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American Morning

Understanding Cancer

Aired March 08, 2006 - 09:30   ET

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

MILES O'BRIEN, CNN ANCHOR: All right, we are dedicating -- good morning. Good to have you with us. We got about 30 minutes left. Lot of questions, e-mails, IMs coming in. People obviously very tuned in and want to have some answers. We have some people who can do that for you.
Dedicating the entire hour to understanding cancer -- as if an hour could give us enough time to understand cancer. But we're going to try to get at least a start. Continue sending the questions, CNN.com/am, or the IM is CNN_AM.

SOLEDAD O'BRIEN, CNN ANCHOR: Other stories, though, that we're watching, as well, as we monitor this. And of course we're watching the president, because we're expecting him to land in New Orleans really any minute.

(COMMERCIAL BREAK)

M. O'BRIEN: Let's get back to a special topic for this hour of AMERICAN MORNING, understanding cancer. Lung cancer in particular is our focus.

Dr. Bruce Johnson of the Dana Farber Cancer Institute is here and -- as is our senior medical correspondent Dr. Sanjay Gupta. We are well-qualified in the doctor department.

S. O'BRIEN: We are. Which means we'll get right to the IMs and right to the e-mails. We'll try to plow through as many as we can.

Here's a question -- IM. "Does lung cancer get less attention politically and socially because a majority of lung cancer cases are smokers and they 'could have done something' to keep from getting it?" In other words, you got the disease, but hey, it's your fault.

DR. BRUCE JOHNSON, DANA-FARBER CANCER INSTITUTE: The first point I'd like to make on this one is the majority of people who get lung cancer are people who have either never smoked or have quit smoking. So the public health measure that you should quit smoking cigarettes has been heated, and the majority of people that get it have stopped smoking. The -- there's about 40 percent or 50 percent of people who get it are current smokers. So that's the first one.

The second issue about whether it gets the public attention that other diseases do, for instance breast cancer and prostate cancer. And one of things that happens is we don't have as an effective voice for it, and that we don't have as many survivors, which is what was mentioned -- been mentioned before, that an awful lot of the people die from this.

And the second thing is that some people are more afraid to speak up because it's something that they deserved or something that they got because of their former smoking history.

SANJAY GUPTA, CNN SR. MEDICAL CORRESPONDENT: Let me just say one more thing I found fascinating. Between '96 and 2002, funding for breast cancer was around a billion, and for lung cancer was around $33 million.

M. O'BRIEN: Interesting. That's telling right there.

GUPTA: OK, so it's about thirty-fold. And lung cancer is a much bigger killer.

M. O'BRIEN: The constituency may not be there. All right, couple things. Two related things. One e-mail, one IM. Alice in Atlanta has this. "I started smoking at the age of 18, smoked for 25 years. I'm now 60. Haven't smoked for 17 years. Should I get a CAT scan for lung cancer?"

And sort of related to this, Lee Torrigan (ph) has an IM, who says, "How long after you quit smoking are your chances for developing lung cancer decreased and are your lungs ever back to normal?"

These are really good questions, because I think there are a lot of former smokers out there.

S. O'BRIEN: Lot of smokers who are worried.

M. O'BRIEN: You want to take it Dr. Johnson?

JOHNSON: Sure. Number one is, it's never too late to quit smoking. If a person has stopped, you'll cut your risk in half by getting lung cancer by five or ten years after you quit. And it keeps going down. And that happens whether you quit -- whether you're 30 or whether you're 60.

The second thing is that if you have the capability to quit, if you can quit by the time you're 30, which Dr. Gupta mentioned last night, is that you can cut your risk to that of a person who has never smoked within five to ten years. So the earlier you can quit, the better. And particularly if you can quit by the time you were 30, you'll go back to a non-smoker.

S. O'BRIEN: What about the part about the CAT scan? If you were a smoker and you're a smoker for a long time, should you go get a CAT scan every year, every two years, just because..

M. O'BRIEN: Yes, who should get a CAT scan?

GUPTA: You know, it's funny. And I talked -- Dr. Johnson and I were just talking about this. This is a -- you've hit on the most -- probably most controversial area. Because we don't know, really, the community, who to screen in general. We don't know if, for example, even you have a strong family history if you should get screened. Even smoking, how many years of smoking, should you get screened. And I think that's the guideline they're still trying to come up with. You said you might screen some of these patients.

JOHNSON: Well, the question about whether screening's going to help or not. The current modality that's being investigated most thoroughly is CT scanning, or computerized tomography of the chest. And one of the things that we've screened with before is chest X-rays, where you need to have to have something that's about a half an inch across or a centimeter to be able to see it.

