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Brian Lehrer: It's the Brian Lehrer show on WNYC. Good morning, everyone. We'll begin the show today with something a little bit morbid, but bear with me, it's for good reason. Leading causes of death in the United States, 2021, according to the Centers for Disease Control CDC. The big three were heart disease, around 700,000 deaths. Then cancer, around 600,000 deaths. Then COVID, around 400,000 deaths. Then going down the list from there and it really drops off after that accidents were the fourth leading cause of death around 200,000 of them.

Then stroke 160,000, then down further chronic lung disease, Alzheimer's, and diabetes as the leading causes of death in America last year. Now, you may have already figured out that I'm giving you those stats in relation to the so-called cancer Moonshot that President Biden announced yesterday on the 60th anniversary of President John F. Kennedy announcing the actual Moonshot Program in 1962, that did land an American on the moon. As you certainly know, except those of you who believe it was a hoax, by the end of that decade. In Biden's Moonshot speech, he also praised a president of the opposite party. Here is the president yesterday.

Joe Biden: We've made enormous progress in the past 50 years since President Nixon signed the National Cancer Act to declare a war on cancer. We learned cancer is not a single disease, but there are over 200 different types of cancers caused by different genetic mutations in our cells. We discovered new medicines, therapies, early detection, and prevention measures to extend and to save lives.

Brian Lehrer: President Biden yesterday, tracing the war on cancer all the way back to President Richard Nixon, who declared that war. Of course, Nixon did a lot of declaring war. War in cancer, war on drugs, war in Cambodia, the war to obstruct the Watergate investigation. Oops, you have to resign now. He did launch the war on cancer that has led to the progress that Biden cited there. Yet, cancer is still the second leading cause of death in the United States last year as year after year, right behind heart disease.

By the way, if there's a lot less cancer than 50 years ago, there are still many times more cancer than 100 years ago. Cancer is largely a disease of modern Western lifestyles. Article on PubMed in 2018, compared what they cited as a 5% cancer rate in 1900 to the 33% of women and 50% of men who get some kind of cancer during their lifetimes in the United States today. I'm sure every one of you listening right now, if you haven't had cancer yourself, you know somebody close to you who has.

What can Joe Biden's Cancer Moonshot accomplish and what would it actually take? With us now are two guests, Sarah Owermohle is a Washington correspondent at the medical news organization's STAT News reporting on the Biden administration's health goals, federal health policy, and politics. She previously covered health policy and the drug industry for POLITICO. Dr. Barrett Rollins, cancer researcher with the Dana-Farber Cancer Institute for more than 30 years.

Dr. Rollins has studied cancer at the molecular level, including the role of what they call white blood cell trafficking which sounds like someone is smuggling in white blood cells from somewhere, we'll find out what it really means, and the very interesting area of the interactions between inflammation and cancer, we'll talk about that with him. He is also author of the book In Sickness, a memoir about his own wife's fatal breast cancer, despite being a cancer researcher herself. Barrett Rollins, Sarah Owermohle, welcome to WNYC.

Sarah Owermohle: Thank you for having us.

Barrett Rollins: Thank you very much.

Brian Lehrer: Sarah, as the president acknowledged, there's been a war on cancer in this country for 50 years, what did he announce yesterday that's actually anything new?

Sarah Owermohle: Yesterday he was kind of re-energizing what he actually announced in March as a sort of Cancer Moonshot 2.0. If you remember when he was vice president for Barrack Obama, towards the end of his presidency, they launched the first Moonshot. That was more focused on accelerating research, finding answers. This new Moonshot Biden says is focused on a more holistic view of how to prevent cancers, how to improve cancer care, and also how to minimize disparities. It's things like upping cancer screenings, which they're very concerned.

A lot of people have been getting those for highly preventable cancers during the pandemic. I heard estimates earlier this year that there's at least 9 million people who are behind on screenings for easily treatable cancers I should say, or can be prevented with early screening. Then there's also, talking about preventing cancers entirely through lifestyle changes as well. It's more than the early research lab portion tha Moonshot 1.0 was. This is looking at our holistic view of how people live their lives and what they can do to prevent cancer.

