Speaker 1: My mother lost her battle to cancer when she was
Speaker 1: fifty six years old, and so here I am at
Speaker 1: fifty seven. So my fifty seventh birthday was so important
Speaker 1: because I wanted to reach and bypass that milestone. She
Speaker 1: found out she had cancer right at the same age
Speaker 1: that I did at. My name is Donna Otis. I
Speaker 1: live in San Diego, California. I am a stage four
Speaker 1: metastatic cancer fighter. How do I say this without crying? Um,
Speaker 1: I'm a mom, I'm a single mom. I love life
Speaker 1: and cancer will never define me. Hi. Everyone, I'm Katie
Speaker 1: Curic and this is next question. You know, March maybe
Speaker 1: calling cancer Awareness month, but as many of you know,
Speaker 1: my mission has been to increase awareness of this second
Speaker 1: leading cancer killer every day of the year. So we've
Speaker 1: put together a special episode on this topic with the
Speaker 1: hopes that it will motivate many of you to call
Speaker 1: your doctor and get screened. As a lot of you
Speaker 1: all know, my first husband, Jay died gosh twenty three
Speaker 1: years ago. He had been diagnosed with stage four calling cancer.
Speaker 1: He battled the disease for nine months and then died
Speaker 1: at just forty two. I've been advocating for early detection
Speaker 1: ever since I even got a colonoscopy on television. I'm
Speaker 1: a little nervous that in our normal well today. I
Speaker 1: wanted to see where we are in terms of research, detection,
Speaker 1: and treatment, and also understand why our country still has
Speaker 1: such vast health disparities that leave black of Americans more
Speaker 1: susceptible to this disease than others. You'll be hearing from
Speaker 1: two of the top scientists in this area a bit later,
Speaker 1: but first I wanted to start with my friend Donna.
Speaker 1: Early detection is so important. Donna Otis is the CEO
Speaker 1: of a private golf club in San Diego, and a
Speaker 1: couple of years ago we got to talking and I
Speaker 1: learned about her calling cancer diagnosis and preparing for this episode.
Speaker 1: I asked if she would be willing to share her story,
Speaker 1: and she bravely agreed. I did not get a colonoscopy
Speaker 1: at fifty. I did one of those um colonnaise, you know,
Speaker 1: just kind of those quick tests, and nothing came up.
Speaker 1: I was in San Francisco at the time. I was
Speaker 1: fifty one, and I actually so not to get to graphic,
Speaker 1: but it's reality. I had blood in my stool and
Speaker 1: I got did eat something wrong? And so I did
Speaker 1: the let the hospital know. They sent me a kit
Speaker 1: and it came back negative. So I said okay. And
Speaker 1: then fast forward another year and I was fifty two
Speaker 1: and I noticed again it had stopped. And then I
Speaker 1: noticed again, so I went back to the hospital and
Speaker 1: they said, okay, try try another stool um sample. Tests
Speaker 1: I did that came back negative. And then one day
Speaker 1: in August two thousand eighteen, I just started to feel
Speaker 1: like my stomach wasn't right um and I was in
Speaker 1: some pain in the intestinal area. And then I said, well,
Speaker 1: let me just go see and check it out. Go
Speaker 1: to the doctors. And that's when they said, you know,
Speaker 1: let's let's do a pollnoscopy. And you know when I
Speaker 1: woke up and they said, h we see something in
Speaker 1: a little strange um. Let's let's take a look at
Speaker 1: it a little closer, and let's get a biopsy. And
Speaker 1: you know, it took a couple of months to get
Speaker 1: all the biopsies and the tests done, and I, oddly enough,
Speaker 1: I happened to be driving to Santa Barbara, UM with
Speaker 1: with a friend of mine and you know, you can
Speaker 1: open everything up on your on your chart. It's the
Speaker 1: day and age of technology now you can opt not
Speaker 1: to look at it and say I'm going to wait
Speaker 1: until the doctor preasum into the office. But everything, your
Speaker 1: test results, your CT scans, all of that comes right
Speaker 1: to your phone now. And I opened it up in
Speaker 1: clear as day, there's that word cancer. I put my
Speaker 1: phone down and I didn't want to say anything, and
Speaker 1: I opened it back up again, and not only was
Speaker 1: it cancer, but it was labeled as stage three, and
Speaker 1: I thought crap. I didn't want to call anybody. I
Speaker 1: just wanted to try and digest it. And my I
Speaker 1: went in to fight flight mode, like okay, what am
Speaker 1: I going to do with my twenty two year old daughter?
Speaker 1: She was twenty at the time, and how am I
Speaker 1: going to take care of things? And that's just that
Speaker 1: was my immediate reaction, like crap, I'm not ready. And
Speaker 1: the appointments, biopsies and CT scans that followed, Donna got
Speaker 1: more bad news. Sorry, it's now it has traveled to
Speaker 1: your liver. And then the next blow after the full
Speaker 1: um CT scan was well we think it's in your
Speaker 1: lungs too, So um I said, okay, this really can't
Speaker 1: be happening. So I went into this whole disbelief mode. UM,
Speaker 1: and then being a single mom. You know, what am
Speaker 1: I going to do with my job? And how am
Speaker 1: I gonna live? You know, just all those things come
Speaker 1: rushing through um, rushing through your head. And someone said
Speaker 1: to me, you know, Donna, you really don't know how
Speaker 1: strong you are until the only thing you can be
Speaker 1: is strong. Donna's co workers and friends rallied around her.
Speaker 1: She asked for help and gathered her village. Meanwhile, she
Speaker 1: got her treatment plan, and before she knew it was
Speaker 1: on the cancer diagnosis roller coaster ride. This started chemo
Speaker 1: in December of two thousand eighteen, and then I did
Speaker 1: chemo all the way through till September. Of My first
Speaker 1: round of chemo was okay. UM. The second round, I
Speaker 1: had a severe allergic reaction. I couldn't walk or talk.
