THIS AFTERNOON. OUR CONVERSATION CENTERS AROUND A CANCER. UP. INVOLVING ASIAN AMERICAN. WOMEN. ARE GROWING GROWING NUMBER OF LUNG CANCER CASES AND THE DIAGNOSIS. OFTEN SEEMS TO COME COMPLETELY OUT OF NOWHERE. JOINING ME NOW IS DR HEATHER WAKELY, PROFESSOR OF MEDICINE AND CHIEF OF THE DIVISION OF ONCOLOGY AT STANFORD UNIVERSITY. SHE IS ALSO THE DEPUTY DIRECTOR OF THE STANFORD CANCER. INSTITUTE. THANK YOU SO MUCH FOR BEING >>HERE. THANK YOU FOR HAVING ME AND FOR COVERING THIS REALLY IMPORTANT >Liz>TOPIC. IT IS AN IMPORTANT TOPIC AND YOU ACTUALLY APPROACH DOCTOR. DR SCARLETT GOMEZ, WHO WE MET IN THE LAST BLOCK ABOUT WHAT YOU WERE SEEING IN YOUR PRACTICE AMONG ASIAN AMERICAN WOMEN DIAGNOSED WITH LUNG CANCER. WHAT WERE YOU SAYING? >>WE WERE NOTICING IN CLINIC THAT MANY OF THE PATIENTS COMING IN. WE'RE PRESENTING. THEY NEVER HAD A SMOKING HISTORY. AND MANY OF THEM ASIAN AMERICAN AND SO REALLY WANTED. TO TRY TO UNDERSTAND THE WHY OF >Liz>THAT >>WE STARTED LOOKING AT THE QUESTION ABOUT WHY ARE PEOPLE WHO HAVE NEVER SMOKED, GETTING LUNG CANCER? AND THEN REALLY FOCUSED ON HOW THAT MIGHT BE DIFFERENT IN DIFFERENT ASIAN AMERICAN COMMUNITIES. AND JUST KIND OF BUILT FROM THERE, AND WE HAD BEEN TALKING FOR A LONG TIME ABOUT DOING THIS TYPE OF A TRIAL THAT BECAME THE FANS STUDY CASE CONTROL TRIAL WHERE WE'RE REALLY ABLE TO ASK THE QUESTIONS, AS OPPOSED >Liz>TO >>JUST LOOKING. WHAT'S ALREADY BEEN PUBLISHED BUT REALLY GENERATING SOME OF THE NEW INFORMATION >Liz>AS WELL. NOW IT'S IMPORTANT TO NOTE THE STUDY IS STILL ONGOING. SO THE FINAL RESULTS AREN'T OUT YET. BUT WHAT DO YOU THINK IS BEHIND THIS UPTICK? >>I THINK IT'S LIKELY GOING TO BE MULTIPLE. >Liz>THINGS, OKAY? >>WE DO THINK THAT THERE IS SOME KIND OF GENETIC >Liz>RISK, >>BUT WE HAVEN'T BEEN ABLE TO IDENTIFY IT AND WE BEING THE GLOBAL MEDICAL COMMUNITY BECAUSE MANY PEOPLE HAVE >Liz>LOOKED >>BUT WE KNOW THAT THE RATE OF LUNG CANCER FOR PEOPLE WHO DON'T HAVE ANY HISTORY OF SMOKING CIGARETTES IS HIGHEST IN FAR EAST ASIA AND THEN KIND OF GETS LOWER. AS YOU MOVE WEST. IN THE US, OF COURSE, IT'S GOING TO VARY BASED >Liz>ON THE >>PEOPLE WHO LIVE IN THE AREA WHERE YOU ARE. THERE IS SOME SORT OF GENETIC RISK THEIR BUT WE ALSO THINK THIS UPTICK IS A LOT OF ITS RELATED TO AIR POLLUTION, AND THERE'S BEEN SOME SCIENCE CLEARLY LINKING THAT, BUT THERE'S A LOT THAT WE STILL CAN'T SPECIFICALLY SAY IT'S HAD THIS OR HOW >Liz>THAT AND SPECIFICALLY SPECIFICALLY ASIAN AMERICAN. WOMEN. IS THERE A HORMONAL COMPONENT TO THIS? WHY NOT ASIAN AMERICAN >>MEN? IT IS ACTUALLY IN BOTH MEN AND WOMEN, BUT IT'S MUCH MORE IN THE ASIAN AMERICAN >Liz>WOMEN. >>PART OF THAT, AND I'M NOT TRYING TO TO GET TOO TECHNICAL, BUT WE KNOW THAT A LOT OF THE LUNG CANCER THAT DEVELOPS AND THAT'S SPECIFIC GROUP OF PEOPLE HAS A MUTATION. IN A GENE CALLED E G. FR. AND THAT GENE IS THE DRIVER FOR LUNG CANCER. FOR MANY PEOPLE WHO GET LUNG CANCER, ESPECIALLY IN THAT HISTORY OF NONSMOKING UM AND IT'S >Liz>IN ASIA, >>SO IT'S ASIAN AMERICANS, BUT IT'S ALSO IN ASIA THAT THIS PHENOMENON IS BEING SEEN AND THAT TENDS TO HAPPEN MORE IN WOMEN THAN MEN. WE DON'T KNOW WHY, AND THAT HORMONAL LINKED