Brian Lehrer: Dr. Rollins, the president noted in his speech that the first 25 years of the 50-year war on cancer did not bend the curve very much on the cancer death rate in this country. In the last 25 years, it's come down 25%, which is really a lot. Can you say what the main things are that started working and why?

Barrett Rollins: I think the main things that started working are some of the things that Sarah pointed out. This particular Moonshot, I have to tell you as a scientist and a sort of ingrained skeptic, Moonshot always raised my hackles. I happen to be on vacation now, my sister-in-law was here and when I said that we were going to talk about the Moonshot, she exploded and said, "All Moonshots are BS," but more colorfully.

What's different about this one, and I think I even persuaded her, maybe I can persuade your listeners is that exactly what Sarah said. This is about capitalizing on the things that we already know have impacted cancer mortality. The reason that overall cancer mortality has decreased somewhere between 25 and 32% since about 1991, according to the American cancer society really has to do with screening and smoking cessation. These are the things that a population level that really decrease mortality.

The problem is that even though colonoscopies have decreased mortality, decreased deaths from colorectal cancer by over 40%, more than half of the eligible population are not getting screened. Imagine what the impact would be if you could actually push out screening to everybody who needs it and deserves it. That's why I think that this particular Moonshot has a goal. Biden's overall goal is a 50% reduction in mortality by about 2047, I think it's 25 years. That is doable if you think about democratizing screening and prevention. I think that's where the money is.

Brian Lehrer: Sarah, do you want to pick up on that? Dr. Rollins just said democratizing screening and prevention and cited a large percentage of the population that should be getting colonoscopies. I think the usual rule of thumb is when you hit 50 years old, you should get your first one that's if you have no other extra risk factors that have been identified. Then generally every five years unless they find something along the way.

Then comes access. NPR had a story on Morning Edition today about the higher cervical cancer disease rates and death rates among Black women and rural women because they don't get as much information about HPV vaccines for prevention of that cancer and don't have as much regular care for early detection screenings. Primary care physicians who are going to remind them and things like that. Is anything like that part of Biden's initiative?

Sarah Owermohle: Absolutely. That's why this is also very different from the first version of Moonshot which was really focused on research and therefore focused a lot of the energy in the national cancer Institutes and research universities like where Dr. Rollins works. Because that's what those goals were at that time, but when you take it out to these bigger issues of disparities of who is actually getting access to this treatment or screening or knows that they need it, that really takes in all these different parts of government, federal to state to local, which is why this is pretty big. I mean, the word Moonshot is fitting here.

It's worth noting too when I said nine million people earlier, that's nine million people who already have care and are delayed on screening. That doesn't even account for people who don't have regular care, don't have a regular provider, and don't know about things like for instance, the HPV vaccine now being available to adult women. When they talk about how they're going to do things like this, a lot of it does come down to local efforts and disparities research and how to best communicate those things, which is very far outside of what the original Moonshot was about. One thing that I think is going to be interesting is that the original Moonshot had funding. It had $1.8 billion for

seven years, we're in the sixth year of that now.

As of right now, the new Moonshot does not technically have funding. There's questions of how they are going to achieve this. I think that you saw some of that in Biden's speech yesterday when he was talking about achievements so far and they weren't quite within the realm of Moonshot. It was things like mentioning that the inflation reduction act included drug pricing reforms, things like mentioning the burn pit bill that passed recently varied things across departments basically.

Brian Lehrer: Listeners, we can take your questions on cancer in America generally and President Biden's new cancer Moonshot announced yesterday. 212-433-WNYC, (212)433-9692 for Sarah Owermohle who covers healthcare policy and politics for STAT News, and Dr. Barrett Rollins cancer researcher with the Dana-Farber Cancer Institute, (212) 433-WNYC, (212) 433-9692 or tweet your question @BrianLehrer.

