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HOUSE CALL WITH DR. SANJAY GUPTA

To Live Long With Lung Cancer, Early Detection Key; Some Scientists Believe Lung Cancer Deserves More Funding

Aired March 11, 2006 - 08:30   ET

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


TONY HARRIS, CNN ANCHOR: Good morning, everyone. Now in the news, an update on our developing story. Former Yugoslav President Slobodan Milosevic has dies. A tribunal press officer in the Netherlands says he was found dead in his prison cell at the U.N. detention center near the Hague. He was on trial at the Hague, charged with genocide, crimes against humanity and war crimes during the disintegration of Yugoslavia in the 1990s.
The Iraqi interior ministry has confirmed the body of a man found west of Baghdad is that of kidnapped American Tom Fox. Fox was found bound with gunshot wounds to his head. He was among four Christian peace activists kidnapped last November. There's no immediate word on the whereabouts of Fox's fellow hostages.

Right now, President Bush is meeting with Defense Secretary Donald Rumsfeld. They're discussing what to do about improvised explosive devices or IEDs in Iraq. A staggering number of troops have been killed by the so-called homemade bombs.

In the case against Lewis "Scooter" Libby, a federal judge has ordered the government to hand over some top secret White House notes. They could be used to defend Libby against perjury charges. Libby is Vice President Cheney's former chief of staff. He's accused of lying to the FBI about how he learned the identity of CIA operative Valerie Plame.

You'll love it. Scientists going wild. Perhaps the most ambitious of all NASA missions yet. The Mars orbiter is now circling the red planet. It will look for evidence of water. The folks at NASA hope it will provide the most detailed information ever about the planet.

Those are the headlines. "HOUSE CALL" starts right now.

DR. SANJAY GUPTA, CNN SENIOR MEDICAL CORRESPONDENT: Good morning and welcome to HOUSE CALL. I'm Dr. Sanjay Gupta.

Well, this morning, we're talking about what many of you have been talking about for several days now: lung cancer. Earlier this week, the widow of Christopher Reeve died of this disease. Dana Reeve was just 44 years old and had never been a smoker. We first heard she was ill last August, just days after Peter Jennings succumbed to the disease, a reminder to all of us just how lethal lung cancer can be.

The disease kills more Americans each year than breast, prostate, and colon cancer combined. That's more than 162,000 people this year alone. And the frustration is, there just doesn't seem to be any set way to screen for the silent killer.

(BEGIN VIDEOTAPE)

GUPTA (voice-over): In the world of lung cancer, early detection can mean living for years, versus surviving for months. Micki McCabe is living proof. For her, it started as a nagging cough. Doctors prescribed antibiotics for what they thought was pneumonia. No improvement.

MICKI MCCABE, LUNG CANCER SURVIVOR: I had the CAT scan, which did seem to indicate that there were some tumors. I remember asking him then, did it seem very likely that I had lung cancer? He answered me very forthrightly that, more than likely, I did have lung cancer.

GUPTA: But you see, Micki's case is rare. When it comes to lung cancer, most patients don't have the luxury of early detection. Doctors might recommend a CAT scan for a smoker over age 50, but that's where the rules end.

DR. ROBERT J. KROST, NY PRESBYTERIAN MEDICAL CTR.: It's really hard to make any recommendations about screening in a patient who is not a smoker.

GUPTA: To be even clearer, doctors have no set guidelines for lung cancer screening. Unlike mammograms for breast cancer, colonoscopies for colon cancer, and PSA tests for prostate cancer, in lung cancer, we aren't even sure who to screen.

Now CT scans have been proven to detect lung cancer better and earlier than X-rays or other diagnostic tests. So now a 50,000 patient study is trying to determine if CAT scans are the way to go. Results from that study are expected in the next few years. But for now, they're expensive and not covered by insurance.

DR. SANJAY SAINI, EMORY SCHOOL OF MEDICINE: Whether or not CT lung cancer screening with CT does, in fact, save lives, we don't know the answer to that yet.

Unfortunately, as you look inside the human body, there are things that we find that can be potentially bad. But we also find things that are of no consequence.

GUPTA: They're called false positives, irregular results that can lead people to unnecessary procedures, many of them invasive. And they're estimated to occur somewhere between 25 to 70 percent of the time. Dr. Len Horovitz says that may be true, but it's still worth the risk.

DR. LEN HOROVITZ, LUNG CANCER SPECIALIST: If there's a 25 percent false negative rate, that means that there's a 75 percent positive rate.

