MS. SELLERS: Good afternoon and welcome to Chasing Cancer 2020. I’m Frances Stead Sellers, a senior writer at The Washington Post.

My first guest today is Dr. Siddhartha Mukherjee. He's a renowned oncologist, is a Pulitzer Prize-winning author, and he's also serving on Governor Andrew Cuomo's commission to rebuild New York's economy in the wake of the pandemic. Welcome, Dr. Mukherjee.

I'd like--

DR. MUKHERJEE: Thank you. Thank you for having me.

MS. SELLERS: Delighted to have you. I'd like to start by asking you about the huge surge in cases we have across some of the parts of the country, and states in the South and Southwest, particularly. What's going on there? Is America opening too quickly, too soon, too unscientifically?

DR. MUKHERJEE: Well, I think--I mean, some aspects of the surge were expected. So, I think some of it is just the fact that once you let the--once you let people interact there will be infections. I do fear that we are opening without adequate masking and adequate protection. I'm extraordinarily worried that the messaging that we've tried so desperately to move into people's minds over the last two months has not fully penetrated. And that is, you know, avoid crowded spaces, avoid closed spaces, and avoid contact, and obviously, if you're ill yourself, get tested and get isolated and quarantined. Right now, in the absence of a vaccine and with the very, very few medicines that we have available against COVID-19, this public health strategy is the best strategy. You can either, you know, basically isolate yourself, or you can isolate your respiratory system by wearing a mask.

And I think part of the problem is that outside, you know, many, many other--many places, I see photographs of people--I've not been traveling outside New York City, but I see photographs of people wearing no masks, in close contact with each other, and I think that's a big, big, big, big problem. In New York, I was out this morning, and virtually everyone is masked.

MS. SELLERS: So, I was going to ask you specifically about New York because you're serving on this commission there. What does New York have now? Does it have specific tools to protect against a second wave? Are you worried about that given what we're seeing in, you know, as I said states like Arizona and Florida and Texas?

DR. MUKHERJEE: So again, we're using the best public health measures that we know, and as--right now, in the absence of a vaccine and with very few medicines that work, the best public health measures are the ones I described.

New York, as you very well know, is opening in phases. We are now in a--in the first phase of the opening, and businesses are now open. Some businesses are now open in--you know. Restaurants are open on--in open spaces, and that's because we know from a lot of data that most of the infections, virtually all of the infections, with COVID-19 occur in closed, crowded spaces, when you have intimate contact with respiratory droplets from someone who is infected.

So, I think the phase-by-phase opening is actually the right way to do things. I think really emphasizing that masking and isolation and avoiding of crowds in closed spaces is the right way to do things. And if you don't do it, I think we will face a second wave which will unfortunately cripple--you know, if we do another shutdown, it will cripple the economy once again--


DR. MUKHERJEE: --and that's what we want to avoid. I would implore, really implore the governors of Florida and Arizona and Texas to take this extremely seriously.

MS. SELLERS: You have mentioned vaccines a couple of times, and President Trump has talked about rolling out hundreds of millions of doses of vaccines by January even. Some scientists have talked and thought this was possibly an unrealistic goal. What's your thinking here? When do you think we might have a vaccine, and when do you think that might bring us back to a sort of normal way of life?

DR. MUKHERJEE: Well, so you know, most people who work on vaccines--I did a roundtable with the leading corona virologists and vaccine people recently. You can find it on the web. Most people think that 18 months is an extraordinarily ambitious goal, but potentially achievable. So that brings us really into the middle of the summer next year.

Vaccines are extraordinary things because they have to be not only developed and tested, but they also have to be safe. We cannot compromise on safety. And also, they have to be deployed. It's not just enough to have a vaccine. It is you need to give the vaccine. You need to have enough doses available so that you can get a real immunity.

So, I think the--you know, the idea that we would have a vaccine by the winter is extraordinarily ambitious. I mean, is it possible? I suppose it is possible. But we cannot--we really--because vaccines are given to healthy people, we cannot compromise on safety.

MS. SELLERS: And I guess right now, with all the vaccine hesitancy there is out there, there's an even higher burden on this vaccine to be safe. Right? We've got people distrusting measles vaccines and other...

DR. MUKHERJEE: That's right. So that makes it an even greater challenge, as I said. And a vaccine--a vaccine by itself in a tube is not useful. A vaccinated human being is what we need. And you know, those are two different things. We need to rebuild trust in the scientific system. Vaccines in the history of humanity have saved millions of lives; millions of lives have been saved. So, we need to get over the distrust of vaccines.

