Leading LC Specialist Dr. Mark G. Kris Interviewed

[Christine]

Dr. Mark G. Kris, one of the nation's leading lung cancer specialists, will give a free public speech Wednesday night (11/1) at the Hyatt Regency in Louisville as part of a Norton Healthcare Foundation and Norton Cancer Care lecture series.

Kris is chief of thoracic oncology service and associate chairman of clinical trials in the Department of Medicine at Memorial Sloan-Kettering Cancer Center in New York City.

He is a noted clinical investigator in the field of chemotherapy. His research focuses on new anti-cancer agents for lung cancer and support in the care of patients.

He's also an expert in anti-nausea therapy, working to reduce the gastrointestinal side effects of anti-cancer drugs.

Kris played a key role in establishing a new treatment approach for the most common form of lung cancer by using an effective combination of chemotherapy to shrink tumors before surgery or radiation.

In advance of his visit, we spoke with him in a telephone interview from his office in New York. Here are excerpts from the conversation:

Q: How would you rate public awareness of lung cancer and its deadliness?

A: People aren't as knowledgeable as they could be. It's sad. While it is the No. 2 killer of women (heart disease is No. 1), they often don't think about lung cancer.

Would you describe how lung cancer ranks as a cancer killer?

Lung cancer is the leading cancer killer of both men and women. If you're going to lose a loved one or friend to cancer, lung cancer is the most likely thing.

If people think back to friends and family whom they have lost from cancer, lung cancer is always there. But people don't think of it.

(Lung cancer takes more lives than breast, colon, ovarian and prostate cancers combined, Kris confirmed.)

In your experience do people who are diagnosed with lung cancer receive less empathy and understanding than they deserve because of a notion that "they did it to themselves" by smoking?

Clearly there is a feeling of guilt. There have been lung cancer sufferers who have died and in their obituaries they've asked that people put in that they never smoked. It is because there is this societal feeling that this person brought this on himself.

People need to understand, and physicians are part of this too. You say, oh, they should have stopped smoking. They should have heard the word. Well, the majority of people who get lung cancer in 2006 don't smoke. They either never smoked or they heard the word to stop smoking and they did.

The truth is these people have an illness and they're human beings and all the resources our society has should be brought to bear to help them, and these questions (about smoking) aren't relevant. If you talk to patients with this illness, they are fairly livid about it.

Does society kind of blame lung cancer sufferers? Yes. Do they blame themselves? Yes. That's one sort of hurdle we all need to get over.

As you pointed out, nonsmokers also get lung cancer. Dana Reeve, a nonsmoker and widow of "Superman" star Christopher Reeve, died of lung cancer earlier this year. What can you tell us about the number of lung cancer deaths among nonsmokers?

It's a sizable number -- between 10,000 and 20,000 Americans every year who have never smoked get lung cancer.

Gender issue

Does lung cancer have a gender bias?

People are debating this. Bottom line is it's just as deadly for men and women. It does appear, however, that women with the diagnosis of lung cancer live longer than men. Reasons for that are not known.

There is some scientific data that women who contract lung cancer from smoking have smoked for fewer years (than men who get lung cancer) or get it earlier with the same amount of smoking. It's still controversial.

Has the incidence of lung cancer among men and women changed since you started practicing medicine?

When I started it was four (males) to one (female). If you saw a woman sitting there and you were scheduled to meet a patient for the first time you'd say, "where's the patient?" meaning her husband.

Now if I see a man, I say, "Where's the patient?" I think for the last four years at Sloan Kettering we've actually seen more women than men.

It's just amazing how it's changing, and it does reflect the increase in cigarette smoking that occurred in women in the '50s and '60s.

Another thing that happened with men and women is the proportional decrease in smokers is huge in men. Over 50 percent of men smoked in 1965 and 30-some percent of women. Both groups are now close to 20 percent. The decrease in smoking among men is much greater than in women.

Does lung cancer have a racial bias?

I don't know about susceptibility to lung cancer, but the course of lung cancer is more virulent in African Americans. People are trying to discover whether that's due to socioeconomic factors, genetic factors or something else.

What about early detection of lung cancer?

We don't have an established way to find lung cancer early. There is no screening test for lung cancer endorsed by anybody that would do that -- nothing like a mammogram or Pap test. Sadly, most lung cancer is discovered when the patient has symptoms.

Trials are under way to see if X-rays or helical CAT scans can find lung cancer earlier.

(A major study published in today's issue of the New England Journal of Medicine proves that annual CT screenings can detect lung cancers as early as stage 1, when it is still curable, dramatically increasing survival rates.)

Research

Do misconceptions about lung cancer affect funding for research?

Absolutely. Per death, the number (amount of funding) is very tiny for lung cancer research. We really need money for all health-care research. It's not just lung cancer research. If we could increase funding for health-related research, lung cancer would benefit.

It may be a scientist studying a certain gene in a zebra fish leads to a certain breakthrough in the treatment of lung cancer.

What are the newest breakthroughs in lung cancer treatment?

Using characteristics of the cancer tumor, the molecular characteristics, to choose treatment. You don't want to subject people to any kind of treatment that isn't beneficial to them.

There is the testing of mutated genes to find drugs that will counter the effects of the mutated gene so that treatment of the cancer can continue. Patients live longer and have a higher quality of life, but the sad thing is the disease is still deadly and people succumb to it. That's where we need a breakthrough.

Prevention

What can an individual do to avoid getting lung cancer?

It's really all about smoking. If you never are exposed to cigarettes, you cut your risk down tremendously.

Also, if you stop smoking, you cut your risk down. Unfortunately, it never goes back to zero.

What about staying away from second-hand smoke? Is it important?

This is pure opinion, but there is no safe amount of smoking. Therefore, knowing how people vary in their sensitivity to things, there must be some in whom second-hand smoke is enough to trigger lung cancer. It can't be good.

Are there any Web sites you would recommend for people who want to increase their health literacy and understanding of lung cancer?

I'm part of the American Society of Clinical Oncology, ASCO. We have a site, People Living With Cancer, www. plwc. org, which is geared toward patients with all types of cancer. Cancercare.org is another. It has information about coping, physical needs and survivorship. Both are good resources. I'm on the boards of both.

Reporter Linda Stahl can be reached at (502) 582-4666.