Speaker 1: You physically cannot touch anything remotely cold, not even a
Speaker 1: door knob, this huge, painful, tingling sensation. My eyes completely
Speaker 1: shut because of the nerve endings. You go like this
Speaker 1: and you get a handful of hair. I couldn't take
Speaker 1: care of myself. I really just wanted to die. I
Speaker 1: think at that point I just said, okay, let's let's
Speaker 1: pack it up. Let's let's get anything situated, let's get
Speaker 1: a living will. And UM. I had those tough conversations
Speaker 1: with my daughter to say, listen, UM, we're going to
Speaker 1: fast track your life a little bit. You're going to
Speaker 1: have to be an adult fairly quickly here, and you
Speaker 1: forget about things like teaching your kid some of your
Speaker 1: old mom's recipes. Um, you forget to teach your kid,
Speaker 1: or you think about it like, well, I can always
Speaker 1: teach her. You know how to sew a button on
Speaker 1: a shirt. Donna found the strength as she has at
Speaker 1: every turn, and the treatments continued. I went through radiation,
Speaker 1: thirty rounds of radiation. Skin turn start extremely painful. After
Speaker 1: you leave, you have to wear a pump for forty
Speaker 1: eight hours. So you know, when you go to work
Speaker 1: and you see the tube hanging and everyone's looking at
Speaker 1: me like you're doing okay, And I said, don't feel
Speaker 1: sorry for me, don't treat any different. I've gone through
Speaker 1: two surgeries. Um. The first surgery was to remove part
Speaker 1: of my liver, to remove my rectum. The post surgery
Speaker 1: and waking up to this bag that is out of
Speaker 1: your body and you can see your intestine which is
Speaker 1: out of your body as well. Um, it's pretty difficult.
Speaker 1: And the type of clothes you have to wear, you
Speaker 1: can only wear certain very bad you know, loose and
Speaker 1: baggy clothes, and you have to time your release of
Speaker 1: your bag at a certain time because sometimes it could
Speaker 1: just really blow up. But this I made this bag
Speaker 1: define me. Um, and it took over me for for
Speaker 1: about a year. Um, pretty feeling pretty sad, feeling sorry
Speaker 1: for myself. But then um, but then my daughter said
Speaker 1: to me, but Mom, you wake up every day on
Speaker 1: this side of the world. Don't worry about the bag.
Speaker 1: And then my second surgery was in November of to
Speaker 1: do the reversal, meaning put my intestines back, get everything
Speaker 1: all attached. And then after radiation, um, you know, you
Speaker 1: do the surgery and then you go into chemo mode. Um.
Speaker 1: And so after one chemo treatment your body gets sort
Speaker 1: of immune to it, and then they shift you to another.
Speaker 1: And then the other was another strong poisonous chemo that
Speaker 1: reaked havoc um. But I had to do it, and
Speaker 1: that almost left me with complete hair loss. And then
Speaker 1: from there, you know, we're just fighting for time. And
Speaker 1: so I got the final news was not the final news.
Speaker 1: But the news was, Donna, you will never be cured
Speaker 1: of cancer. You will have to do chemo for the
Speaker 1: rest of your life until you pass. And we can't
Speaker 1: determine whether it's two or three years. Um, it's hard
Speaker 1: to say. And so you know, you keep on getting.
Speaker 1: You know, you're like one of those um those toys
Speaker 1: as a kid that's a plastic thing. It's got a
Speaker 1: base and you keep on knocking it over, but it
Speaker 1: stands right back up. Well, I felt like I was.
Speaker 1: I was one of those um but I got right
Speaker 1: back up because I had no choice. Recently, Donna got
Speaker 1: the chance to join an immunotherapy trial, which marks a
Speaker 1: new experimental face of treatment, one that's giving her and
Speaker 1: everyone who loves her hope. We're going to see how
Speaker 1: it goes. The doctor's like, hanging there, Let's just try
Speaker 1: this immuno therapy, blast out that tumor and then uh,
Speaker 1: and then we'll kind of take it from there. So
Speaker 1: here I am today, and I'm gonna live till tomorrow,
Speaker 1: and I'm gonna keep on going. This May, Donna is
Speaker 1: taking an important trip. She'll travel to Kentucky and watch
Speaker 1: her daughter graduate from college. A huge emotional milestone for
Speaker 1: both of them. That was what I was living for.
Speaker 1: That was my first target was when they gave me
Speaker 1: two years and I was like, crap, I won't be
Speaker 1: able to see her graduate and that was in my head.
Speaker 1: So um, so that's done pretty quick here in a
Speaker 1: couple of months, and then my my next target is
Speaker 1: is to to try and get to If I can
Speaker 1: get to sixty years old, that would be. That would
Speaker 1: be that's my next school. After after she graduates, we'll
Speaker 1: be right back. We begins tonight with the sudden and
Speaker 1: very tragic debt sending shot waves across the country devastating
Speaker 1: and shocking news that actor Chadwick Boseman has died at
Speaker 1: forty three after a valiant four year fight. Chadwick Boseman
Speaker 1: lost his battle with colon cancer Friday. For four years,
Speaker 1: Chadwick Boseman had been quietly fighting colon cancer, making something
Speaker 1: like seven films while enduring countless surgeries and chemotherapy. When
Speaker 1: the Black Panther actor died in August of it was
Speaker 1: devastating to those who loved him, as well as his
Speaker 1: legion of fans. It's not just a loss that we're
Speaker 1: feeling we're going to feel his absence. His absence, but
Speaker 1: his death at such a young age also put colon
Speaker 1: cancer and some grave statistics in the spotlight. One that
Speaker 1: more young people are being diagnosed with colon cancer than
Speaker 1: ever before, and two that Black Americans are more likely
Speaker 1: to get colorectal cancer and more likely to die from it.
Speaker 1: Black Americans have the highest colorectal cancer incidents and mortality
Speaker 1: rates of all racial and ethnic groups in the United States.