When you do these CT scans, you can see it as small as two millimeters, or one tenth of an inch. And the majority of people you pick up have the earliest stage lung cancer. And the trial to test to find out if it actually cuts down on cancer deaths is currently ongoing. It's called a National Lung Cancer Screening Trial and it's randomized 50,000 patients to either get screened with a CT scan or a chest X-ray. And the results of that are expected in the next one to two years to give us some guidelines about whether it will help or not.

GUPTA: I mean, it is remarkable. You think about it, you have mammograms for breast cancer, you have PSA tests for prostate cancer, colonoscopies...

M. O'BRIEN: But nothing yet.

GUPTA: The biggest killer of all, we don't have a screening test.

M. O'BRIEN: Sort of on this same front, from Pale Site (ph) on IM: "Does chest pain near the esophagus and pain while breathing indicate the possibility of lung cancer?" We talked about coughs, but are there any other things that people should be looking out for?

JOHNSON: Well, one of the most common symptoms that people have is -- some people call it chest pain, other people call it epigastric pain. You get -- and it's after meals. And that's one of the most common medical complaints, and that's not something that you necessarily have to think of lung cancer.

The parts of chest pain that are associated with lung cancer is ones that are a bit higher up, and they tend feel like it's in the bone or being pressing on the bone. And that's more of a pain that's related to lung cancer, rather than one that's lower down.

M. O'BRIEN: All right. We have time for one more?

S. O'BRIEN: Yes. I think we got time. Let's get another one.

M. O'BRIEN: Yes. Do this one. This is a good one. From Brooklyn Bum.

S. O'BRIEN: "Both of my parents are heavy smokers. I'm 23 now. They smoked as long as I can remember." OK, so this is someone who's clearly getting second-hand smoke his whole entire life. My question is, how do I decrease my risk of getting lung cancer from all the second-hand smoke?

GUPTA: You know, it's the same thing Dr. Johnson was saying. Getting out of the exposure now today is probably going to decrease your risk somewhat. Second-hand smoke is certainly a potential risk factor for lung cancer. And people have been talking about this for years. Second-hand smoke is a risk factor for all sorts of lung- related diseases. But if you want to decrease your risk, get out of the second-hand smoke. I mean, you have to do that.

M. O'BRIEN: Or get the parents to get out of the house when they smoke, or something.

GUPTA: Yes, or get them to stop smoking, even better.

M. O'BRIEN: That would be even better.

S. O'BRIEN: On all fronts, right?

M. O'BRIEN: Keep them going. We got about 50 IM boxes open.

(CROSSTALK)

S. O'BRIEN: I have bad eyes, so I have to practically lean over to see what we're doing here. But we're going to get to all these IMs if we can. We'll plow right through them. We're going to get to our e-mail questions, as well. CNN.com/am, or if you're IMing, CNN_AM.

Quick break and we're back in just a moment.

(COMMERCIAL BREAK)

M. O'BRIEN: Live pictures now, courtesy of our affiliate in WWL. New Orleans, Louisiana is the dateline. Louis Armstrong International Airport. And as you with probably plainly make out, that is the door to Air Force One. The president is there on his tenth trip to the Gulf region, beginning in New Orleans. He'll tour that city, and see what progress has been done, and in many cases he will see there's a lack of progress, depending on where he goes.

And onward we will fly to the Gulfport, Biloxi part of the world, which is equally hard-hit in many respects. Of course they didn't have the levee failure there. But in parts of that region up the Gulf almost, as if a bomb was dropped on the coastal regions. And still, as it was more than six months ago now after Katrina and then Rita came through. We will keep you posted on the president's journeys. He obviously hasn't disembarked from Air Force One. We'll be watching his progress as he continues his 10th trip to the region -- Soledad.

S. O'BRIEN: In the meanwhile, we continue our discussion about cancer. Every three minutes, believe it or not -- every three minutes -- another person is diagnosed with lung cancer. More than 20,000 of them will be nonsmokers, and most of them will be women.

M. O'BRIEN: Sorry, go ahead.

S. O'BRIEN: No, no, you. M. O'BRIEN: I apologize.

Melissa Zagon heard that diagnosis six years ago. Today she is raising money for research as the head of the Longevity Foundation. She joins us from Chicago.

Melissa, what's it like when you get a diagnosis like that?

S. O'BRIEN: When you haven't smoked?

MELISSA ZAGON, DIAGNOSED WITH LUNG CANCER: It comes out of nowhere. It was so surprising. I had never smoked. I was 32 years old, had a 2-year-old daughter, and it changed my entire life. It was devastating.