Dr. Rollins, can you give us the big century-long or even 200-year-long take on cancer, to what degree is cancer a disease of modern life and for that matter disease of affluence? I've already had somebody who works in healthcare write in after my intro that maybe that 5% of Americans got cancer in 1900, whereas 33 to 50% get cancer today, that the 5% stat that I cited from that PubMed article may really be low because maybe a lot of people got cancer from various exposures in the 1800s, but those deaths were recorded as something else and also cancer deaths go up as we age and people are living a lot longer today. With all of that in mind, can you give us the century-long or 200-year-long view on whether cancer is an artifact of modern life and of affluence?

Barrett Rollins: Yes. I can do a 200-year survey in about 30 seconds, so cut me off.

Brian Lehrer: You should be a guest on every show. Go ahead.

Barrett Rollins: Yes. Cut me off when I go too long, let me start by saying that your point about cancer being a disease of aging is really essential for our understanding much more so than-- to me much more so than even a disease of developed countries. That the unfortunate thing is if we don't start bending the curve, cancer is going to surpass cardiovascular disease as the number one killer as the population ages.

I think that that 5% number you cited at the beginning is a vast underestimate because of sociological reasons when people didn't talk about cancer. What has changed in the past 100 years is a fundamental shift in our understanding of what the disease is. If you think about infectious disease, think about tuberculosis in the 1800s, tuberculosis, no one knew what it came from. People wasted away, it was called consumption. Literature of that century is just filled with discussions of TB as a visitation on people who have done something bad in their lives.

It wasn't until the discovery of the tubercle bacillus, that there was a bacteria that caused it. Once you understood that there was-- how this happened, you could come up with ways to intervene, namely antibiotics, and the mystique around TB has just dissipated. The same thing has happened in the past 100 years with cancer. We now know that it's a disease of genes, even President Biden referred to the genetic basis for cancer. We know why it happens at a molecular level.

We have theories as well as reduction to practice about how to intervene based on that understanding and what I'm seeing, I've been in this business for about 42, 43 years. What I'm seeing is a fundamental change in the sociology, people aren't afraid to talk about it any more, people aren't afraid to get the diag-- well, yes, they are afraid to get the diagnosis, but not with the same level of fear that I saw 40 years ago.

That's because we understand what's happening. In addition to the population level, stuff that I think is going to have the real impact on mortality, what we're going to learn to do over the next couple of years is take our molecular understanding of cancer and develop even better screening techniques, more directed screening techniques, screening techniques that have fewer false positives, and that's going to help us move this mortality curve to a lower place.

Brian Lehrer: Sarah, let's talk about the leading types of cancer by death rate. As of 2020, according to CDC, lung cancer was still number one by far, by way far, followed by colon and rectal cancer, pancreatic cancer, breast cancer, and then prostate cancer, is the fact that lung cancer is still the biggest number by almost three times. The next most common colorectal is that still mostly cigarette smoking?

Sarah Owermohle: Cigarette smoking has gone down a lot as Dr. Rollins mentioned earlier. It also has been a highly effective campaign amongst young people. Even anecdotally, I don't know many young people who smoke cigarettes, although vaping is a whole other thing we can talk about. There has been a shift even just within my generation and people in my generation that smoked cigarettes versus kids.

Just a few-- I'm not a kid, people, just a few years younger than me who never picked them up because of the communications and the ads and stuff that were very effective. It has gone down if you're just looking at cigarette smoking, if you're looking at [unintelligible 00:15:47] tobacco usage, it actually is somewhat stagnant and part of that is because of vaping. I think a big part of it is we still have-- we're not that far out from many, many people smoking. It's only been 20, 25 years.

People are still dealing with the repercussions of that, but then also lung cancer unfortunately has not yet had these treatment breakthroughs that some of the other cancers have had. I'm trying to say that fragilely because there have been some-- in recent years have extended life, but it's still a very deadly cancer.

