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CNN SUNDAY MORNING

Weekend House Call: Promising Cancer Treatments

Aired June 8, 2003 - 08:30   ET

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

HEIDI COLLINS, CNN ANCHOR: Today on "Weekend House Call", promising news in the fight against the No. 2 killer in this country. Before this day is done, 1500 people will die of cancer.
SANJAY GUPTA, CNN MEDICAL CORRESPONDENT: Always amazing to hear those numbers. Lung, breast and colon cancers are responsible for about half of those deaths. More than likely, you know someone who is fighting the disease, or may be you yourself are. But the long, medical battle has just yielded some very, encouraging research on new cancer drugs and treatments. And we want to talk to you about that.

A new study shows chemotherapy may help lung cancer patients live longer.

Patients with early stage lung cancer do not normally receive chemotherapy, but this new study shows that patients treated with chemotherapy after surgery survive longer, or are more likely to be cured of their disease than patients who underwent surgery alone. Now, this new research could completely change the way doctors treat lung cancer patients.

On the breast cancer front, a new study shows that MRI or magnetic resonance imaging is a more accurate way of screening high- risk women for breast or ovarian cancer. In the Dutch study of nearly 2,000 high-risk women, mammograms detected 36 percent of the women's tumors, while MRI's picked up 71 percent.

The differences was even more dramatic for invasive cancer, the kind that's supposed to start spreading to surrounding tissues. Mammograms caught 26 percent of invasive cancers; MRI's caught 83 percent.

It's the largest study of it kind and could have major implications for high risked women screening for breast cancers.

(BEGIN VIDEOTAPE)

UNIDENTIFIED MALE: If my wife were to be in that category, I would certainly have her get screened with MRI. Picking up breast cancer early is the best chance for cure from the disease.

GUPTA (voice-over): For colon cancer, new drugs combined with chemotherapy look promising. A new study show a new medicine called avastin starves tumors by shutting off the blood supply the tumor needs to live and grow.

Another drug called Erbitux, works to stop tumor growth when combined with chemotherapy.

DR. ROBERT MAYER, DANA-FARBER CANCER INST.: These particular compounds, which so much excites someone who treats cancer patients such as I am, undoubtedly will prolong the lives of cancer patients. I very much hope they will also increase the cure rate as well.

GUPTA: This new approach to targeting tumors is showing success but it's not yet a cure. It's definitely adding precious time to patients' lives.

(END VIDEOTAPE)

GUPTA: And any promising new cancer drug or treatment is definitely crucial given the devastating effects of cancer. Worldwide, eight people die from cancer just about every minute mainly due to tobacco use. In the U.S., lung cancer is the leading cause of cancer deaths and the largest risk factor is cigarette smoking. In fact, 87 percent are caused by smoking. Perhaps that's what makes it most tragic and that's why lung cancer is largely preventable.

We'd like to hear from you, we want to talk to you about this. Call us about your questions about lung, breast or colon cancers. If you want to talk about those three cancers today, you can reach us at 800-807-2620; the phone lines are now open. You can also e-mail us, that's at housecall@cnn.com.

To help us wade through a lot of this information, and there is a lot of it, we're joined today by an oncologist, Larry Norton. And he's from Memorial Sloan-Kettering, a very, well regarded, well known oncologist. He's going to help us answer this.

First of all, thank you very much for being with us.

DR. LARRY NORTON, ONCOLOGIST, MEMORIAL SLOAN-KETTERING: Thank you. Nice being here.

GUPTA: Yes. We get so many questions Dr. Norton; we get so many questions here at CNN. Certainly a lot of people interested in cancer. I think we should get right to it, the first e-mail question actually coming from Jim in Johnson City, Tennessee.

He writes, "I have a dear friend that was just informed that he suffers from small cell lung cancer. I would like to know which form of treatment is the most effective to date. I believe it has been found in the early stages."