TO IT IS SOMETHING MANY PEOPLE HAVE LOOKED AT LOOKING AT. IS IT ESTROGEN? IS IT PROGESTERONE IS SOME COMBINATION. PERHAPS LINKED SOMEWHAT TO PROGESTERONE. BUT >Liz>NOT >>AN ACTUALLY CAUSING MORE OF THAT. SO THE WOMEN'S HEALTH INITIATIVE AS A LONG AGO STUDY THAT LOOKED >Liz>AT >>HORMONE REPLACEMENT AND SHOWED A LOT OF THINGS BUT 1 OF THE THINGS THAT SHOWED WAS THOSE RISKS OF LUNG CANCER. ONE NECESSARILY. HIGHER. BUT THE CANCERS MIGHT BE A LITTLE BIT MORE AGGRESSIVE WHEN THERE WAS A PROGESTERONE COMPOTE. BUT WE DON'T HAVE A >Liz>GREAT ANSWER. NOW. WHAT DO YOU THINK IS BEHIND THE RECENT UPTICK RECENT MEANING OR LAST 15 YEARS? IS IT BECAUSE YOU'RE JUST GETTING BETTER AT FINDING LUNG CANCER, OR DO YOU THINK THAT THERE'S SOMETHING GOING ON THAT'S LEADING TO MORE WOMEN? GETTING LUNG CANCER? >>WE THINK THERE'S ACTUALLY A TRUE INCREASE IN THE INCIDENTS IN THE PEOPLE ACTUALLY GETTING THE DISEASE. THERE'S BEEN SOME GREAT GLOBAL WORK, ESPECIALLY IN TAIWAN, WHERE THEY COULD SHOW >Liz>THAT >>EVEN THOUGH SMOKING RATES WERE COMING DOWN THE RATES OF ADENOCARCINOMA SPECIFIC TYPE OF LUNG CANCER THAT WE SEE IN THE MOST COMMON BUT ESPECIALLY THE ONES SEEN IN PEOPLE WHO DON'T HAVE A HISTORY OF SMOKING CIGARETTES. THAT WAS SHOOTING UP DRAMATICALLY. ESPECIALLY IN THE WOMEN. HERE. WE DON'T COLLECT AS DETAILED INFORMATION. ON THE SMOKING HISTORY TO BE ABLE TO ANSWER THAT FROM THE YOU KNOW. QUESTIONS AS CLEARLY BUT IN WORK THAT'S BEEN DONE. WE ARE SEEING THAT INCREASE. ALSO. SCREENING FINDING IT EARLIER. IS SOMETHING THAT WE ARE NOT VERY GOOD AT ESPECIALLY FOR THIS GROUP OF PEOPLE. SO WE DON'T THINK IT'S THE SCREENING BECAUSE WE JUST AREN'T DOING LUNG CANCER SCREENING FOR PEOPLE WHO DON'T HAVE OBVIOUS RISK. FACTORS. SO WE THINK THAT'S REALLY GOING UP AND THAT'S WHY IT'S SUCH A SIGNIFICANT PUBLIC. HEALTH ISSUE. >Liz>I WANT TO. I WANT TO GO OFF THAT BECAUSE SO MANY OF THE WOMEN WE SPOKE TO DON'T FIND OUT THEY HAVE LUNCH. CANCER UNTIL THEIR IN STAGE. 4. WHY IS THAT AND THE SYMPTOMS DON'T REALLY PRESENT. THEMSELVES UNTIL IT'S SUCH AN ADVANCED >>STATE, RIGHT, RIGHT? LUNG CANCER. IT IS SILENT DISEASE. WE THINK ABOUT IT THAT WAY FOR A LOT OF REASONS, BUT ESPECIALLY BECAUSE IT CAN GROW WITHOUT ANY SYMPTOMS. REALLY PAIN RECEPTORS IN THE LUNG, AND SO YOU DON'T FEEL ANYTHING. IF IT HAPPENS TO GROW CLOSE IN WHERE IT CAN CAUSE A CAUSE. THAT COULD BE A SYMPTOM. A LOT OF TIMES, THERE'S JUST NO EVIDENCE THAT IT'S THEIR UNTIL SOMEONE HAS SOME PEOPLE ARE GOING TO GET LUCKY, AND THEY HAVE SOMETHING ELSE HAPPENED, WHICH LEADS THEM TO GET AN X RAY AND BOOM IT'S FOUND BUT A LOT OF TIMES PEOPLE DON'T COME IN UNTIL THEY'RE HAVING LATER. SYMPTOMS >Liz>SUCH AS >>PAIN BECAUSE IT'S GONE SOMEWHERE ELSE, OR REALLY SIGNIFICANT COUGH, SO THAT'S THE CHALLENGE AND IT'S 1 OF THE BIG THINGS WE WANT TO WORK ON ALSO IS. HOW DO WE FIND THESE CANCERS EARLY AND WE WANT TO FIGURE OUT WHY THEY'RE HAPPENING. WE WANT TO STOP THEM FROM HAPPENING. AND IF WE CAN'T DO THAT, AT LEAST FIND THEM EARLY ENOUGH THAT WERE ABLE TO CURE MORE >Liz>PEOPLE. SO MUCH THAT'S BEING DONE IN THIS PARTICULAR FIELD IN THE ADVANCEMENTS THAT ARE BEING MADE EACH