GUPTA: And he points out another possible virtue of a false positive. Simply having any kind of abnormality, even if it turns out to be nothing bad, can still scare people enough to make them stop smoking. (END VIDEOTAPE)

GUPTA: Now smoking is, by far and away, the leading risk factor for lung cancer. And quitting at any time reduces your risk of cancer. We're going to be talking more throughout the show about what causes lung cancer.

But we want to start with how you detect it. And joining me to answer your questions is a pioneer in lung cancer therapies, Dr. Roy Herbst of MD Anderson Cancer Center. He's a thoracic medical oncologist, a specialist in lung cancer.

First of all, welcome, doctor, to the show.

ROY HERBST, DR., LUNG CANCER SPECIALIST: Thank you very much. It's a pleasure to be here.

GUPTA: Appreciate it. We know you're very busy. You know, we've been talking a lot about lung cancer this week. As you know, Dr. Herbst, you have as well. This is your profession.

One of the big controversies has been screening. How do you know who to screen for lung cancer? How do you screen for lung cancer? Where do you stand on this issue?

HERBST: Well, as you showed, it's a very controversial issue. Certainly by the time someone has symptoms, the cancer can be large, perhaps the size of a dime or quarter. And by then, it becomes much more difficult to treat.

The trial that you mentioned, the National Lung Cancer Screening Trial had over 50,000 patients. Some got chest X-ray. The rest got CT scan. And we'll know those results pretty soon.

The pros would be to find the cancer early, remove it, and to do something to prevent it from ever coming back.

The cons, as were mentioned, are the false positives, often resulting in more diagnostic testing, invasive procedures. There are many things that could be possibly seen in the lung, such as scar tissue, infection, that could be confused. There's also the risk over a lifetime against increased radiation exposure. So that has to be considered as well. So...

GUPTA: Well, let's drill on this somewhat, Dr. Herbst, because I think people have specific questions about testing. We got a lot of e-mails. We've been soliciting e-mails about testing specifically.

Marion from Toronto asked this question. "Why does it take so long to diagnose lung cancer? I've had two brothers die who are were not told they had lung cancer until it was incurable."

And doctor, I mean, I don't know her specific story or her brothers' story, but it does seem like it's just caught too late the way things stand now. HERBST: Right. This can be a silent disease. It can spread very soon. We call that metastasis, to other organs, the liver, the lung, the bone. And by the time it causes a symptom, meaning the tumor has gotten large enough to press on something, to cause a laboratory abnormality, it's already out of the barn. It's very difficult to treat.

So it is an issue. And certainly if we had a screening test, that would be wonderful. We don't yet. Right now, patients just have to be attuned to their symptoms and their body. If something doesn't seem right, they should go to their physician. Regular yearly physicals can help with that.

But unfortunately, this is a disease where more than half the time, it's already spread. And that's a very difficult problem.

GUPTA: You know, Dr. Herbst, it's interesting because it seems like one of the basic tenets of medicine, as you just mentioned, is if you catch something early, you're more likely to beat it. You're more likely to cure it even. Is that necessarily true when it comes to lung cancer? Would a screening program actually save or prolong lives?

HERBST: Oh, it definitely would. You know, one of the biggest advances in the last year in cancer therapy has been adjuvant therapy for lung cancer, meaning that once the cancer is removed in the earliest stages, we're now using chemotherapy for this disease, very much like has been done in breast cancer for many years.

The problem is we need to find more cancers early like that. Perhaps we can even find cancers even before they're cancer, the whole idea of finding patients who are at risk of cancer and preventing their cancer with different agents.

So yes, I think that some day, I hope that we will be able to find patients as early as possible and to use some of the new methods of treatment to prevent the cancer from ever coming back.

GUPTA: And a lot of patients and potential patients are hoping there with you. You know, Dr. Herbst, these questions really raise the issue of new funding for new research.

CNN's Joe Johns went to John Hopkins Medical Center and found some frustration regarding this issue among scientists.

(BEGIN VIDEOTAPE)

JOE JOHNS, CNN CORRESPONDENT: One of the realities researchers face is that most, but not all of the people who get lung cancer are smokers, which may be part of the reason why, some scientists say, lung cancer has not gotten the kind of funding they think it deserves.

(voice-over): The facts are hiding in plain sight. Lung cancer is the deadliest form of cancer for both men and women. Almost 163,000 deaths are expected this year. But for such a deadly disease, the funding levels for lung cancer are relatively low. Compare the number of deaths to the amount of funding and the picture is stark. Nearly $14,000 for each breast cancer death, more than $11,000 for every prostate cancer death, and just $1700 per lung cancer death.