NORTON: Well, you can't say specifically unless you know a whole lot more. And of course, you know in this setting we can't diagnose or advise therapy for a specific case. The most important thing that this person can do is get in the hands of an experienced lung cancer oncologist. Clinical oncologists are the ones who really know how to treat this and especially people with experience with that disease.

A lot depends upon the staging, how much is involved. Is it really tiny, is it just a lump, does it involves lymph nodes in the middle of the chest, for example? All of the various treatments do work. Combining them in the proper way is really the critical factor. There are many drugs that can work against that kind of lung cancer and the patient should get treated as soon as possible.

COLLINS: Hi, Dr. Norton. We do have another question coming in, this one by phone. And we have Richard in Miami.

Good morning to you, Richard.

CALLER: Good morning. Good morning doctor.

NORTON: Hi Richard. Hi.

RICHARD: I have got a two parter, a very quick two two-parter. First of all I go for yearly CT scans through the thoracic oncology department here in Miami. And it's for lung cancer detection. And I want to know if it's detected very early through the CT scan, is it curable? And the other part of my question is that I see -- I get a disclaimer from them that says that some lung cancers can't be detected by computer tomography. I didn't know there were different kinds of lung cancers, so can you please comment on that, too?

NORTON: Well, what they're really saying is that this test is not 100 percent. Indeed, how good the test is and whether it saves lives is something we really don't know for sure. The National Cancer Institute is studying this right now with patients who are either getting the test or not getting in the test. They participate in the trial and we'll find out if it really does help.

Finding cancers early sometimes is a very, very big boon to the cure rate. We know that for breast cancer for sure, we're convinced of that. In other cases we're not so sure. So you are participating in something not totally proven yet, although many doctors believe it does work.

I've seen a lot of people who have had these tests and have found little tiny things and have had operations and we find out that what they have in their lung isn't cancer at all. So they had an operation and didn't really need one. On the other hand, you do find small cancers and removing them perhaps is going to improve the cure rate for the disease. Frankly, we just don't know yet.

GUPTA: And that's a very interesting point as well Dr. Norton.

NORTON: Right.

GUPTA: Certainly talking about early detection leading to better survival but it's not quite as easy as that. And we're going to wade through that issue a little bit later on.

But in the meantime, let's take another phone call. Nancy from Florida has a question. Go ahead, Nancy.

CALLER: Hi. You know we're talking about the lung cancer especially from the smokers. And I just kind of feel, isn't there really a false hope about lung cancer because it seems to me that everyone that I know that has had it is dead within one to three years? No matter what kind of treatment they had or if they had surgery or it was too late to do surgery or they caught it early. And I just have a feeling that there's a false hope.

I don't really want to be pessimistic but what are these new treatments that might make there be a real cure rate?

NORTON: Well, I mean, you know if there's false hope, certainly we are not trying to give you know, any false hope. We're trying to give the information. We just had a huge meeting in Chicago. Over 25,000 people called the American Society of Clinical Oncology, where there really was a lot of hope presented about this disease.

Of course, the most important thing is not to get lung cancer in the first place. And that's where smoking comes in. Half of all smokers will die of cancer. One third of all deaths from cancer, one third of all deaths, period in the world, are due to tobacco use. It's by far the biggest preventable cause of death in the world.

GUPTA: That's next?

NORTON: So smoking really is the problem. If we can get people to stop smoking, if we can have a tobacco-free world, which is what our goal is -- ASCO has just come out with a very major statement and is trying to organize many other groups to work together in this particular goal. That's really where we're going to make an impact.

One of the things that surprised me, frankly, is to find out that stopping smoking makes such a difference really at any age, especially below age 30. Stopping smoking may be the real critical factor, indeed. If we can't stop young teenagers from smoking we know how hard that is, especially with all the advertisements and all the peer pressure that they may feel. If we can just get them to stop that's going to make a difference, so that's a disease that we can prevent.