Brian Lehrer: Do you want to add anything to that, Dr. Rollins? It's interesting for example, what Sarah said about lung cancer not having as many breakthroughs in treatment. Are there some cancers that were just treating more successfully than others even if people get them?

Barrett Rollins: This story changes day by day, hour by hour. The first thing I would say is that the biggest impact on lung cancer, mortality is smoking cessation. It's interesting when you look at the curves men stopped smoking before women did, and now women are still dying at a very high rate although that curve is started to decrease as well, but we're starting to--

Brian Lehrer: Although starting from a higher point, right? Many more men than women smoked originally than women started smoking more, as part of the equality movement, really, we can do what you do tell me if you think that's wrong, and now, they're giving it up.

Barrett Rollins: Yes. Virginia Slims had an effect.

Sarah Owermohle: I meant that advertising, not necessarily equality but tobacco companies really knew how to advertise both to women and Black people which is why women and Black people are still higher parts of that curve. Sorry, I didn't mean to interupt.

Brian Lehrer: There's debates over banning menthol cigarettes right which are advertised to African Americans. That's still a political debate. Go ahead.

Barrett Rollins: Yes. There are two points I want to make. One is that even without smoking, we are seeing more and more women who are young or middle-aged develop lung cancer without any smoking history. It's become a real question about what is causing this and whether this is an environmental effect, which most likely is which and that's something that I think the Moonshot is going to start addressing. What are the environmental and lifestyle factors that are contributing to lung cancer without a smoking history?

Having said that, I think it's important to point out that lung cancer has become a paradigm for us in the two major ways that we now treat cancer. One is targeted therapies that are directed against the mutations that actually cause cancer. Those have totally changed the way we treat the disease. It's unbelievable compared to what used to be when I would practice medicine back in the stone age.

If somebody came into my clinic with lung cancer that had already spread to the bones, somewhere outside their chest, you could start a clock and in six months they'd be dead. Same thing happened to my father. Now we have these targeted therapies that they don't work forever, but they can work for several years at a time. When one fails, you start another, when that fails, you start another and people are living now for years where they used to die in six months.

Then the second major impact is immune therapies. I'm beginning to see flattening of the curve. In other words, I'm beginning to see things that indicate that people are being cured of lung cancer with immune therapy. There's a lot of hope and a lot of impact going on, even though it's still a very deadly disease.

Brian Lehrer: Do you want to talk about your own work in this respect? One area I see that you study at Dana-Farber Cancer Institute is the relationship between cancer and inflammation and so many different kinds of illnesses produce inflammation, run of the mill, right? From an injury that gets inflamed to bad cases of COVID that lead to inflammation of the lungs. We take aspirin and ibuprofen because they're anti-inflammatories. Is inflammation that's caused by some other condition then going on in some people to cause cancer?

Barrett Rollins: Yes, absolutely. It's one of the risk factors for developing cancer and the

mechanism really goes back down to genetics. One of the things that happens in a bad inflammatory state is your white blood cells and other tissues make these molecules that damage DNA. If you make enough of this and DNA gets damaged enough, mutations start to appear that can drive cancer.

A perfect example of this is chronic infection in lung that we see the development of lung cancer sometimes in the very same region where someone has had chronic inflammation in the lung. An intervention in inflammatory states, I would consider a category of prevention. If you knew that somebody had a hyperinflammatory state for whatever reason, autoimmune whatever, being able to intervene to reduce that inflammation may decrease the likelihood of cancer. The trials need to be done, but I think that's something that the Moonshot could encompass.

Brian Lehrer: You give us the 100-year and the 200-year view of cancer. Steven in Manhattan is calling in with a billion-year view. I think Steven you're on WNYC. Hello?

Steven: Oh, good morning, Brian. What a fascinating program. I had read a while ago in the New York Times, Science Times, and then I just Googled it to make sure I was right, that they found a type of cancer, Osteosarcoma in dinosaur bones. I just find it absolutely fascinating that it's been around that long. It just is an astonishment to me.