Speaker 1: Dr Edith Mitchell is a professor and oncologist at the
Speaker 1: Sydney Kimmel Cancer Center at Thomas Jefferson University in Philadelphia.
Speaker 1: We asked her why why is the black community hit
Speaker 1: hardest by this disease? So nobody knows for sure. What
Speaker 1: is known is there is a word called red lining.
Speaker 1: Holic is on loans and the sale of properties, so
Speaker 1: that Blacks were relegated to certain parts of the city
Speaker 1: where there may have in a higher number of factories
Speaker 1: and other carcinogens, as well as poor water quality and
Speaker 1: other socioeconomic conditions called the social determinants of health. There
Speaker 1: were fewer healthcare facilities, lack of supermarkets, drug stores, and
Speaker 1: other components of the healthcare arena. When I tell patients
Speaker 1: that I want them to eat fresh fruits and vegetables,
Speaker 1: but there are none nearby where they live, that's a
Speaker 1: social determinant of health. And consequently, all of these components
Speaker 1: contribute to the development of cancers. So if we're going
Speaker 1: to as a country change healthcare display charities, we really
Speaker 1: need to focus on not only the disease process and medications,
Speaker 1: but on lifestyle that contributes to who we are. We
Speaker 1: are who we eat, and consequently, one zip code determines
Speaker 1: more effectively and more accurately how long you will live,
Speaker 1: as opposed to your genetic code, which you inherit from
Speaker 1: your parents. So we've got to change that so that
Speaker 1: our zip code is not the greatest determining factor on
Speaker 1: the disease processes that are experienced in a community, as
Speaker 1: well as the duration of life. Dr Mitchell says it's
Speaker 1: important to highlight the fact that black men are forty
Speaker 1: seven percent more likely to die from calling cancer, partly
Speaker 1: because they are still not getting screened at the same rates.
Speaker 1: Is culture. There is also the history the Tuskegee study
Speaker 1: had only black men, it was not discussed with them,
Speaker 1: and therefore they passed on the disease to other sexual
Speaker 1: partners and therefore put really three generations at risk. So
Speaker 1: black men have a history of mistrust, and one thing
Speaker 1: that we have to instill in people is trust of
Speaker 1: the health care system. Black men prefer going to black doctors,
Speaker 1: and yet for the United States of practicing clinicians in
Speaker 1: only five percent we're black. Yet blacks constitute of the
Speaker 1: United States population. So therefore we need to develop more
Speaker 1: diverse clinicians so that there is a greater percentage of
Speaker 1: Blacks in the population. With so few black doctors, black
Speaker 1: patients don't always get the care they deserve. Implicit bias
Speaker 1: are Explicit bias really affects the interaction between the patient
Speaker 1: and the physician as well as others on the healthcare team,
Speaker 1: so that we need to understand people who are different
Speaker 1: or who may look different from us, and we have
Speaker 1: to learn how to communicate effectively with all patients. It's
Speaker 1: well recognized that in many clinical situations that black patients
Speaker 1: and other minority patients are treated differently. For example, there
Speaker 1: are studies that show that physicians and other clinicians spend
Speaker 1: less time in a examination room with a black patient
Speaker 1: as opposed to a white patient are to someone who
Speaker 1: doesn't speak English as their primary language. There was also
Speaker 1: a study UH and several studies showing that black patients
Speaker 1: did not receive the recommendations for treating an options as
Speaker 1: white patients. For example, patients who had stage one lung
Speaker 1: cancer were offered different recommend nations and not surgery as
Speaker 1: often as white patients. And of course there could have
Speaker 1: been other reasons, but for stage one lung cancer, surgery
Speaker 1: is the major treatment and can be curative. Yet the
Speaker 1: black patients were not offered surgery. Black patients are offered
Speaker 1: clinical trials less frequently, and in many cases it's the
Speaker 1: implus said bias with the assumption that black patients won't participate.
Speaker 1: So while you understand that there can be individual bias
Speaker 1: in health care delivery, there can also be institutional bias.
Speaker 1: So we really have to approach all of those topics
Speaker 1: to make sure that we have the three sixty that
Speaker 1: is a full circle of all of the potential areas
Speaker 1: where we can intervene to improve healthcare delivery. A new
Speaker 1: test is not going to change red lining are the
Speaker 1: lack of supermarkets and other potential components of the atmosphere.
Speaker 1: It's not going to get rid of the factories and
Speaker 1: the exhaust We've got to look at the whole picture
Speaker 1: and make sure that individuals living in certain zip codes
Speaker 1: are not disenfranchised from a good healthcare arena, that they
Speaker 1: have a good place to live, and making sure that
Speaker 1: the overall community is healthy. And therefore we've got to
Speaker 1: change some of the social determinants of health so that
Speaker 1: everybody has equal opportunity to live in a healthy environment
Speaker 1: and a healthy neighborhood. We have a moral imperative to
Speaker 1: fix this. Dr Charlie Fuchs is an oncologist who is
Speaker 1: now leading the hematology and oncology team at the biotech
Speaker 1: firm genem Tech. And it starts on many fronts, which
Speaker 1: is making sure that these communities have the proper access
Speaker 1: to information, education, nutrition, prevention, care, and I frankly, access
Speaker 1: to clinical trials. You know, we talked about how low
Speaker 1: the rate is in the US of patients in general
Speaker 1: participating in clinical trials. You know, you look at all
Speaker 1: these trials across the realm and it's five eight percent,
Speaker 1: maybe ten percent African American. Well, we got to fix that, right,
Speaker 1: I mean, because I was involved in a study because
Speaker 1: the common perception and in fact is that Black Americans
Speaker 1: diagnosed with calin cancer who get treated have a worse outcome.
Speaker 1: And so what we did is we looked at a
Speaker 1: large clinical trial database that enrolled African Americans and whites.
