00:00I want to just start by getting right to the crux of what we want to talk about, and that's
00:04the gap between men and women's health care, especially with regard to aggressive cancers.
00:08Why does that still exist in this day and age?
00:12Well, I think it exists, again, because there was an underfunding and a lack of focus on women's health for
00:19all too long in the halls of public policy, at the research bench, and in clinical settings.
00:23And, you know, when I was head of women's health decades ago, we've shown a spotlight on these inequities, and
00:31we developed initiatives to really address them.
00:34But there are gaps, and that laser-like focus, you know, was not necessarily maintained.
00:40And so we have a ways to go.
00:44And, you know, I really want to talk to you today about lung cancer in women because, again, while we
00:51did talk about this years ago, it is still a major threat for women.
00:56There's a crisis, a lung cancer crisis in America.
00:59A friend of mine, Shira Bola, just developed it.
01:03She's 42 years old, healthy, a runner, eats right, does everything right, but she was a nonsmoker.
01:10In fact, her father was a pulmonologist.
01:13And why?
01:15Well, the fact is that, you know, we focused on men for lung cancer because we knew they smoked.
01:22And so all the research was done on them.
01:24And so we targeted our prevention programs to stop men from smoking.
01:28And their lung cancer rates came down.
01:30But you, I mean, but like, and I think we all know people who've been through this who have been
01:34nonsmokers, like your friend who you just mentioned.
01:36Why is this cancer developing in young, otherwise healthy people who don't have those risk factors?
01:42Well, that's the big question because the research hasn't been done there.
01:45We focused on smoking, you know, and again, because we didn't target women to smoke, their lung cancer rates went
01:52up.
01:52In 1987, lung cancer surpassed breast cancer as the number one cancer killer of women.
01:57More women die of lung cancer than breast cancer, cervical cancer, and ovarian cancer combined.
02:03So we need to, you know, target awareness to women.
02:08But your question is so important.
02:1020% of cancer deaths are in people who never smoked.
02:15And why is that?
02:16Again, we need to focus research efforts there.
02:18And why women?
02:20Women now in 2021, women under 65 surpassed men in terms of their lung cancer deaths among nonsmokers.
02:32Why?
02:33So genetics plays a role.
02:36Environmental factors, people who have been around people who've smoked, people in environmental pollution, radon exposure.
02:45But there are genetic factors.
02:47There's a stronger family history if you've had lung cancer in your family.
02:52But other genetic mutations that are just being identified.
02:55So this is where the research really needs to focus.
02:58And then, you know, most diseases are due to inheriting a gene or with environmental mutations, environmental factors that interact
03:08with normal genes and cause them to misspell.
03:12So only a small percentage of disease, you inherit that gene and it becomes that disease.
03:17It's the environmental exposures.
03:19And why are women more susceptible?
03:20And that's where we need to focus our research.
03:23So how do we need to be better advocates for ourselves?
03:26Because I do feel like when we think of cancer, we don't think of lung cancer for women.
03:31You think about ovarian or breast, right?
03:33And we have systems in place, especially for breast cancer, to kind of, you know, to make sure you're doing
03:38what you need to be doing.
03:39There's a system in place and infrastructure and awareness.
03:42But I do feel like, you know, what do you, like, how do you know when you should be advocating
03:47to say, I'm a little concerned or how do we check it out?
03:50Is there just something we should do as kind of a regular annual checkup?
03:54Well, I think, again, your question is so important.
03:57We need the same kind of national public education campaign that we've done for breast cancer to let women know
04:04that this is the number one cancer death for them, right?
04:07And number two, there are tests, low-dose CT scans, that screen for lung cancer, that can pick it up.
04:17And they're recommended, the U.S. Preventive Services Task Force that recommends the mammography and colonoscopy and cholesterol checks, these
04:26regular preventive screens,
04:29recommends this for people who are 50 to 80 who have a 20-year PAC history.
04:36So they've smoked one pack a day for 20 years.
04:39But that misses a lot of people.
04:41And a lot of people don't even know.
04:43So, for example, 75% of women go along with getting their mammogram every year, but only 6% to
04:497% of people get their lung cancer screens who are eligible for it.
04:54So we're not doing a good job in educating.
04:56And then we need to think about and reassess, I think, the screening guidelines.
05:02Because, for example, should people start getting a CT scan, get a baseline like they do for colonoscopy if they're
05:10average risk?
05:11And then do it every whatever number of years that might be.
05:14Is it 10 years or 5 years?
05:16Depending on their risk.
05:16I think AI will help us with this.
05:19It will be able to scan medical records.
05:21It will be able to come up with risk factors for families.
05:24We now have a whole new set of tools from genomic testing to AI to new screening techniques that will
05:34help us to develop better guidelines.
05:37And hopefully, one day, we're going to have a blood test.
05:40And some are under development to find lung cancer.
05:44Just 30 seconds.
05:45Our policymakers right now want to do this.
05:49Are they in a place, in your view, in Washington, where they're focused on this priority?
05:55I think we're seeing an increased awareness now.
05:58And I know several bills are underway.
06:00So I'm hopeful.
06:01But it's going to take all of us raising our voices and really coming together to raise the awareness.
06:08And I want to thank you, Bloomberg News, for doing this, for raising awareness about the crisis of lung cancer
06:14in women.
06:14As Einstein said, from crisis comes great opportunity.
06:17We have the opportunity to change this trajectory.
06:20Let's do it.
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