Now, the other side of the coin is what to do for the cases that we can't prevent, people who have smoked or the few people who have not smoked and gotten lung cancer. There really are a lot of areas of promise. And I think one of the featured presentations at the ASCO meeting was the presentation on the fact that giving cancer-killing drugs early in the diagnosis of lung cancer really makes a difference.

It's like the beginning of adjuvant chemotherapy for breast cancer. We learned in the '70s and through the '80s that giving drugs to those diagnosed with breast cancer can make a big change in the cure rate. But we started small. The first trials showed 5 percent improvement and then it got bigger, and bigger and bigger.

COLLINS: They always have to start small, don't we?

NORTON: Now we start to see the beginning of that. And this study was the first study that showed that we had a impact, it wasn't a big impact but it was a real impact in people with lung cancer by giving them drugs early.

COLLINS: Dr. Norton, we are going to continue to talk about this, of course. NORTON: Surely.

COLLINS: We are still taking your questions on breast cancer and MRI's.

When is an MRI better than a mammogram? An interesting question indeed. Want to get in on the conversation? Just call 1-800-807-2620 or you can e-mail us at housecall@cnn.com. Look forward to hearing from you.

(COMMERCIAL BREAK)

COLLINS: This is "Weekend House Call." Our topic this morning is cancer, your questions on new treatments, drugs and prevention as well.

GUPTA: And lots of information already coming in. We want to hear from you. The phone number is 800-807-2620. Or if you're an e- mailer, e-mail us at housecall@cnn.com.

We're going to go ahead and get those phone calls lined up. In the meantime, let's check our "Daily Dose Health Quiz." Today's question, how many people alive today have ever had cancer? The answer to that when we come back in 30 seconds. Stay with us.

(COMMERCIAL BREAK)

COLLINS: In our "Daily Dose Health Quiz" we asked just a few seconds ago, how many people alive today have ever had cancer? The answer, according to the National Cancer Institute, approximately 8.9 million Americans with a history of cancer were alive in January 1999. Some of those people were cancer-free while others still had evidence of cancer and may have been undergoing treatment at the time.

Welcome back, everyone, to "Weekend House Call." We are talking about new treatments and prevention for cancer.

GUPTA: Yes, earlier we were just talking about lung cancer and hearing some very large numbers about lung cancer. But also the statistics on breast cancer are daunting as well. Let's look at some of those.

Breast cancer alone will kill 40,200 women this year. While mammograms can detect cancer at an early stage, MRI's, which we've been hearing so much about, may be more accurate in actually screening high-risk women, women with a strong family history, for example.

If you haven't already doing routine breast cancer exams, symptoms may include a lump, skin irritation or pain. Remember, your risk in developing breast cancer increases with age.

Dr. Larry Norton is joining us as well to help us wade through this information. And a lot of e-mail questions out there. Let's go ahead and go to our first one on this particular topic. This comes from Rhonda in Dover, Tennessee. She writes, "I started wearing a training bra at eight years and got my periods at 10 years of age. I have no children. My grandmother had breast cancer and had to have her breast removed. My mom her lymph nodes removed. I am now 37 and have started having mammograms when I turned 35. What are my chances of getting breast cancer?"

And let me just say, obviously, all of those pieces of information relevant when talking about someone with a potential history of breast cancer, or risk of breast cancer -- Dr. Norton.

NORTON: Yes, indeed relevant. You know early menarche, late menopause, family history of breast cancer, these are really are all factors. And she's right in identifying that she might have an increased risk, although we don't know in her case. And I do encourage her to talk to a clinical geneticist, or a medical oncologist -- surgical oncologist to try to really assess her risks.

She's doing the right thing by getting her mammograms starting age 35. I think that's a very good idea. But one of things we learned at this meeting is MRI's might help as well. MRI's is a test that does not involve radiation and does look like it picks up more breast cancers. The problem is it also picks other things that turns up not to be breast cancer. So, finding specific breast cancer with it is the term that we use is the issue.