Speaker 1: And as you know, within a clinical trial, everything is prescribed,
Speaker 1: the treatment, the follow up, everything, because you've got to
Speaker 1: follow the menu because it's a clinical trial. And in
Speaker 1: the context of that clinical trial, there's no difference between
Speaker 1: white Americans and Black Americans, meaning that there is no
Speaker 1: biologic difference, and if they get access to proper care,
Speaker 1: they do just as well. So it's a moral imperative.
Speaker 1: The fix here is not complicated. It's access to care,
Speaker 1: it's access to education, it's all the things that are
Speaker 1: plainly obvious. When we come back, we'll have more with
Speaker 1: Dr Charlie Fuchs. We'll talk about the COVID effect on
Speaker 1: cancer screening as well as new research and treatment. That's
Speaker 1: right after this. I've known Dr Charlie Fuchs for a
Speaker 1: few years now. He's a trusted and respected oncologist who
Speaker 1: has worked with us at Stand Up to Cancer. He
Speaker 1: was the director of the Yale Cancer Center, but he
Speaker 1: recently made the jump to the research and product development
Speaker 1: end of the health spectrum at the biotech firm Genete
Speaker 1: Tech in San Francisco. So he is I think the
Speaker 1: perfect person to sit down and talk about where we
Speaker 1: are now with colon cancer and what the future looks like.
Speaker 1: Here we are after the pandemic or on the verge
Speaker 1: of being post pandemic, and so many people did not
Speaker 1: get screened and that is translating to a lot of
Speaker 1: cancer deaths if we don't really sound the alarm. So
Speaker 1: are you concerned about this period of time and about
Speaker 1: people putting off screening and what is the impact of that? No, Katy,
Speaker 1: I'm I'm really concerned. The fact is is that if
Speaker 1: every year American Cancer Society puts out the cancer statistics
Speaker 1: for the year, you know cancer in particular. Last January
Speaker 1: was cancer statistics, and you know, as you know, in January,
Speaker 1: we didn't know what we were about to get ourselves
Speaker 1: into with the pandemic. And I was actually interviewed um
Speaker 1: about the statistics in January which showed this progressive decline
Speaker 1: in cancer mortality decline and cancer incidents, and one of
Speaker 1: those was colon cancer. Right, We've made so much strides
Speaker 1: over the past three decades with early detection, with treatment, UM,
Speaker 1: with understanding the genetics and UM. You know, we were
Speaker 1: looking forward to continue declines. We're clearly not going to
Speaker 1: see that next year because the data are compelling. For instance,
Speaker 1: study showed that in the first three months of the pandemic,
Speaker 1: there was an eighty percent drop in cancer screening. So
Speaker 1: we're at of where we would have been the year before,
Speaker 1: and you just don't rapidly recover from that. And I
Speaker 1: can tell you, you know, what are we seeing. We're
Speaker 1: seeing people not getting screened. We're gonna be seeing sadly,
Speaker 1: people who are now presenting with cancer colon cancer at
Speaker 1: later stages, and we're going to see a backtrack. I
Speaker 1: don't think, you know, I think we need to be
Speaker 1: prepared for that reality. And what we have to do
Speaker 1: is just focus on what can we do today, which
Speaker 1: is returned to screening. And as you know, the American
Speaker 1: Cancer Society, a number of organizations, even the Biden administration
Speaker 1: is now pushing that, and we have to remind people
Speaker 1: that it is safe to go back, that it's safe
Speaker 1: to get screened, that patients who are concerned about symptoms
Speaker 1: need to follow up with their doctor. Patients who are
Speaker 1: being treated for cancers shouldn't hesitate to get get their
Speaker 1: therapy on time in its full course. And these are
Speaker 1: the things that we have to do, while at the
Speaker 1: same time we have to make sure that we enable
Speaker 1: all our researchers to continue their work despite all the
Speaker 1: complications of the pandemic. You should get your first calling
Speaker 1: oscarpy or your first calling cancer screen at at age five,
Speaker 1: according to the American Cancer Society and other organizations. Um,
Speaker 1: why was that lowered? That's exactly right, And just to
Speaker 1: be clear clear, it's age forty five for an averageous
Speaker 1: person because we could talk about what happens if we
Speaker 1: have a family history, which should be younger. But um,
Speaker 1: it was fifty, and why is it now forty five?
Speaker 1: Because as you know, there's this very alarming trend of
Speaker 1: an increase in younger people with calling cancer that is
Speaker 1: under fifty, under forty and there's only speculation as why
Speaker 1: that is. But it's rising at a rate faster than
Speaker 1: probably any other cancer that is calling cancer under age fifty. So,
Speaker 1: thank goodness, various organizations, American Cancer Society among others, have
Speaker 1: now reduced it and hopefully that will have an impact.
Speaker 1: But this trend is alarming. It's alarming, and it's also
Speaker 1: sort of maddening that you all, no offense, Charlie, haven't
Speaker 1: figured it out why this is happening. I mean, I
Speaker 1: know there's a lot of people studying this. This has
Speaker 1: been going on for a couple of years now, and
Speaker 1: why are we closer to understanding why this is happening.
Speaker 1: I've heard obesity, you know, for years that that was
Speaker 1: one of the culprits. But it seems to me there
Speaker 1: must be other things going on here, and what's taking
Speaker 1: so long to figure it out. I think it's a
Speaker 1: fair criticism. I think part of it is obesity. Now,
Speaker 1: when I say that, when I give a lecture to
Speaker 1: allay audience, I will tell you invariably I people appropriately
Speaker 1: come up to me at the end of my talk
Speaker 1: and say, much like you mentioned earlier, you know, my
Speaker 1: relative who was diagnosed at a young age was not obese.
Speaker 1: So I'm not suggesting to you that obesity is the
Speaker 1: only explanation. But I think we have to recognize and
Speaker 1: not to not the fact that obesity is a real
Speaker 1: risk factor for this malignancy. That there's no question that
Speaker 1: child had. Obesity is an issue and has been an
Speaker 1: issue over the past several decades in this country that
Speaker 1: has to be dealt with, but it's not the only answer.