S. O'BRIEN: What went through your mind, I mean, especially when you're think about your 2-year-old daughter, and someone says, you know what, your best bet is you're going to have a year to live.

ZAGON: And, frankly, they never told me that. I didn't ask, but I did look up the statistics, and I knew the prognosis was grim. The first thing I did was make sure I had my affairs in order. I rewrote my will. I took care of work, and then I hoped for the best. I researched every possible treatment option. I had eight oncology consults to make sure that I was getting the best treatment I could possibly get, and I particularly researched clinical trials because I wanted to make sure that I was looking at the new and novel treatments that might have some benefit for me.

M. O'BRIEN: Well, you know, it seems to me the downside of that, Melissa, is that you could almost get too much advice, conflicting advice. Did you find yourself kind of confused at a certain point as to what to do with all the possibilities out there?

ZAGON: I did. I was fortunate to have a brother, still have a brother, who is a doctor, who was able to help me wade through it. And it was a lot of information. I did figure it out. But it was a challenge.

M. O'BRIEN: How have you -- I'm sorry, finish up.

ZAGON: I was going to say, and it's worked out very well for me, because of the new drugs that have come out just recently over the past five years. I've been one of the few who have been lucky enough to survive for so long.

S. O'BRIEN: Melissa, let me you a question. When you heard, as we all did, that Dana Reeve had died, and leaving behind a 13-year-old son, I've I got to imagine some news like that has just got to hit you like a ton of bricks.

ZAGON: Absolutely. I worry about my daughter, Hannah (ph), everyday. Most of my life is devoted to making sure that she is well- cared for. When I'm able to do it, which most of the time I man, it's great. And when I'm going through treatments, my number-one concern is to make sure that she's cared for. S. O'BRIEN: Oh my gosh, it must be so difficult. I cannot even imagine.

M. O'BRIEN: Do you feel as if you have licked it, or do you feel that this is just a battle that you will fight for the remainder of your life?

ZAGON: This is a battle I will fight for the remainder of my life. I don't know how long my life will be. I've beaten the odds far. I don't imagine any doctor would have given me more than 12 or 18 months to live, and it's been just about five and a half years now. It's been constant treatment, either chemotherapy or radiation to my brain, because i have a brain metastasis, or just a maintenance drug to keep the cancer from spreading. It will be a battle I fight, and it's a battle that others are fighting as well, and that's why I'm trying to raise money for research, so that we don't have to keep fighting, so that we can find a treatment, and then ultimately a cure.

S. O'BRIEN: One of the voices -- I mean, we've been talking about that, in some cases -- not the number of survivors, to sort of get that critical mass going, to raise the money. I think it's just shocking. It's appalling, frankly, that there are so -- so much money goes into breast cancer research, which is terrific, but it's a tiny percentage for what's going into lung cancer research as well.

GUPTA: It's considered a smoker's disease still.

S. O'BRIEN: Oh, that's terrible.

GUPTA: It's nice there are people like her out there.

S. O'BRIEN: There you go.

Thank you for talking with us. Of course she's the chairwoman of the Longevity Foundation. We appreciate you talking with us, Melissa, and best of luck to you and your family as well.

ZAGON: Thank you very much. Thanks for having me.

S. O'BRIEN: We've got some news just into CNN. We want to give you an update now. Arrests have been made in connection with that string of Alabama church fires. Federal law enforcement sources are telling CNN that two people have been rested, a third suspect is being sought, arrested in Birmingham, Alabama. They are going to appear, we are told, later today in federal court in Birmingham. So as soon as we get more information about progress being made in this investigation in those Alabama church fires, we're going to update you on that well.

Up next, we are back with Dr. Sanjay Gupta and of course Dr. Johnson as well. They answer more of your e-mail questions.

That's just ahead. Stay with us.

(COMMERCIAL BREAK) S. O'BRIEN: Welcome back. And we are back with our experts, Dr. Sanjay Gupta and also Dr. Bruce Johnson from the Dana Farber. Nice to see you both, and thanks for thinking around for the entire hour, by the way.

Let's get right to the questions and answer as many as we can in the few minutes we have remaining.

First this one. "Are there any speculations as to why the cancer rates for minorities are so much higher than for whites?"

JOHNSON: One of the things that we've studied -- and one of my colleagues, Chris Lathan (ph), has looked into this -- is number one that the death rates from lung cancer are higher in black men than Caucasian men. And part of it is cigarette smoking.

