And a good deal of our research is, therefore, devoted to trying to understand the different ways that people interact with the treatments that they're given.

BATTISTA: Dr. Potter?

POTTER: I think that's absolutely right, and I think we've come a long way with a lot of those kinds of approaches. One of the important things to note, however, is that over the next 10, 15 years we're going to see a very rapidly rising rate of cancer, not in the developed world but in the developing world, largely due to lung cancer but also due to increasing urbanization and other aspects of changing diet and lifestyle. And those countries could be spending their entire health budgets just treating the cancer cases they have. So that speaks very much to, A, trying to think about how to develop lower-cost treatments that are relevant in these particular countries, and it certainly speaks to the need for prevention and early detection. Because when cancers are detected early, they are treated at much lower costs.

KHAN: So I'm going to put you both on the spot. Dr. Potter first and then Dr. Rosenberg, a one-line word of advice or sentence of advice for anyone who may be trying to minimize their risk of cancer.

Dr. Potter first.

POTTER: Don't smoke.

KHAN: And Dr. Rosenberg?

ROSENBERG: Don't smoke. It's the one piece of advice we can give that would save over 120,000 lives every year in the United States alone.

KHAN: Gentlemen, thank you very much. Dr. Steven Rosenberg and Dr. John Potter.

BATTISTA: Thank you.

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