Speaker 1: We recently completed analysis and I will tell you it's complicated.
Speaker 1: It's a very the people under age fifty with colon cancer,
Speaker 1: it is a very heterogeneous group, and we're trying to
Speaker 1: look at the subsets understand the genetics. Part of it
Speaker 1: is I think genetically driven, there's no question. Part of
Speaker 1: it I think has died and lifestyle and then there's
Speaker 1: an element we have to sort out. And I don't
Speaker 1: deny the fact that we have some catching up to do.
Speaker 1: In the meantime, I think, what can we do. We
Speaker 1: can make sure we're taking excellent family histories at the
Speaker 1: primary care setting, right. I mean the problem is when
Speaker 1: I take a family history and I'm an oncologist, that's
Speaker 1: too late. Right. That needs to happen at the primary
Speaker 1: care setting, right before any cancer. Definitely we need to
Speaker 1: do that. We need to work on obesity. We got
Speaker 1: to get screening earlier, and let's be let's be honest
Speaker 1: with ourselves. You know this because you authored the Katie
Speaker 1: Curic effect for colin oscarpies. Getting people who are older
Speaker 1: to get colin oscary was work. It's not going to
Speaker 1: be easy to get younger people to do it, and
Speaker 1: that's something we got to work on. I want to
Speaker 1: talk about screening in just a minute. But you know,
Speaker 1: are there any other theories that are being studied right now?
Speaker 1: I remember uh that there was some thought that it
Speaker 1: might be the over prescription of antibiotics that might somehow
Speaker 1: affect gut health or inflammation. What are what are scientists
Speaker 1: looking at as possibilities? Because, um, when you say genetic,
Speaker 1: that doesn't necessarily just mean a family history of colon cancer.
Speaker 1: It could be a family history of other glandular cancers.
Speaker 1: To write, you know, if you have a history of
Speaker 1: breast cancer, for example, Jay, my late husband's mom had
Speaker 1: ovary and his grandmother had breast and there may be
Speaker 1: some kind of length between all these cancers. Are among
Speaker 1: all these cancers and a family correct? Absolutely, that's a
Speaker 1: great point. I think what we're realizing is we started
Speaker 1: with what were the means that we were decidedly in
Speaker 1: the biology of colon cancer, and we are that we've
Speaker 1: been identifying those genes, but we've now realized to your point.
Speaker 1: We did an analysis looking at the broca genes the
Speaker 1: breast cancer genes and found that potentially four and a
Speaker 1: half percent of colon cancers were associated with that gene,
Speaker 1: which isn't on the list. And so we really need
Speaker 1: to think, we have to really question our assumptions about
Speaker 1: these genes and realize, yeah, if somebody's got a distinct
Speaker 1: family history of of colon cancer of of breast cancer,
Speaker 1: rather that colin's now probably on the list. And then
Speaker 1: there are there are sort of subtle genes, not these
Speaker 1: sort of high press penagence genes, these genes that you
Speaker 1: know are at risk, but genes that are a little
Speaker 1: more subtle in their effect that probably account for a
Speaker 1: lot of this. And not to get in the weeds,
Speaker 1: but genes like check two and some of the others
Speaker 1: that get talked about. That's these genes are probably accounting
Speaker 1: for a substantial number of colon cancers. We're just not
Speaker 1: fully appreciating this. So we have our work cut out
Speaker 1: in terms of understanding the genes. And you know, I
Speaker 1: was going to say, there are a lot of genes
Speaker 1: that just haven't been discovered, right, that are floating around
Speaker 1: people's biologies and we just just don't know what they
Speaker 1: are and the role they might play in cancer. But
Speaker 1: but what are what are some of the things that
Speaker 1: you're looking at and other people like you, Charlie, are
Speaker 1: looking at in terms of this alarming increase among young people. Well,
Speaker 1: we're doing very large population studies and we're obviously getting
Speaker 1: lifestyle data, we're getting family history data, we're characterizing the
Speaker 1: tumors genetically. We're at the same time also trying to
Speaker 1: understand um the outcome is it is it a different disease?
Speaker 1: And we actually have an analysis that we're hoping to
Speaker 1: publish in the next several months about all some of
Speaker 1: these things. So we I don't have an answer, I
Speaker 1: think that, but I will tell you in our last
Speaker 1: analysis what was abundantly clear is this is a mix
Speaker 1: of causes of calm cancer. And I think part of
Speaker 1: the reason, Katie, we don't have an answer is because
Speaker 1: there isn't going to be one answer here. There's gonna
Speaker 1: be several. And that is the lesson in cancer, Right,
Speaker 1: It's not one disease, it's probably a hundred diseases and
Speaker 1: in a hundred different well really millions of diseases, and
Speaker 1: million different different biologies, and I think that's one thing, right,
Speaker 1: is so the way I react to or I don't
Speaker 1: even like to talk in the hypothetical, but the way
Speaker 1: one person reacts to maybe uh, potential cancer or sell
Speaker 1: mutation or something happening that kicks off camp cancer in
Speaker 1: his or her body is a lot different than the
Speaker 1: other person's biology. So it's really this delicate interplay between
Speaker 1: the disease and the host, if you will write the
Speaker 1: host organism. Oh, absolutely, you know, And we had I
Speaker 1: was talking to something about this recently. We did a
Speaker 1: study because let me just track back. You know, there
Speaker 1: are people who will tell you who get colon cancer
Speaker 1: who said, I don't understand this. I had a colonoscopy
Speaker 1: less than five years ago, and how could that be?