The second thing, and one that concerns us quite a bit is that the outcome is worse. And one of the things that they're studying is to find that out. One of the reasons, maybe, is that it may be that people don't get as much invasive staging to find out if the lung cancers are indeed resectible (ph) and may not have the kind of access to care that leads to improved survival rates.

S. O'BRIEN: So it could be like a socioeconomic issue that's linked to race, as opposed to a medical -- that's somehow genetically or biologically the tumors are more aggressive in black men, is what you're saying?

JOHNSON: That's correct. The -- in black men, the smoking rates are a bit higher, number one, and number two, the lung cancer rates are higher. And after they get it, when they get treated, their outcomes are a bit worse.

M. O'BRIEN: I got good follow-up to that. These are two related IMs. "My grandfather smoked for over 50 years, died without any smoking-related diseases like other cancers. How much of it is genetic?"

And then related to this. "I read that only 10 percent of smokers get lung cancer." Is that really true? That sounds low.

GUPTA: Well, you have -- you know, if you look at the country, have either 100 million either smokers or former smokers right now in the country, and you have about 170,000 cases of lung cancer a year. So that might be about right, actually, in overall numbers.

JOHNSON: The other thing that happens, too, is that -- as we mentioned before -- most people who have smoked at some time in their life have quit, so that the exposure to cigarette smoke. The people who start smoking and keep smoking through their 70s run about a 20 percent risk of getting lung cancer, one in five. They also increase their risk of dying from stroke and heart attack. And so it has quite an impact on their life that goes beyond just getting lung cancer.

S. O'BRIEN: So you could die of a heart attack but actually be a smoker. And that could very heavily linked. Let me ask you about some other causes or potential causes.

This is a question from Alison (in Atlanta). "Can asbestos cause lung cancer?" And also Ashley in New York says "What about marijuana? Does that cause lung cancer." And a final here -- let's just get all in, because I think they're kind of linked. Patty in Georgia says, "Are lung cancer patients good candidates for lung transplants?"

GUPTA: Let's just trade off. I mean, asbestos, first of all, can cause different types of lung cancer. There's two types of lung cancer, typically, small cell and non-small cell. The name's probably not that important. But asbestos has been linked to both of those. It also can cause a condition called mesothelioma, which is a different type of lung disease which can be very problematic, very difficult to treat, as well.

JOHNSON: That's right, and most of the information about asbestos comes from industrial exposures before they began making the workplace safer for people who have exposed to asbestos.

S. O'BRIEN: What about marijuana?

JOHNSON: Well, as a lot of people know, marijuana -- smoking marijuana is against the law. And if you smoke -- you know, people who are heavy smokers will smoke between one to five packs a day. And if you're smoking one to five packs of cigarettes a day. You're spending almost every waking moment puffing on it. And since it's difficult to smoke marijuana in public places without being arrested in the United States, it's difficult to maintain those kinds of exposures and they tend to be relatively light.

GUPTA: It's hard to study, because people aren't going to come out and say...

S. O'BRIEN: Yes, I would imagine.

M. O'BRIEN: Here's one that's interesting. Referring to Dana Reeve. "What about the stress of caring for and then watching her husband die?" This is a difficult thing to pin down, I know, scientifically. But do you think that has some effect here at all on her health?

GUPTA: There is something called caregiver burden, bereavement effect, the same thing. It's actually been studied somewhat -- it's actually been older couples, for the most part, over 60 years old. But they actually found that people who either had a spouse who had died or a spouse who was very ill that they cared, it had a significant effect both physically and psychologically, so much so that two-thirds of the caregivers actually were either hospitalized themselves. One third of them actually died within a decade. That may be related to this.

S. O'BRIEN: Usually an older population.

GUPTA: This was a study of over 60, right.

S. O'BRIEN: Well, you guys, we're out of time. And we could sit around and talk about this for hours. Thank you so much.

(CROSSTALK)

S. O'BRIEN: Excellent questions, too, from our audience. We appreciate that. Dr. Gupta, Dr. Johnson from the Dana Farber. We certainly appreciate it.

GUPTA: Doctor, doctor.

S. O'BRIEN: Doctor, doctor, doctor. Dr. O'Brien.

M. O'BRIEN: Dr. Klein (ph), Dr. Howard (ph). All right. Thanks for being with us.

S. O'BRIEN: If you want more information about anything we've discussed about lung cancer or really any cancer, log on to the American Cancer Society's Web site. It's at ACS.org. If you've got questions about second-hand smoke, radon, you can go to EPA.gov. For general questions, a really good Web site is this one. Lungcanceralliance -- that's one word -- dot-org.

Quick break. We're back in just a moment.

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