National Cancer Institute director opens up about her own cancer diagnosis

AILSA CHANG, HOST:

At least 50% – that is how much President Biden wants to cut the cancer death rate in the next quarter century. It’s part of his so-called Cancer Moonshot that he started when he was vice president. And Biden recommitted to the effort during last week’s State of the Union.

(SOUNDBITE OF 2023 STATE OF THE UNION ADDRESS)

PRESIDENT JOE BIDEN: For the lives we can save…

(APPLAUSE)

BIDEN: For the lives we can save and the lives we’ve lost, let this be a truly American moment that rallies the country and the world together and prove that we can still do big things.

CHANG: Well, accomplishing those big things – like better treatments, fewer deaths, building more support for patients and families – much of all that will fall on Dr. Monica Bertagnolli. She’s a cancer surgeon and, since last October, the head of the National Cancer Institute. But fighting cancer is not just a professional mission for Dr. Bertagnolli. It’s a personal one, too. She was diagnosed with early stage breast cancer last December.

Dr. Bertagnolli joins us now. Welcome to ALL THINGS CONSIDERED.

MONICA BERTAGNOLLI: Thank you so much, Ailsa. It’s great to be here.

CHANG: It’s so great to have you. I just want to start by asking you, how are you doing? How are you feeling these days?

BERTAGNOLLI: I’m doing really well. I’m doing really well.

CHANG: Good.

BERTAGNOLLI: I’m well into my treatment. And my family and my physicians are taking very good care of me; so is the team at NCI, by the way.

CHANG: That’s really good to hear. What is it like to be diagnosed with a disease that you have spent so much of your professional life treating?

BERTAGNOLLI: Well, I think I was shocked just like anyone would be. You know, I went in for my regular mammogram expecting it to be negative like all the others and got a nasty surprise. And so now I know what it feels like.

CHANG: Do you see yourself entering any clinical trials yourself?

BERTAGNOLLI: Oh, yes. I’m on a clinical trial right now.

CHANG: Oh, wow.

BERTAGNOLLI: First thing I asked my doctors was, is there anything available for me? And there was a study available for me, and I signed on.

CHANG: What is that like, just being part of the process now?

BERTAGNOLLI: Oh, I’m just happy to do it. I’ll tell you, you know, one of the things that I thought about so much since this diagnosis is just how grateful I am to all the women who’ve been on clinical trials that have produced the treatments that I am receiving.

CHANG: Yeah.

BERTAGNOLLI: It’s the least I can do.

CHANG: It’s the least you can do. Well, President Biden has laid out some pretty ambitious goals for his Cancer Moonshot, such as cutting the cancer death rate by 50% in 25 years, as we mentioned. How doable is that piece of it, you think?

BERTAGNOLLI: So we can do it, but it is not going to be easy, and it is going to take a lot of collaboration. NCI can do a lot contributing the science and the research behind that goal, but it’s going to take all of our society to play their role in doing the prevention, the effective treatment for every single patient throughout our entire country. Finally, it’s not just a numbers game. We might be able to drop the mortality rate by 50% by only focusing on the very most common tumors. And of course, we can’t do that. We have to do it across the board. So even the very rare tumors will also see their rate dropped dramatically.

CHANG: Well, I ask about the feasibility of that particular goal because you are someone who’s even acknowledged that clinical trials need to be streamlined. There’s a lot of criticism that life-saving treatments take too long to be approved and that it’s really hard to get into clinical trials that could potentially improve treatment. So how do you address those challenges now as the director of the National Cancer Institute?

BERTAGNOLLI: We can be a lot smarter in how we design our trials, a lot more lightning-focused on achieving exactly the data we need. The second is we really need more trials. We have a wealth of opportunity that the basic science community is providing us in new therapies that I like to say is like a firehose. But unfortunately, it goes down to the size of a garden hose in terms of our ability actually to support and conduct trials.

CHANG: Yeah. You use the phrase lightning-focused – you want to see the efforts be lightning-focused. I mean, the National Cancer Institute still does have to exist within the rest of the federal public health system, a system that’s bureaucratic and extremely complex. Can it be made more efficient in time to meet President Biden’s goal, you think?

BERTAGNOLLI: Yes. I’ll give you one quick example. We’ve just launched a new collaboration, a new trial for patients with lung cancer. That was a partnership between NCI, the FDA, the drug companies Merck and Lilly and the National Clinical Trials Network and the Lung-MAP program. And this trial, it was produced in record time. But the reason it happened is because every single one of those partners were committed to making it happen quickly and being very simple.

CHANG: Well, I also want to talk about the personal financial costs of cancer treatments to patients because a lot of the most innovative treatments come at a very high price. And I mean that literally. Like, how can patients get the benefits of these advances in medicine without being ruined financially?

BERTAGNOLLI: Oh, it’s a terrible challenge. We’re getting better. Our patients are getting better access to coverage every year that goes by. But it’s absolutely essential that we find a way for everyone with cancer to have their care covered so that they can live a full life without being bankrupt as a result of their treatment.

CHANG: I mean, if I may just put more texture on this point, our work with Kaiser Health News on medical debt showed that cancer patients were among the most seriously affected. It showed that about two-thirds of adults with health care debt who have had cancer themselves or in their families have cut spending on food, clothing or just other household basics. And one poll showed that 1 in 4 people have declared bankruptcy or lost their home to eviction or foreclosure. So, like, I just can’t imagine facing such a terrible choice – to face either potentially dying from cancer or living in financial ruin. I mean, how do we get to a place where everyone’s cancer care is covered, as you just said it should be?

BERTAGNOLLI: Yeah. Well, I think at NCI we are – we’re a research institute. We’re focused on research. So what we can do is we can determine what’s the best treatment, what’s the most effective treatment that can hopefully minimize health care cost. We can also help identify what’s the best way to deliver care in the community so that it’s very efficient. But then I think this is part of what President Biden is talking about. We’re not going to solve the problem without the rest of government and the rest of society stepping up to solve problems like this one.

CHANG: As someone who’s done cancer research for decades, in what research area have you seen the most payoff in terms of helping the most patients?

BERTAGNOLLI: There have been some truly dramatic new treatments, like immunotherapy, which, you know, has been very exciting. Some other new targeted therapies have been very exciting for particular diseases like melanoma and lung cancer in some of the tissues of blood. But those are really, you know, very powerful for individual, smaller groups of patients, where the thing that truly has made a huge difference in terms of absolute numbers, the single biggest thing has been having people stop smoking. It’s so special. It means there’s no cancer. That’s what we want. We don’t want to…

CHANG: Yeah.

BERTAGNOLLI: …Be treating it ever.

CHANG: Yeah. Dr. Monica Bertagnolli is the director of the National Cancer Institute. Thank you very much for speaking with us.

BERTAGNOLLI: Thanks so much, Ailsa. It’s great to be here.

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