Dr. Chi Van Dang is vice dean of research at Hopkins. He says federal funding increases have failed to keep pace with inflation. He compares the process of finding a cure to other demands for spending.

DR. CHI VAN DANG, JOHN HOPKINS MEDICAL CENTER: If you look at the war on cancer in total, and compare it to other wars that we've invested in, it really is quite miniscule.

JOHNS: For researchers looking for weapons against lung cancer, it doesn't matter how patients get sick, but that doesn't change the perception the automatic conclusion of most people that lung cancer is a self-inflicted disease. Smokers assume the risk by lighting up.

Public attitude set public funding priorities. So Dana Reeves' death could be important in changing those attitudes, because she didn't smoke and still died of lung cancer.

DR. JAMES HERMAN, JOHNS HOPKINS MEDICAL CTR.: I think in some ways it's helpful when somebody without a history of smoking comes forward and is willing to speak up about it, because I think in that case it's really impossible to blame her for the development of her disease.

JOHNS: And with many battles left to fight in this war, Dana Reeves' legacy could live on in the research labs.

Joe Johns, CNN, Baltimore.

(END VIDEOTAPE)

GUPTA: All right, Joe, thanks.

You know, Dr. Herbst, you're so dependent in so many ways for the cutting edge therapies that you develop, you're dependent on funding. What needs to happen to increase funding for your lab and for what you do?

HERBST: Right. It's very important. We've made so many advances and we're doing better, but we need money to take us over the hump.

And I think that, as you show, the funding for lung cancer is perhaps less than it should be. But there is a good deal of funding coming from the government and private philanthropy.

The problem is we need more advocacy in this disease. Many of the patients who get lung cancer are so sick, they don't live long enough to become experienced advocates and to rally the troops.

The other problem, of course, is the whole idea of smoking and it's a smoking-related disease. But clearly, as we see now and we're learning more and more, it's not. There are many people who get this disease, who haven't smoked. And about half the people who get the disease have stopped smoking. So we need something to do for those people. Very important problem.

GUPTA: Well, I think what you're doing, and hopefully this show, is stimulating some advocacy out there. Really important stuff.

And coming up, Dr. Herbst tells us about the latest treatments he's been working on. Important stuff. Stay with us.

UNIDENTIFIED FEMALE: Secondhand smoke, family history, chemicals in the air, what causes this deadly cancer? And what are your chances of being diagnosed? We're helping you beat the odds on HOUSE CALL.

(COMMERCIAL BREAK)

UNIDENTIFIED FEMALE: Non-smokers make up 20 percent of female lung cancer patients. The number is lower for men. Just 10 percent are non-smokers.

Doctors haven't found an explanation for these numbers. The average age of people diagnosed with the disease is 70. Dana Reeve was just 44 when she was diagnosed.

According to a researcher at the American Cancer Institute, fewer than three percent of lung tumors occur in people younger than 45. Lung cancer kills quickly. Nearly 60 percent of those diagnosed with the disease die within one year. Dana Reeve was diagnosed just last summer.

(END VIDEOTAPE)

GUPTA: Those are some -- just some facts behind lung cancer. I want to give you some others as well.

In the past 20 years, lung cancer death among men has increased 20 percent, but increased 150 percent during the same time period for women.

And another staggering number. Deaths from lung cancer among women increased 600 percent from 1950 to 1997, 600 percent in fewer than 50 years.

Helping us battle these numbers is Dr. Roy Herbst. He's an oncologist. He's a leader in the field of lung cancer.

You know, the numbers are just numbers, Dr. Herbst. When you hear them like that, they're kind of disheartening. I know there's been a war on cancer for some time. I want to try and answer some of the questions that our viewers have been sending in about this.

Samantha in Pennsylvania asks this question. Why are women non- smokers at increased risk for lung cancer? And we saw a lot of people talking about this this week. Is there an answer for this phenomenon? HERBST: Well, we're beginning to learn that. I think one thing to stress is non-smokers, both men and women, can get lung cancer. You need to look back. Do they have passive smoking exposure? Do they work in clubs, on airplanes? So that's part of it as well.

But clearly, we're finding now that women who have never smoked do have a particular type of lung cancer. It tends to be a type call called bronchial alveolar.