Brian Lehrer: Sarah, I'll assume that's not on your beat covering health policy in the Biden administration.

Sarah Owermohle: [unintelligible 00:21:39] dinosaurs. Yes, I want to.

Brian Lehrer: I'll give that to Dr. Rollins, go ahead.

Barrett Rollins: Come on Sarah. I think this is a fabulous question. I remember seeing that article. The other thing I work on at Dana-Farber is a very rare disease of childhood. I'm not even going to say the name because it's a complicated name, that was also found in a dinosaur. I think what this reflects is this is the price that we pay for being a multicellular organism. The more complicated an organism becomes, the more chances there are for something to go wrong. It's an organizational entropy price we pay for being the complicated beings we are. I'm not surprised that cancer existed in pre-history.

Brian Lehrer: We'll continue in a minute with Sarah Owermohle from STAT News and Dr. Barrett Rollins from the Dana-Farber Cancer Institute on President Biden's Cancer Moonshot Initiative announcement yesterday and cancer in America generally. When we come back, we'll take more of your calls.

Our board is full with people asking interesting questions about this, and we'll also go over some stats that might surprise you on the demographics of cancer in America, including by ethnic group. Some of this is going to be surprising to some of you and also by geography. Certain states seem to have a lot more cancers than others. Stay with us.

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Brian Lehrer: Brian Lehrer on WNYC as we're talking about president Biden's announcement of a cancer Moonshot, as he called it, initiative yesterday. He went to Boston to do that where President John F. Kennedy was from and announced the moon Moonshot 60 years ago to the day yesterday, 1962 to 2022.

We're talking generally about cancer in America with an overview from our guests, Dr. Barrett Rollins cancer researcher with the Dana-Farber Cancer Institute, and Sarah Owermohle who covers health policy and the Biden administration for the medical news site, STAT News. I want to take a call from somebody who has survived cancer twice, he says. I think this will play into learning about what has been working in recent decades. Harry in Forest Hills, you're on WNYC. Harry, thank you so much for calling in.

Harry: Yes, I'm here. How are you? I'll give you a speedy rundown. I was self-employed doing a type of work that involved the use of a dye that had benzene. It was years later that I found out benzene is highly carcinogenic. I was 25. I had noticed some lumps that then satellited. It's one led to another to another. I sought medical help. I received a biopsy and then I was told I'd be spending some additional time in hospital. One thing I underwent radiation treatment. They only took three days of the 20 and the area that they had targeted there was a steel block.

Now, the reason they put a steel block there was to get extra radiation to the area. I was given a brief amount of time to live. It was an experimental program at that time. It was [unintelligible 00:25:22] lymphoma which is now called non-Hodgkin's lymphoma. Jumping ahead, 37 years later, I had some other problem. My doctor sent to your blood test scanned and he said, "I have some bad news for you, your old unwelcome guest has returned now." Again, it was the same thing I underwent, treatment. I was--

Brian Lehrer: Harry, for the sake of time, is your point that data is lacking on how well some treatments work because here are some treatments that work very well on you.

Harry: Yes. I would've liked to have been tracked regarding the radiation because, when I was in the hospital, I had a surgeon look at me and he said, "Well, being that you received radiation in the past," he said, "It basically cooks the organs. It makes things stick together. It makes things difficult for a surgeon." I will give another reason for the point.

I had received 4,000 rads of radiation which is a high amount of radiation that was to the abdomen. The doctor who I spoke to a few years back who wanted to give it again, he said, "We don't use that much, we used 40 grays." The gray measurement to something new and all they did was move the decimal to digits.

Brian Lehrer: Harry, I'm going to leave it there. Thank you very much for your story. I'm glad you're okay. We actually have a few people calling in Dr. Rollins saying they used radiation as a treatment for cancer, but radiation can also cause cancer. What? What do you say to the main points that Harry was trying to make there?