So, we're basically learning how best to use this new technology and also learning who should get it. So, it's not quite ready yet for everybody to run out and get an MRI. But it's something people should know about, especially people who are at higher risk.

GUPTA: Now, Dr. Norton, at the other end of the spectrum people talk a lot about self-breast exams. And there has been news about that lately in terms of not being so recommended by the various oncology societies. Can you talk about that a little bit?

NORTON: Well, I think that we can't really tell. I know that the American Cancer Society said that they're not pushing it as a major recommendation at the present time. I still think it's a good idea. I think it's a good idea for women to know what their breasts feel like so that if they feel anything different they can call it to the attention of a medical professional.

It's hard to take a study, a bunch of people and say you are randomized to examine your breasts and you are randomized not to touch your breasts. It's just not going to happen. And attempts to really study it have not been satisfactory for that reason. But knowledge is still a good thing. And I think as long as people don't panic when they feel something, know who to go to, know how to get it examined properly, it's a good thing to get more information to know what your body feels like and to take responsibility as well.

COLLINS: Dr. Norton, we want to get to more phone calls now this morning. And we have Kathy on the line from Richmond, Virginia, this morning.

Hi, Kathy.

CALLER: Hi, how are you?

COLLINS: Great.

CALLER: And I'm calling to talk with Dr. Norton about the fact that I have just recently had an abnormal mammogram and I'm due to have a stereo tactic biopsy this Thursday. I am 57 years old and have had non-Hodgkin's lymphoma. I had a bone transplant six years ago. And obviously, I've done a lot to try to save my life.

What I wanting to know is if these come back to be precancerous, what are my options?

NORTON: Well, that's something you are going to have to discuss because it depends on a lot of factors. Depends on if it can be removed entirely, for example, if what we call the margins are clear, if the rest of the breast looks clear.

This is a situation however, where at Memorial Sloan-Kettering we would definitely do an MRI to see if there is anything else in the breast that should be biopsied that we should pay attention to. So, this is a good example of a situation where an MRI would help in addition to the biopsy that you're planning to do.

COLLINS: All right, Dr. Norton, thank you so much.

NORTON: Thank you.

COLLINS: And we want to let you know when we do come back, the latest news on colon cancer as well. Some new drugs are being tested but they may be a long way from FDA approval. What to look for when we come back when we come back in just a moment.

(COMMERCIAL BREAK)

GUPTA: Welcome back to "Weekend House Call," our subject today is cancer. We've already made our way through lung and breast cancer. We're going also try to target colon cancer. It's the third most common form of cancer in both men and women, important point there. In fact, more than 57,000 Americans will die this year from colon cancer. This type of cancer doesn't often show early symptoms, but early screening tests can often detect it.

We've got a lot of questions about this as well. Again, Dr. Larry Norton joining us from Memorial Sloan Kettering to help us get through some of this information.

First question, Dr. Norton from Robin in Arkansas who writes," My dad just recently passed away from colon cancer. He only lived 12 months from the time he found out. My question is, why did this cancer spread so quickly, even with chemotherapy?"

NORTON: Well, of course, I can't say for sure. But my guess is it was pretty advanced when it was diagnosed. And this is one of the most important things we can say about colon cancer, get your colonoscopies. Finding the cancer when it is at the tip of a polyp or when you have a polyp that isn't cancer yet, but might turn into cancer and removing it prevents the disease. If people got the colonoscopies they should, the incidents of colon cancer would drop dramatically. And that's the most important thing that this person should do.

COLLINS: It is amazing what it can do when you find it early enough. That is for sure.

We have a caller coming in now, Diane in Tennessee has a question for you, I believe.

Hi, Diane.

CALLER: Hi, how are you doing? I have colon cancer. I've finished my fifth chemo treatment and one to go. What are my odds of getting it again and what can I do to keep it from reoccurring?