The good news is that this type of lung cancer has new agents, such as a drug Tarceva, that seem to work especially well in this setting. So as we're identifying a group of patients with this disease, we're actually identifying even better treatments for a specific group. So we're beginning to subset lung cancer and treat it in different ways, hopefully more effectively.

GUPTA: Let's drill down a little bit on some of those causes. Another viewer question now from Helen in Michigan. "My dad died of lung cancer last year. He was a smoker and we breathed in our share as children. Should my sister and I be worried about second-hand smoke and be screened?"

I mean, Dr. Herbst, how big of a - I mean, we hear about second- hand smoke a lot. And it's been, you know, smoking's been outlawed in a lot of public places, but how big a factor does second-hand smoke play? And should people who are exposed frequently as children even be screened?

HERBST: Well, it is something to consider. There's both the smoke that would come right out of someone's mouth as they're smoking. And of course, the smoke that comes out the sides, and it fills a room.

But yes, the carcinogens are there. And it's really very hard to quantify how much exposure someone has.

There's a large genetic component to lung cancer and other causes as well. So I think that there's really no screening to be done for this family, but the children should be aware that they have this exposure. And if they develop symptoms or signs of a pulmonary problem, they should make their physician aware of it.

But clearly, it's something to be avoided in the future. We should really make our environment smoke free. There needs to be legislation about that. Many public places and hospitals have it, but we need to see it everywhere.

GUPTA: OK. Let's keep going with the possible causes, because I find this fascinating. Experts point to radon gas as another lung cancer-causing compound. I mean, could that be part of the rise that we're seeing in the cases?

HERBST: Absolutely. Radon is actually a major cause of the disease, probably responsible for about 10 percent of cases. Not a problem here in Houston, where we have no basements. But in cities that have underground areas, pipes, and places that are poorly ventilated, this is certainly something that needs to be looked at. There are ways to check for this. And I would recommend that people do that.

GUPTA: Yes. I mean, you get your home checked. And you can actually do something about it, I understand, such as putting gravel...

HERBST: Right.

GUPTA: ...and plastic around. Important to do, I mean, especially when you're talking about it like this.

We are talking with Dr. Roy Herbst. And we're taking all your questions about lung cancer. Just ahead, new treatments for this deadly disease.

UNIDENTIFIED FEMALE: We know it's hard to treat, difficult to diagnose, but can you help yourself? Symptoms you should be looking for. That's just ahead.

But first, this week's medical headlines in "The Pulse."

(BEGIN VIDEOTAPE)

CHRISTY FEIG, CNN CORRESPONDENT (voice-over): A new vaccine is being developed in hopes of battling the deadly bird flu virus. According to Secretary of Health and Human Services Mike Levitt, this vaccine will fight one form of a mutated H5N1 virus.

Children could benefit from another vaccine still in development, this one to prevent middle ear infections. According to a study the British medical journal Lancet, the vaccine reduces the frequency of bacterial ear infections by a third.

Christy Feig, CNN.

(COMMERCIAL BREAK)

(BEGIN VIDEO CLIP)

LANCE ARMSTRONG, CANCER SURVIVOR: The perception around lung cancer is that if somebody gets lung cancer, they smoked for 20, 30 years, then they deserve it. Well, nobody deserves cancer.

(END VIDEO CLIP)

GUPTA: It is an aggressive predator that can take lives quickly. Lung cancer is the number one cancer killer of all time, but there is some hope out there. We're finding out about the latest tests and treatments from a pioneer in lung cancer therapies, Dr. Roy Herbst of MD Anderson Cancer Center in Houston, a fellow Texas with Lance Armstrong.

Let's talk some numbers, first of all, Dr. Herbst. Once you're diagnosed with lung cancer, your five-year survival rate on average is just 15 percent. Now this improves if your cancer is found early, which doesn't happen often enough, it improves to about 49 percent, but that's still less than a 50 percent chance that if you're diagnosed with lung cancer, you'll be alive five years from now.

That means a lot of loved ones are being lost, something one of our viewers, John, is unfortunately, all too familiar with. He wrote us this.

"My wife, a non-smoker, passed away 12 years ago of small cell lung cancer. Why is this cancer so virulent? And are there better treatment methods available today?"

Dr. Herbst, we - you know, you said something very interesting to me when I first met you about how your waiting room used to be empty all the time when you first were at MD Anderson, because your patients weren't surviving. But that was changing to some extent. What are some of the new treatments you are working on?

HERBST: Right. Now there is hope. You know, the numbers you see, you know, are improving slightly and certainly for better groups of patients, even more so.