The other thing that I think it's important to emphasize is that vaccines have been getting safer and safer and safer every year, and that's because new technologies have allowed us to make much safer vaccines than were ever present before. As you know, there's a lot of misinformation about vaccines, and that's because vaccine--the vaccine technologies date back way, you know, into the--into the late 1800s and 1700s. So, this--you know, we have become progressively able to create safer and safer and safer vaccines. So, there's a lot of misinformation about vaccines that needs to go so that we can actually get safe vaccines into the hands of people.

MS. SELLERS: That brings me to an audience question. Sylvia Wolf in New York asks whether there will ever be a vaccine for cancer.

DR. MUKHERJEE: Well, Sylvia, you know, there is no such thing as cancer as a single disease. So, it is a multiplicity of diseases, and therefore, I would say that it's impossible to imagine a single vaccine for cancer.

Now let me give you some examples. There is a highly effective vaccine developed by scientists against one virus that causes cancer, the human papillomavirus that causes cervical cancer, and we know that that vaccine--so the so-called HPV vaccine--is highly effective at reducing the risk of cervical cancer. But the idea that there would be a vaccine against all cancers I think is unlikely because every cancer is really a different disease.

MS. SELLERS: Right. So, since the pandemic began, it's become increasingly hard for people to visit their doctors to get screened, to have follow-up appointments. What's your greatest concern now when it comes to treating patients with cancer?

DR. MUKHERJEE: Well, so we've tried--I think across the nation we've tried to maintain schedules for chemotherapy and other life-saving treatments for cancer patients as much as we can. I think where we've seen--where we've seen a drop-off has been in cancer screening, and I--you know, I can--let me emphasize that colonoscopy and mammography are tested mechanisms of screening. And so, people are afraid to go to the hospital, and we've seen a drop-off of people coming in for routine cancer screening. And you know, the--catching cancer early is a very, very important part of the way we treat cancer. And so, we just have to wait and see and encourage people to maintain their regular screenings, again with the appropriate precautions that are required to go to the hospital.

MS. SELLERS: So, it brings me to another audience question. This is from Leo Jones in Washington, D.C., and he tells a story that I think many people will relate to. He has a friend who was recently--recently died, in fact, from COVID-19, and he says he and his friend suspect that the virus was caught during a visit to a hospital for chemotherapy. So, his question, which I'm going to read, is: Should patients with early-stage cancers consider suspending hospital treatments for a year until the U.S. has better control of the virus?

DR. MUKHERJEE: The answer is, no, they should not do that. I think in most places, in most cancer centers, the chemo--outpatient chemotherapy wards have been isolated and intensive testing is deployed before you can get chemotherapy. So, in fact I know from our chemotherapy wards, the outpatient chemotherapy wards, that there--you know, the levels of safety are incredible and enormous. Obviously, there are other parts of the hospital, and depending on where you are in the United States, where there are COVID patients and there--but they're really different parts of the hospital. It's very, very unusual to have an outpatient chemotherapy suite, which is where most chemotherapy is applied, to be comingled in any way with a ward that has patients with COVID in it, in the United States.

So, you know, treating cancer early and appropriately remains an incredibly important goal, and I would--I would discourage people from delaying chemotherapy or surgical therapy or radiotherapy for early cancers because of worries about COVID.

MS. SELLERS: Are there forms of cancer treatment that can be done through telemedicine? Is that a transition that you are seeing? I've talked to various other doctors, including ER doctors, who talked about telemedicine forming an ever more important role here. So, I'd love to hear from you about cancer treatment.

DR. MUKHERJEE: One of the--one of the major focuses of the governor's panel in New York is telemedicine. It is very clear that telemedicine is going to be part of our future, and that is not only because of COVID-19. It was going this way even before COVID-19, but COVID-19 has in some ways just emphasized the idea over again.

I think that the--you know, we need to get the right kind of telemedicine, and the idea that I favor is a kind of hybrid model in which you would have maybe two out of three visits as telemedicine visits and then one out of the three visits being an actual hand-to-hand or face-to-face visit.