NORTON: Well, I mean you're doing the right thing. I can't give you your specific odds but you're doing right by getting this therapy. But one of the most important things you should know about is that there are some real advances now against this disease. Perhaps two of the most exciting advances we've had against any disease in the last few years have occurred at colon cancer at this last ASCO meeting.

A drug that attacks something that's found commonly in colon cancer called EGFR. It's an antibody that attacks that and also a drug that stops the blood vessels from growing, so you starve the tumor. Those are very exciting advances, new types of treatments.

So I think, you know, you should know that there is something in the future in case you have further problems. Right now, please you know, get your screening, get your follow-up and you should do real well.

GUPTA: Yes. And I should just point out as a side note, one of the drugs Dr. Norton is referring to, Erbitux, actually the drug that caused so much controversy with ImClone and Martha Stewart.

A lot of questions coming in. We have a phone call from Greg in California.

Go ahead sir.

CALLER: Yes, my name is Greg Gibson and I just had cancer surgery about three weeks ago. And I've had three different opinions on my -- from my oncologist what kind of chemotherapy I should go through. One says do it aggressive for six months. One says I don't have to do anything. And another one says some people do take chemo and some don't with mine so I'm kind of confused.

NORTON: Well you sound -- I don't know your case, but it sounds like you are on the borderline where you benefit from...

GREG: I had a Stage One cancer, yes. NORTON: You may benefit or not from the therapy and so you may get difference of opinion in this regard. I think you have to find an adviser here that you really do have confidence in and that you have a personal connection with and you have go with that advice.

I must tell you that the chemotherapy for colon cancer is not really very rough, if it's well done by really experienced oncologists. And it would give you, therefore some safety, some guarantee. It would improve your odds of doing well. We know that for sure in colon cancer, as we know in breast cancer and lung cancer the same thing. So you shouldn't be so afraid of the chemotherapy is the major thing.

But I think if you're not sure yet, I think you still have to talk to other people and make up your own mind. At the end of this show, I'll give you a Web site where you can get a whole lot more information and that will help you discuss this with your doctors.

GUPTA: And we'll have a chance to get some final thoughts as well from Dr. Norton when we come back. Also, you know, I just point out that it's hard often to give individual advice to patients but Dr. Norton obviously giving us a lot of information on cancer.

Some final thoughts just after this break.

(COMMERCIAL BREAK)

GUPTA: All right. Welcome back to "Weekend House Call." Dr. Norton has been our guest from Memorial Sloan Kettering.

Some final thoughts, sir.

NORTON: Well, the most important thing is knowledge. People armed with information so they can have a really productive discussion. We do have a Web site, the American site of oncology, it's called People Living With Cancer, www.plwc.org. And we've worked really hard to make this informative and up to date.

So please get information when you have to make a medical decision. Don't just trust opinions. Get information. Be armed with really good questions. And that's the best way that you can really get the kind of information you need to make decisions that's going to help you optimally.

GUPTA: All right. Dr. Norton, thank you so much...

NORTON: Thank you.

GUPTA: ... for wading through some of this very important information, difficult information.

NORTON: Thank you.

GUPTA: You really helped us out a lot today and as well as for answering our questions. There are some basic things you can do to reduce your risk of cancer. And I think that's important for people to remember. No. 1, as Dr. Norton already talked about, don't use tobacco. And even if you stopped smoking after having done it for 15 or 20 years, it will still make a difference. There are health benefits to quitting. Eat a variety of healthy foods. Stay active and maintain a healthy weight. Protect yourself from the sun and see your doctor for preventive screenings. Many cancers are detectable. Catching them early does make a huge difference.

That's all the time we have for today. Please join us again next week, next Saturday and Sunday at 8:30 Eastern, 5:30 Pacific for another edition of "Weekend House Call". This is the place for answers to your medical questions. I'm Dr. Sanjay Gupta, thanks for watching. CNN SUNDAY MORNING continues right now.

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