Speaker 1: Was there a mistake? This is a real phenomenon. So
Speaker 1: we actually did a study, Katie, of cancers that we're
Speaker 1: diagnosed less than five years after a colonoscopy. And I
Speaker 1: don't want to alarm people with that or tell them
Speaker 1: not to get the colonosopy, because it works, but it's
Speaker 1: not perfect. And when we look at those cancers that
Speaker 1: happened within five years of a colonoscopy, they are biologically different.
Speaker 1: They're different in terms of the appearance they're they're flatter,
Speaker 1: they're hard to see, and they have different genetic ideologies,
Speaker 1: different genetic underpinnings. And so to your point, each of
Speaker 1: these cancers, in this case col is it's a Schmoor
Speaker 1: gess Bourg of genetic diseases. And that's the opportunity, right
Speaker 1: If long as we're prepared to say, hey, you know what,
Speaker 1: I'm willing to develop a therapy where it's only going
Speaker 1: to work for five of calling cancer. Admittedly as peculiar
Speaker 1: as that sounds, if we know what that five is,
Speaker 1: we're gonna make real progress, you know, Charlie. For so
Speaker 1: long I was the colonoscopy queen, and I still believe
Speaker 1: colonoscopies are the gold standard for detecting and treating and
Speaker 1: preventing colorectal cancer. But a lot of people can't afford them.
Speaker 1: A lot of people aren't getting them. One in three
Speaker 1: people are not getting any kind of tests, you know,
Speaker 1: when they're when their age appropriate in this case forty five.
Speaker 1: What about some of these other tests. I've been working
Speaker 1: with Exact Sciences, for example, a little bit on their
Speaker 1: at home stool tests. And you know, one of the
Speaker 1: things I realized is best test is actually the one
Speaker 1: that gets done. So can you talk to us a
Speaker 1: little bit about the differences between some of these like
Speaker 1: fecal occult blood tests and fit tests and um these
Speaker 1: at home tests, and if you feel comfortable for certain
Speaker 1: people recommending them. Absolutely, I mean I think to your point,
Speaker 1: people just have to get screened, because I think the
Speaker 1: latest statistic, Katie, is that about sixty percent of people
Speaker 1: who should be screened for colon cancer aren't. Wow, so
Speaker 1: it's much higher than I thought. Yeah, so you know
Speaker 1: roughly about you know, people are not getting screened. We
Speaker 1: should be screened. Oh I was right, I said that. Sorry, Yeah,
Speaker 1: so it's it's um But you know, the third of
Speaker 1: the population not getting screened is a problem, and that's
Speaker 1: of any test. And to your point, there are a
Speaker 1: panoply of tests. Colin Oscarby saves lives. It's an important test,
Speaker 1: it's safe. And I'm just gonna be clear, if if
Speaker 1: you have access to colin ouspy and everyone should, that's
Speaker 1: what you should do. And I think you taught this
Speaker 1: nation and Frank of the world of value a lesson
Speaker 1: by volunteering to do that on television. And that's for me,
Speaker 1: that's the lesson. If somebody is gonna ask me what tests,
Speaker 1: that's it. And I just you know, I got a
Speaker 1: call in ouspy during the pandemic, because, like you, I
Speaker 1: want to send a message that it's safe to be
Speaker 1: screened and it's important. But if you can't, there are
Speaker 1: other tests. One is, we know that calling cancer is
Speaker 1: a disease of genetic mutations in the tumor, and those
Speaker 1: those cells shed into the stool, and so you could
Speaker 1: detect those mutations in the stool, and so Exact Sciences,
Speaker 1: among other places, have now developed tests where you can
Speaker 1: detect the mutation in the stool using very sensitive techniques.
Speaker 1: And I think it's it's a good test. It's an
Speaker 1: at home test, particularly important in the middle of a pandemic.
Speaker 1: It picks up a substantial number of colon cancers, not
Speaker 1: all of them. It's not great for picking up polyps,
Speaker 1: which is, as you know, the precursor. And frankly, what
Speaker 1: do we really want to find with a colonospy. We
Speaker 1: don't want to find a cancer. We want to find
Speaker 1: a polyp and remove the polyp, right, So you don't
Speaker 1: get cancer. And to be the other aspect of the
Speaker 1: test of the stool is whether it be mutations or
Speaker 1: testing for blood in the stool or things like that.
Speaker 1: If it's positive, well you still have to get a colonoscopy.
Speaker 1: So I think people should be aware of the fact that, yes,
Speaker 1: you can do the DNA test, and that's great because
Speaker 1: we want you to get a test whatever it is.
Speaker 1: You're prepared to do it, but if it's positive, you
Speaker 1: gotta get their colonoscopy, right, But it could weed out
Speaker 1: people who maybe are nervous about getting a colonospy or
Speaker 1: don't have access to it, or can't afford it right,
Speaker 1: or don't don't have health insurance, and it could weed
Speaker 1: out those people. So they know, well, I'm okay for
Speaker 1: now at least, right, but you're right to be able
Speaker 1: to remove a polyp is ideal And in the middle
Speaker 1: of a pandemic, we have to be thinking about home testing,
Speaker 1: right because right now our health systems are extremely text
Speaker 1: We're trying to reduce congestion in clinics, right, we have to.
Speaker 1: So I'm I'm a proponent of whatever tests you can get,
Speaker 1: but um, when we're all back to normal and we're
Speaker 1: all vaccinated. Katie, I'm gonna be on my you know,
Speaker 1: on my soapbox, get a colonoscopy. I'm thrilled that we're
Speaker 1: working on DNA detection technologies for calling cancer. And listen,
Speaker 1: I hope that, you know, Dr McCoy comes out with
Speaker 1: this tri quarter and that's that's gonna be the test.
Speaker 1: But in the meantime, it's still a calling scarp. Are
Speaker 1: we any closer to better treatments for people who do
Speaker 1: have pulling cancer that is advanced, maybe stage three or
Speaker 1: even stage four, which was Jay's situation when he was diagnosed.