Barrett Rollins: Yes, Harry raised some very important points and I would say two things. One is that one of the biggest risk factors for having cancer is already having had cancer. We now know one of the reasons for that. I'm like a dog with a bone. I'm going to go back to the genetics. Our DNA gets damaged all the time from sun, from smog, from you name it, from things that we eat.

We've evolved a very efficient repair mechanism to make sure that whatever is damaged gets fixed. Some people on a genetic basis, they inherit from their parents a defective repair system. Those people are very high risk for cancers. That's one of the basis I think for screening populations to find people who have defective repair mechanisms because they're at risk for cancer and that may be what's happening with Harry.

The second point to make has to do with the Moonshot, which is that one of the things that Biden talks about is following patients. It's getting their data, following them from the point of first contact with a physician all the way through, and making that data completely available to all subsequent physicians who see that patient. Harry would've been in much better shape had something like that been in place.

Brian Lehrer: Sarah, there are disparities in who gets cancer and who dies from cancer that seem to run somewhat along the usual lines of privilege in this country although not totally. Immigration status may figure in an interesting way. According to CDC, Black Americans have the highest cancer death rates, but they are followed by whites and then Latinos have a lower cancer death rates than either, and Asian Americans lower still. What do you make of that?

Sarah Owermohle: I think it's like you and Dr. Rollin said. There's so many factors that go into it. It can be where you live, the occupation that you have. With what Harry described, we probably know now that he was exposed to harmful toxins that he could have been protected against that we didn't have knowledge about before.

That's in part what the second version of, or Moonshot 2.0 is trying to do is not just track a patient like Harry through the course of his care in any remission, but tracking what causes these cancers in the first place and why people in certain areas and certain groups are getting cancers more than others. Sometimes we'll find out that in certain populations, they'll be higher death rates than others, and why some treatments are not having a success in one population group that they're having in another. I'd also add to just with Harry's story and what Dr. Rollins was saying about the ways that environmental exposures, food, things like that can play a role in getting cancer

or how it metastasizes is the health and human services department. The federal agency for help did start recently, an office of environmental justice. Going back to the money question, because I talked earlier about how the Moonshot doesn't have new money. The environmental justice office doesn't have funding yet either, but what they are hoping to do is to track some of these questions as well.

Brian Lehrer: Are Republicans against the funding for the Moonshot?

Sarah Owermohle: Not for the Moonshot. I would go back to, you mentioned at the top of this conversation, President Biden mentioning President Nixon and going across the island acknowledging that. I think that that was very intentional throughout his speech yesterday. He had plucked the strings of patriotism, bipartisanship, "This affects everybody regardless of what party you in, regardless of where you live."

It was very similar to the way that he talked in 2016 when trying to rally support for the original Moonshot, which didn't end up not only getting an overwhelming amount of support but then majority leader, Mitch McConnell named the original Moonshot after Bill Biden, Biden's son who he lost to cancer. Nobody's really against, of course, cancer research or cancer care and improved care and screenings. It comes down to funding and who's willing to give more funding and where it would go.

Brian Lehrer: Since you mentioned Biden using the Moonshot to talk about unity or, using unity to talk about the Moonshot, here's a clip of the president yesterday, an example of how he did that.

President Biden: I gave you my word as a Biden. This cancer Moonshot is one of the reasons why I ran for president. It's part of my unity agenda that I laid out in my state of the union address to rally the American people to work together because we know this, cancer does not discriminate red and blue. It doesn't care if you're a Republican or a Democrat.

Brian Lehrer: Maybe not, but Dr. Rollins, there does seem to be a geographic cancer belt in this country. It's almost entirely in red states. A CDC map that I was looking at this morning shows the highest rates in the Midwest and South. All in states connected to each other, Alabama, Mississippi, Louisiana, but not Texas for some reason, plus Ohio and Indiana are in the highest cancer group. Kentucky, Tennessee, West Virginia, Arkansas, and Oklahoma and this is largely a map of Republican America, but then Maine is also in that highest group which wouldn't fit in politically. Any thoughts on cancer by state in the US?

