A Hopeful Outlook on Taming Cancer

By: Source: AARP Bulletin Today Date Posted: 2004-01-08 07:59:59

Andrew C. von Eschenbach, M.D., director of the National Cancer Institute (NCI), explains why he has a bandage on his face. "They just found some skin cancer, a basal cell carcinoma on my nose," he says. Then he quickly puts his visitor at ease. "Just when I think I'm going to start a career as a movie star, I get this!"

Von Eschenbach, 62, has been down this road before. Indeed, he's living proof that a cancer diagnosis is no longer a death sentence. He was diagnosed with, and treated for, prostate cancer. He was 57 at the time—the same age at which his own father had died of prostate cancer. Earlier he had survived a bout of melanoma, another type of skin cancer.

"Being a cancer patient," von Eschenbach has pointed out, "brings with it a deep sense of urgency about eradicating this disease."

Spend some time with von Eschenbach, and that sense of urgency is unmistakable. Two years into his tenure as the director of the federal agency that finances and directs most cancer research in the United States, he leads more than 4,000 employees and oversees an annual budget of nearly $4.7 billion.

Von Eschenbach, a nationally recognized urologic surgeon, has devoted most of his professional life to eliminating death and suffering from cancer. He formerly directed the Prostate Cancer Research Program at the M.D. Anderson Cancer Center, a part of the University of Texas in Houston.

Meeting recently with an AARP Bulletin writer in his Bethesda, Md., office, von Eschenbach talked about his mission at NCI, his personal experiences with cancer and some of the advances that are transforming the lives of cancer patients.

AARP Bulletin: You recently announced a goal for the National Cancer Institute: the elimination of "death and suffering" from cancer by the year 2015. Why 12 years from now?

Dr. von Eschenbach: It's not a magic moment, obviously. Hopefully, we will do it sooner. But 2015 was what I believed was a realistic target, given the progress we are making in the laboratory.

By declaring 2015 as your target date, are you saying, "We're not going to solve this thing, but we may be able to control it—and soon"?

Correct. And that's a very important distinction. I did not say we were going to eliminate cancer. I don't know when that will happen, if ever. We are asking, "What can we reasonably expect?" And the answer is that there's much we can do to eliminate the burden of the disease on those who get it.

Beyond that, I see a time coming when we'll be able to develop interventions that not only prevent and eliminate the disease in some people, but that also control cancer in others—much like we control high blood pressure and diabetes today. So thanks to research, there'll be people who will live with it and who will not die from cancer. There'll be others who won't get it in the first place.

What have we learned that's helping us to finally understand cancer?

We used to think of cancer as something that just happened to a person. Now we understand cancer as a long process. It may start with a genetic predisposition or because of things you were exposed to. The process continues to the point where it becomes a tumor that spreads and can take your life. But it's not something that happens instantaneously.

By understanding cancer at the genetic, molecular and cellular levels, we can intervene much more effectively than ever before to pre-empt the cancer process.

Treatment in the future will be by design, based on your genes, what chemicals they are expressing, what the specific tumor looks like, how it works, where it is.

With the exception of the juvenile cancers, should we think of cancer as mostly a disease of age?

Oh, yes. The most significant risk factor for cancer is aging. As our bodies age, we are susceptible to malignant transformations.

Of course, we should do certain things when we are younger to prevent late-life cancer—diet, exercise, avoiding tobacco products, being careful about sun exposure.

For those who are already elderly, we should make sure that we avail ourselves of all the opportunities for early detection. Women should undergo mammography. Many men are getting the prostate specific antigen test, the PSA test, for prostate cancer. And we're trying out new ways of detecting lung cancer with imaging technology.

Down the track, there's this whole new area of looking at proteins in body fluids and blood for cancer markers. This is very exciting. Preliminary work done with protein patterns in the bloodstream of women with ovarian cancer suggests it may be an extremely effective way to do early detection.

If science is going to transform cancer detection and therapies, will there be a corresponding reform in the way people are treated in hospitals? Many patients find their treatment impersonal, even harsh.

I wouldn't use the word "reform." As director of the NCI, I go to our cancer centers and am overwhelmed by the level of compassion and sensitivity that's apparent there. The centers have placed a great deal of emphasis on caring for patients as people.

M.D. Anderson Cancer Center, for example, where I was a surgeon for many years, has a Place of Wellness that helps patients with issues around nutrition, introduces them to meditation, relaxation, exercises, yoga. You're seeing efforts to complement the tried-and-true interventions with additional ones that may be helpful.

You've had prostate cancer yourself. As a cancer doctor, what was your reaction to the diagnosis?

I was very upset. As a professional, I was very aware of all the potential risks that come with having prostate cancer, particularly the risk to your life. My cancer was found early because of PSA. The expectation was that with treatment I would do very, very well.

But I had to look at the options, and I had to make choices. I chose surgery because it gave me the best option for eliminating the cancer. But I knew it would carry with it a higher risk of complications … and there was also the fear of undergoing a major surgical operation. After all, the last thing any surgeon ever wants to do is be operated on.

After your bouts with cancer, what have you learned about the disease—you, personally?

That you have to be engaged in the process. You just don't have it and then forget about it. It becomes a part of your life. Having cancer changes you. Therefore many of us who are cancer survivors recognize that it's not an event that's over and done with. You have to manage and deal with some of the aftereffects.

Despite your difficult experiences with cancer, you seem optimistic about fighting it. Are you?

I'm not saying that we know everything we need to know. But we are on a different path than we were before—and that does leave me optimistic. We have options and opportunities today that were unimaginable 30 years ago. It is now a new moment. If we seize and capture and commit ourselves to this, I think we can create a world where no one suffers and dies from cancer.

Claudia Dreifus is a freelance writer in New York City.