Speaker 1: It was all over his liver and it was on
Speaker 1: the march north to his long and then the back
Speaker 1: of his eye and to his brain, and as you
Speaker 1: can imagine, it was harrowing. I was so livid that
Speaker 1: the treatment he received was the same treatment that had
Speaker 1: been around since the fifties, five of you and LUKEA. Warren,
Speaker 1: and I was really really frustrated by that that was
Speaker 1: twenty three years ago. Are there better uh chemotherapeutic agents?
Speaker 1: Are there? Is there any progress being made in immunotherapy,
Speaker 1: which is helping people in so many other cancers, or
Speaker 1: and monoclonal antibodies, and all the different kind of approaches
Speaker 1: is monoclonal antibodies the same as immunotherapy, Charlie, are different.
Speaker 1: Immunotherapy is one of the approaches of using monoclon out
Speaker 1: of bodies, but there are much broader approaches. But let
Speaker 1: me just step back, Katie and say, look, Um, given
Speaker 1: the tragedy that you and your family went through with Jay,
Speaker 1: it's so admirable of what you decided to do and
Speaker 1: take on this cause and the wake of that, and
Speaker 1: and you've made a big difference and I hope you
Speaker 1: know that on so many different fronts in terms of
Speaker 1: funding cancer research, in terms of building awareness and getting
Speaker 1: people to screen. I mean you, you've done it all
Speaker 1: and we owe you a lot for that, particularly in
Speaker 1: the wake of what was such a challenging time for
Speaker 1: you and the family and what Jay went through. But
Speaker 1: I do think we've made progress. Now. That was twenty
Speaker 1: three years ago, and I would say at a real
Speaker 1: inflection point in colon cancer that people should you are
Speaker 1: where is? It was two thousand four And in two
Speaker 1: thousand four, Um, the first of a series of mono
Speaker 1: clone l antibodies came out, which was a drug that
Speaker 1: actually realized that you could block the blood supply to
Speaker 1: tumors and impact therapy. That's it. That isn't that an
Speaker 1: anti anchio genesis? Are you talking about a baston? You're good, Katie,
Speaker 1: Maybe you should be Maybe I should be interviewing you.
Speaker 1: It was approved for calling cancer and it was a
Speaker 1: game changer, um and and and it was a game
Speaker 1: changer in so many different fronts. Firstly, one, it opened
Speaker 1: up a field which is blocking the blood supply matter,
Speaker 1: which opened up a litany of investigation. This works due
Speaker 1: to Falkman's original work. Ultimately the drug developed by Jennet Tech.
Speaker 1: And but but not only that, it was really the
Speaker 1: move to biologics, right because you know this because five
Speaker 1: floor URSL was the only drug. And what we learned was,
Speaker 1: you know what beyond andered cytotoxic chemotherapy, cell killing chemotherapies.
Speaker 1: By understanding the biology, we can develop drugs that target
Speaker 1: the biology of monoclonals. Because of Aston, as you know,
Speaker 1: is a monoclone lantibar. Will you explain for our listeners,
Speaker 1: because I actually could use a refresher what exactly you
Speaker 1: mean when you say a monoclonal antibody. Absolutely, So we
Speaker 1: make we all make antibodies to block infection. And these
Speaker 1: are little molecules that are coded to cover the target
Speaker 1: the surface of something, be at a bacteria or some
Speaker 1: other microorganism that shouldn't be in our bodies, right, somebody
Speaker 1: you know, something that affects us. But what people realize
Speaker 1: is you could develop antibodies in the lab that, instead
Speaker 1: of targeting a bacteria, can to target some other surface
Speaker 1: that's relevant to cancer, be at the surface of a
Speaker 1: cancer cell, or the surface of a molecule that stimulates
Speaker 1: blood supply for tumors. And so what a vast it is.
Speaker 1: It's an antibody that's designed in the lab that targets
Speaker 1: a molecule that makes that helps cancers develop a blood supply.
Speaker 1: So it essentially grabs it, blocks it degrades it, and
Speaker 1: um so you take that away from the cancer. The
Speaker 1: cancer is now starved. If it's blood supply, it's It
Speaker 1: was really revolutionary at the time, but what did it do.
Speaker 1: It essentially tripled the longevity of people with metastatic advanced
Speaker 1: calling cancer. Tripled it and it's still not where we
Speaker 1: want to be. We still have a long ways to go.
Speaker 1: But you know, Katie, to your point earlier, when I
Speaker 1: first started this field a long time ago, longer than
Speaker 1: I could or admit. When I would meet a new
Speaker 1: patient and family with advanced calling cancer, I would look
Speaker 1: at the patient and in my mind, I think, you know,
Speaker 1: what if if I have this person sitting in my
Speaker 1: office a year from now and feeling good, that's an
Speaker 1: accomplishment that I'll be glad I could get to. And
Speaker 1: I'm not joking. That was my aspiration because the average
Speaker 1: survival for a new patient with colon cancer when I
Speaker 1: started this game was nine to ten months, which is ridiculous,
Speaker 1: totally inadequate. And so you know, we're a lot longer now,
Speaker 1: but we got a ways to go. And each of
Speaker 1: these incremental steps teaches us about how do we leverage
Speaker 1: the biology, how do we develop new therapy. So we
Speaker 1: now have multiple antibodies hitting different targets. We have I think,
Speaker 1: new drugs that are focused on really what was the
Speaker 1: biologic target as opposed to some random drug off the shelf.