Barrett Rollins: Yes. One hypothesis could be that there's a swath of horrible carcinogens that just blankets the country in those states and that's a hypothesis that would need to be tested. I think a more straightforward one is that we have learned in the past two years that public health interventions actually save lives and, public health interventions need to be supported at the state level, and in states in which you do see vigorous support of public health interventions, you see better outcomes.

Brian Lehrer: Another listener question, this one comes via Twitter. Listener writes discoveries about the role of genetics in cancer. Mary Claire King, and her work on familial breast cancer, BRCA1 and BRCA2. Thanks to Dr. King, physicians, and improved treatments, I'm still alive after breast cancer in ovarian cancer, writes this listener. My mother didn't have those opportunities. Yet someone else writes, is it true that younger women are getting breast cancer than in the past and if so why? Dr. Rollins on either of those things?

Barrett Rollins: I know much more about the former than the latter. I think the example of Mary-Claire King and the dozens of scientists who contributed to the discoveries of BRCA1 and BRCA2, that's an example of taking a fundamental understanding about how breast cancer develops and turning it into therapies that have saved individual lives. I think we'll see more and more of that going forward.

Sarah Owermohle: On the latter about younger women, I believe that the research has shown lately that a lot of it for both breast cancer and colorectal cancer, and there being more younger women having cases that a lot of it is tied to alcohol use and also diet, particularly with colorectal cancer like meat consumption. That's been what some of the studies have been, but I think we're going to find out, especially in the coming years, the way that alcohol use and the rise in alcohol use has affected younger people and their cancer rates.

Brian Lehrer: We have a call on that. Let me take it, Adam in Queens you're on WNYC. Hi Adam?

Adam: How's it going? I think your guest just touched on what I was going to ask about and respectfully, the work they're doing is amazing. I just wonder if half of the money and resources that went into treatment of things that we've already discussed or alluded to had a lot to do with lifestyle. If half of those resources went into educating people about diet, getting our population off of GMO'd and inorganic foods and all that stuff.

If that would have as big of an impact on cancer and so many other diseases like diabetes and all these things that everyone-- like everyone in my family that has these things, they just want to take a pill rather than do the hard work of eating healthy, exercising, and living a more healthy lifestyle. I'm wondering if the guest could speak to that.

Brian Lehrer: Adam, thank you. Sarah, can you take that? Is there funding, since so much of this funding is federal funding for research on the link between cancer and specific foods in our diets, or does industry manage to block that?

Sarah Owermohle: No, there is funding on that, and there is usually that's going through something like either NIH and it's various, I should say, National Institutes of Health and its various campuses, or the Centers for Disease Control and Prevention, which of course is where a lot of the messaging, especially to communities happens about the benefits of certain things or the risks of certain things. What's difficult about this though is well, the second version of the Moonshot does want to tackle some of these goals.

Some of the stuff that you just described are absolutely things that they want to address. They realize that there are lifestyle changes that need to be made, especially for this lofty goal of essentially vastly curbing, having cancer cases in general, this would be a critical part of that. The problem is that this would go through-- bureaucracy is a lumbering machine. It would go through many different agencies and you'd have to have many different people coming to the table and how best to do that.

Then it becomes the issue of, we can all agree that, fund cancer treatment. I don't think that there's many people in Congress who would say, "I don't want to fund cancer treatment. People with cancer don't need my help." Where it gets more difficult and from a political perspective is if you say, "Okay, we want to pass a bill that would effectively limit, processed sugar in your foods." That's where I would highly question whether that would happen, because of the influences that people would have and different concerns there. It's a difficult question.

Brian Lehrer: It's one thing to imply that it's people's personal choices as the caller did. It's another thing to get something structural through Congress. Why are so many people making bad health decisions if it's structural in what's found to be profitable by food manufacturers, et cetera?

We're almost at a time, I did say in the intro that I would ask you Dr. Rollins about your research on what you call white blood cell trafficking. Trafficking always sounds nefarious. What is it in this case?