It's really important for me to emphasize that telemedicine is not just facetime with your doctor. There needs to be a wide infrastructure built. It needs to be accessible. It needs to be equitable. It needs to reach minorities. It needs to reach places like rural areas, where you may not have broadband access that's compatible with telemedicine. So, there's an enormous--there's enormous amount of infrastructure that needs to be built, but the answer is very clear. I think a hybrid model with telemedicine and face-to-face medicine needs to be built, and that is just the way forward.

MS. SELLERS: So, let's step back just into the lab a little bit. We've been talking about treatment, but we have this huge focus right now on coronavirus and an enormous amount of research going into that. Is that going to hurt some of the innovations in cancer at this point, or are we--are they being delayed? Do you see problems in that area? Or can they, the two issues, move ahead symbiotically?

DR. MUKHERJEE: There has been a very concerted effort from the NIH and from other societies to make sure that the--that cancer research is not delayed. There was a time, I have to say, that clinical trials for cancer had to be slowed down, and in fact, recruitment slowed down because we--you know, the hospital was overwhelmed by coronavirus.

And this is again a good reason to be thoughtful about this because if you--you know. Containment of the COVID-19 pandemic not only helps people with COVID-19, but of course, it helps people with any medical condition. So, we are now--we've now restarted in New York, at least at my hospital, restarted virtually every trial. The IRBs are functioning again. A lot of the meetings are being done through the web, but nonetheless, they are still functioning. And laboratories are up and running with new protocols to keep social distancing and masking available. So, we are back, I would say mostly on track, but remember we are in phase one of the--of the reopening.

MS. SELLERS: Right. So, talk a little bit more broadly about the health care system as a whole. How has the virus changed how things are being done? You've talked a little bit about telemedicine. Do you see other changes that will be ongoing and potentially beneficial that will emerge from this situation?

DR. MUKHERJEE: Yes. So, I think--I mean, one of the things that's emerged is we--we've learned very quickly, I think, that we need a--that we need a strong pandemic response team. We've learned very quickly again that we need to strengthen the CDC and the FDA. One of the most crucial--I would say one of the most crucial problems and/or challenges for COVID-19 was there was a 42-day delay between the detection of the first case of COVID-19 in Seattle and the widespread availability of testing from the CDC/FDA for patients. That delay should--you know, really put us back in terms of being able to track and trace and isolate people, and by the time the testing kits were widely available, you know, the pandemic had already spread in the United States. So, we've learned lessons there. As I said, they are very sobering lessons.

One more lesson is that the current system by which we stockpile and give personal protective equipment to doctors facing a pandemic was not in the right place. Many doctors and nurses, as you know, were infected. Some of them have, unfortunately, died. This was a huge tragedy. And so that's another thing we've learned, that we really, really need in the middle of pandemic to have clear guidelines and adequate equipment for doctors and nurses to protect themselves and, of course, for patients to be protected as well.

MS. SELLERS: And this is key, of course, in going ahead with cancer treatment as well, that all these investments and broad issues will become important as well in how we deal with cancer going ahead. Right? Not just individual treatment but looking at these public health aspects and making sure minorities are brought in for treatment.

DR. MUKHERJEE: Absolutely. I mean, you know, there has been an enormous effort preceding COVID to ensure that our treatment was equitable. I mean, the non-equitable treatment for African Americans versus non-African Americans, or Hispanics versus non-Hispanics, has been very widely studied and noted.


DR. MUKHERJEE: And certainly for--

MS. SELLERS: In cancer. In cancer.

DR. MUKHERJEE: In cancer. That's correct, in cancer. And so, you know, this has been widely studied, widely noted. There have been multiple panels and commissions who have tried to correct it. I believe it will be corrected, but if anything, the COVID pandemic has made it very clear that health care equities are an incredibly important issue to address as we move forward into the next months ahead.

MS. SELLERS: So, I think I have time for one last question, and that's really about that you work at Columbia, you're training the next generation of students who will go off and be oncologists and do their own work, in the midst of a pandemic. How are you preparing them to be the future oncologists we all need, to go out in such a stressful situation, and face and help people dealing with this terrible disease?

DR. MUKHERJEE: Well, I think it's reminding people. I mean, the COVID pandemic has reminded people that health is an incredibly important part of the infrastructure of the nation. Our--you know, without health, you can't have a functioning economy. Without health care, appropriately delivered, you can't have a functioning economy, you can't have a functioning populace.