Speaker 1: And we also know that calling cancer is not one disease,
Speaker 1: but a subset of diseases where there's a specific gene
Speaker 1: gene that's driving in we're targeting that dreen gene. Now,
Speaker 1: the the major advances that really we saw this tripling
Speaker 1: of survival in colon cancer and advanced calling cancer was
Speaker 1: really I would say between two thousand and four and
Speaker 1: two thousand twelve. And I'll be honest, I think we've
Speaker 1: languished a little bit since then because you mentioned immunotherapy,
Speaker 1: which is a different type of monoclaudal that activates our
Speaker 1: immune system, which has frankly revolutionized cancer therapy, truly revolutionized
Speaker 1: lung cancer, melanoma, variety of difficulty treat cancers. However, that
Speaker 1: approach works for four of calling cancer patients don't benefit
Speaker 1: from it. Why because somehow the calling cancers are hostile
Speaker 1: to our immune system, and we got to figure out
Speaker 1: how to convert those cancers to being more a menable,
Speaker 1: more inviting to our immune system such that we can
Speaker 1: leverage these drugs to attack the cancer. But why has
Speaker 1: it been so successful in other cancers? What is it
Speaker 1: about colorectal cancer that makes immunotherapy less effective? So I
Speaker 1: think the other thing we've learned over the past two
Speaker 1: decades is we used to only focus on the cancer cell.
Speaker 1: But if you look at a tumor under the microscope.
Speaker 1: It's not just cancer cells. It's a variety of cells,
Speaker 1: imune cells, other types of cells that the cancer in
Speaker 1: some respects are recruiting for their own benefit. Now, one
Speaker 1: of those is our blood vessels, right, the cancer is
Speaker 1: recruiting blood vessels. What else is it recruiting. Colon cancer
Speaker 1: is clearly recruiting cells, our own cells that suppress an
Speaker 1: immune response. And it might see simple, well, let's just
Speaker 1: turn in those cells off, but it's not so simple
Speaker 1: how we do it. We don't fully understand how colon
Speaker 1: cancer recruits those cells to the tumor and how we
Speaker 1: turn that signal off. But I think we're a lot
Speaker 1: closer in understanding that there's a number of new targets,
Speaker 1: new drugs to do that that hopefully we then combine
Speaker 1: with the immunotherapies to make them work. So stay tuned.
Speaker 1: I I you know, I've been doing this for a while.
Speaker 1: I'm really optimistic of what this decade is going to
Speaker 1: do in cancer in general, but I think in colon cancer,
Speaker 1: because I think we're on the precipice now of taking
Speaker 1: these understandings of immunotherapy, of the of the micro environment
Speaker 1: within a tumor beyond the cancer cell within understanding biologics
Speaker 1: with targeted therapies, with genetics, and that's like, isn't that
Speaker 1: epigenetics sort of the coding on the cell itself, right,
Speaker 1: that that sometimes protects the cell from the medication. Right,
Speaker 1: it's weird. It's like the cell has a little survival
Speaker 1: mechanism that's hard to penetrate. Well, there's that, and there's
Speaker 1: that because these are cells that are able to mutate.
Speaker 1: They are even when therapies work, the cells figure out
Speaker 1: how to become resistant. They develop in a second, third,
Speaker 1: fourth mutation, which I know seems almost impossible to beat.
Speaker 1: It's like whack a mole. But it's we Actually, I
Speaker 1: think our understanding the underlying processes like epigenetics as you
Speaker 1: describe it, where I think we can beat it. Um
Speaker 1: You know, cancer is the great challenge of the twenty
Speaker 1: one century. You know, in the beginning of the last
Speaker 1: century was infectious disease, which is how ironic is we're
Speaker 1: in the middle of a pandemic now. But once we
Speaker 1: get past this, because we've done so much to eliminate
Speaker 1: infectious disease as the major killer of Americans, it's now cancer,
Speaker 1: and I really feel like we are poised to truly
Speaker 1: make a difference. Before we wrap up, I wanted to
Speaker 1: end with some thoughts from my friend Donna. After the
Speaker 1: colonoscopy and during the testing phase and biopsy and all,
Speaker 1: the doctor said that that tumor had to have been
Speaker 1: growing for the past two years, that it wasn't a
Speaker 1: young tumor. It was a tumor that was about two
Speaker 1: years old. So I just know from a personal experience
Speaker 1: that I should have at fifty gone in and got
Speaker 1: my connoscope. That's the lesson learned. So for those that
Speaker 1: are listening or however way the message is delivered, early
Speaker 1: detection is going to be a lifesaver. It truly is
Speaker 1: going to be a lifesaver. So, UM, I encourage you all.
Speaker 1: I mean, if it's forty five, as soon as you
Speaker 1: go on your birthday, if you have to when you
Speaker 1: turn forty, go get the test um. But you know,
Speaker 1: but I'm I'm not going to look back, because um,
Speaker 1: that's not that's not the message. The messages is that
Speaker 1: I've learned a lot and I can help those that
Speaker 1: are going through it. Um and the messages go get
Speaker 1: tested and if you're nervous about getting a colonoscopy. Well,
Speaker 1: I've had a few, and I'm telling you it's really
Speaker 1: not that bad. And I've got an insider scoop on
Speaker 1: the best way to prep. Back when I did my
Speaker 1: first colonoscopy, gosh, twenty one years ago, I had to
Speaker 1: drink this gallon of nasty, salty, chalky, cherry flavored water.
Speaker 1: I put on a pretty good show for all of you.
Speaker 1: M looking forward to it. Here goes nothing, but it
Speaker 1: was terrible. What I didn't show in the pieces. I
Speaker 1: actually threw up the last glass all over my kitchen floor.
Speaker 1: So instead it's your favorite flavor of Gatorade with Mary Lax.
Speaker 1: Donna agrees, I'll do that again. H recommend. Thank you
Speaker 1: again to all my guests today. Donna otis Dr Edith
Speaker 1: Mitchell and Dr Charlie Fuchs. Now you all know what
Speaker 1: to do. Talk to your doctor and go get tested.
Speaker 1: Next Question with Katie Kurik is a production of I
Speaker 1: Heart Media and Katie Kurk Media. The executive producers Army,
Speaker 1: Katie Couric and Courtney Litz. The supervising producer is Lauren Hansen.
Speaker 1: Associate producers Derek Clements Adriana Fassio and Emily Pinto. The
Speaker 1: show is edited and mixed by Derrick Clements. For more
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