Barrett Rollins: This really gets down to fundamental biology. If you cut your finger, one of the reasons that it heals is that white blood cells get attracted to that site and fix it. I used to work on these small molecules are kind of like hormones that direct white blood cells, where to go and where not to go.

The connection to cancer is again, this inflammation stuff and there's some evidence to suggest that these hormone-like molecules are made by several cancers. They track white blood cells, the white blood cells make the situation a little worse. In some cases, they might make them a little better, but it's all about that basic biology of how do white blood cells get around your body.

Brian Lehrer: Last thing, Sarah, if you can take this because it was in the speech or maybe I'll throw it to Dr. Rollins for the medical aspect, but President Biden mentioned cancer vaccines. If cancer isn't a virus, this is for me as a layperson, not a health reporter or a doctor, if cancer isn't a virus, which is what I think most vaccines work to prevent, how could there be vaccines against cancer?

Sarah Owermohle: There's one already, the HPE vaccine. That's the one that they point to and say, and I don't know how much anyone here watches TV, but you've probably seen a lot of ads that are trying to translate this to parents of young children as something that's not about an STD, but about preventing cancer. That one does exist, but going forward, there's a lot of hopes that people have--

Brian Lehrer: Although that's a virus, right? Then it has become associated, seems to be associated with later development of cancer.

Sarah Owermohle: Exactly, and so they do want to try to apply that to some others but of course like you said, since that comes from a virus, it's a different model entirely. There has been a lot of research done on messenger RNA. Of course, the technology that's been used for coronavirus vaccines,

there has been research on how to apply that in cancer and obviously, there's been a lot of attention on messenger RNA these past few years. There's hope that that will get accelerated, but I don't, Dr. Rollins might have more on the research side of that.

Barrett Rollins: Yes, I think this distinction between viral and nonviral causes is an important one but remember, I told you that the cancers get caused because of alterations in DNA. Remember, the DNA is the blueprint for how proteins are made. If you have damage in DNA, the protein that gets made is abnormal, it looks different. That's exactly what our immune system is designed to detect.

That's why to detect viruses because viruses don't usually exist within us. If a cancer makes an unusual protein, that means our immune system can see it and if we make a vaccine against that protein, there are some cases, Melanoma in particular in which you give somebody a vaccine, and it stimulates their own immune system to get rid of the cancer. That's another very hopeful Avenue.

Brian Lehrer: We thank Dr. Barrett Rollins cancer researcher with the Dana-Farber Cancer Institute for more than 30 years. Dr. Rollins has studied cancer at the molecular level, including some of the things that we talked about today. He is also the author of the book, In Sickness, a memoir about his own wife's fatal breast cancer, despite being a cancer researcher herself which is-- oh, oh that's the forthcoming book. You want to tell us when that's going to be out, Dr. Rollins? I'm also curious, how hard was that for you as a cancer researcher yourself to write this personal tale. I wonder if it changed your relationship with your work in any way to be so personally connected to it?

Barrett Rollins: It did. This was a very difficult story. My wife was a brilliant, brilliant cancer researcher. She invented the field of outcomes research in cancer but this story has to do with the fact that a high IQ does not prevent you from behaving irrationally. She developed breast cancer, she hid it from me and the rest of the world for about six years.

She revealed it to me and I've conspired with her to keep hiding it. It's just an amazing thing to think that someone that smart, and me too, not as smart as she was, but we behaved very irrationally. I would hope that would help people see that their responses to this disease encompass the entire spectrum of responses. I hope people can read it. It's going to come out on November 15th.

Brian Lehrer: Thank you for taking the risks, the emotional risks involved, and being self-revelatory in that way. Of course, thank you for your research. We also thank Sarah Owermohle Washington correspondent at the medical news organization, STAT News, who reports on the Biden administration's health goals, federal health policy, and politics and previously covered health policy and the drug industry for POLITICO. Thank you both so much. Fascinating discussion.

Barrett Rollins: Thank you.

 

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