The one thing that's very important is we are treating lung cancer in a combined modality approach. By that, I mean, we're really attacking it with chemotherapy, radiation therapy, surgery. And by combining these different arenas, we're able to really have even greater benefits.

The question about small cell lung cancer, that's a type of lung cancer, about 15 percent of lung cancer. If it's found early with a disease that's still in the chest, we can combine chemotherapy and radiation therapy together, sometimes some preventive radiation therapy to the brain. And we can cure that disease in about 15 and 20 percent of the patients.

GUPTA: I mean, should most patients, when they come see their doctor about lung cancer, should they be asking to get all three of these therapies? I mean, is this something that is going to give them a better chance of survival overall if they have all three modalities?

HERBST: No, not at all. In fact, not all are applicable to any patient. But what they should do, and much of this cancer's taken care of in the community and it's done in an excellent way. But they need to make sure that all aspects of the cancer are looked at, that the diagnose and the stage are made appropriately, and that they're having access to the best treatments. And that also includes clinical trials.

Because at MD Anderson, you know, we're really trying to raise the bar on this disease by studying new agents, you know, drugs that are really targeting in on the cancer, more specific for any given type of cancer.

Because lung cancer, we saw today, there are non-smokers, there are smokers, there's radon gas. So every person's lung cancer might be slightly different. So if we understand the enemy, we can fight the war better. And I think right now in 2006, we know a lot more about what makes lung cancer cells grow. And some of the new therapies we now have, I think, are working in that direction.

HERBST: Dr. Roy Herbst from MD Anderson is our guest. More on this deadly cancer coming up. And we're checking in with our bod squad as well. Stay with us.

(COMMERCIAL BREAK)

GUPTA: Welcome back to HOUSE CALL. We're talking about cancer this morning. And one way experts will tell you to prevent it is by eating your fruits and vegetables. But we were wondering, are all fruits created equal? Our bod squad takes a look.

(BEGIN VIDEOTAPE)

HOLLY FIRFER, CNN CORRESPONDENT (voice-over): We love them, strawberries, grapes, pineapples and apples, delicious fresh fruits rich in Vitamin A and C, folate, potassium and fiber. But are fresh fruits any better for us than their dried counterparts? Registered dietician Dana Nahari says they both have similar amounts of nutrients.

DANA NAHARI, REGISTERED DIETICIAN: Because of the water content associated with fresh produce, it can fill your stomach up more. And you get less amount of calories in for the amount of volume that you're consuming.

FIRFER: Dana has a healthy take home message when it comes to people with diabetes. Fresh fruit or dried fruits can play an important role in satisfying the sweet tooth and combating obesity.

NAHARI: Fruits and vegetables are a very important part of weight management, which can help to also prevent the onset of diabetes in youth and later on in life.

FIRFER: Holly Firfer, CNN.

(COMMERCIAL BREAK)

GUPTA: For more information on cancer and specifically lung cancer, click on www.cancer.org. That's the Web site for the American Cancer Society.

Dr. Roy Herbst from MD Anderson is our guest today. Dr. Herbst, a lot of people watching today. If someone out there has recently been given the diagnosis of lung cancer, or know someone who has, how do they gain access to some of the cutting edge treatments we've been talking about today?

HERBST: Well, you know, that's very important. You know, the last few years, we've seen new agents that target tumor blood vessels, such as the drug Avastin, agents that target the way cells grow such as a drug called Tarceva. These are all developed in clinical trials. These clinical trials originated out of work at cancer centers, but the trials were done at the cancer centers and in the community.

So if someone has this disease, there is hope. There are better and newer therapies. They should ask their physicians what's available for me.

Cancer doctors are very up-to-date on the newest therapies. They have to be, because it's changing so fast. So they need to ask questions. Is there something better? And is there a reason to be referred? And if there is, centers like MD Anderson are there to help in that way.

GUPTA: There are very good cancer hospitals. There are very good doctors like yourself, Dr. Herbst. Thank you very much.

That's all the time, unfortunately, we have for today. Thanks to my guest, Dr. Roy Herbst for all that valuable information. Good luck on all your research as well, doctor. Thanks to you all at home as well for all your e-mail questions.

Make sure to watch next weekend when we do the final check in with our "new you" participants. That's right. Our pairs will do the final measuring to determine who is the biggest loser. That's next weekend at 8:30 Eastern.

GUPTA: Thanks for watching. I'm Dr. Sanjay Gupta. Stay tuned now for more news on CNN.

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