So, if anything, I've found that the students are more energized. They're giving more of their time. Many of them have volunteered in various capacities during the pandemic, which was a very encouraging sign. They're afraid, I think. But the one thing that's been very clear is that, you know, if anything, the pandemic has convinced us that without adequate health care and adequate distribution of health care, you know, we can't function as an economy and we can't function as a nation. So, they're--

MS. SELLERS: Thank you so much. I didn't mean to interrupt that last sentence, but thank you so much for joining us. That's a great note to finish on.

We have a short video now and another segment, and then I'll be back with Dr. Otis Brawley. So please stay tuned after the next segment.

[Video plays]


--Richardson-Heron, Pfizer's Chief Patient Officer, and it's really great to be here today. With me is Sue Peschin, the President and CEO of the Alliance for Aging Research. Now, Sue is here with me today to address one of the biggest blind spots in cancer, and that is age.

You know, while access to, and delivery of, quality cancer care is not a new issue, the conversation to date has largely excluded older people as a distinct and vulnerable population, but we all know that age is one of the greatest risk factors for developing cancer. And issues faced by older people are only further exacerbated by a person's race, socioeconomic status and where they live. And as was just mentioned, study after study shows that older people are not receiving optimal care, as well as those of racial and ethnic backgrounds, and this has serious implications ranging from a greater risk of experiencing decreased quality of life to dying prematurely from certain diseases. And then on top of this, the data clearly show that older African Americans are more likely to die of cancer than older white Americans.

You know, at this time, when racism is at the center of our nation's conversation, change must come, biases must end, and we must strive for the highest quality outcomes for all Americans regardless of their race or their age.

So, Sue, I just want to say thank you again for joining me today for this very important discussion. Let's jump right in. What are some of the reasons older people may not be receiving standard treatments?

MS. PESCHIN: Thank you so much for having me, and that's a great question. The COVID-19 pandemic has really brought to light, in dramatic and tragic ways, health care inequities and disparities that older adults face. People aged 65 and older make up 80 percent of all COVID-19 deaths, so the vast majority. And some people will say, well, everybody dies of something. But COVID-19 is really an extra something. It's highly infectious and deadlier in older people. And this dismissive attitude towards older people, unfortunately, really isn't new. Ageism is common, and COVID-19 has just revealed it a little bit more, and it's led to the marginalization of older people within our communities.

DR. RICHARDSON-HERON: And you know, the truth really is, Sue, you know, thankfully all of us are living longer, healthier and more active lives. So, we just have to ask ourselves why is it that our loved ones 65 and older are not receiving the best care we can offer, particularly when it comes to cancer. You know, when I think about it, I think the answer is it's complicated. It's a problem that spans challenges in our medical, our societal and our policy arenas.

MS. PESCHIN: Yes, that is exactly right, Dr. Dara. Older people aren't represented at the rates they should be in cancer clinical trials, and that makes it harder for clinicians [audio distortion] the available evidence.

A few years back, the FDA did an analysis of registered cancer trials, and they found that only about 40 percent of trial participants were aged 65 and older, and that's compared with them representing about 60 percent of the overall population with cancer. Also, about half of older people have at least one chronic condition on top of their having cancer. So, understanding how additional chronic conditions can impact cancer treatment is really important.

Older adults are individuals, and so there's a need for individualized care decisions. A one-size-fits-all approach doesn't really work. One person might be focused on getting rid of their cancer no matter what the side effects or risks might be while another might want to make sure they're able to reach a family occasion free of discomfort. Ideally, the health care team should support a patient's access to the care that they want, whether interventional or palliative. Age bias, as well as race and cultural biases, may impact whether critical discussions about treatment goals and decision-making are taking place between patients and their health care providers, and that really needs to get recognized and fixed.

DR. RICHARDSON-HERON: Yeah, yeah, when you take it all in together, it's really difficult for older people to get the care they need and deserve. So, in your opinion, what can we do to fix the problem?

MS. PESCHIN: Yes, let's focus on solutions. So first, we really need to increase the number of older people participating in clinical trials for all types of conditions that impact them but also for--certainly for cancer. And we can learn from the European Medicines Agency about how their geriatric medicine strategy has improved data gathering on older people and if this model would work in the United States with the FDA. Then we have to support our health care practitioners to use better clinical tools for older adults, such as geriatric assessments, and those tools help to fully evaluate the person at an individual level, and that helps support the treatment decisions based on their goals and their values. And last, we really need to support improved access to affordable high-quality health care.

DR. RICHARDSON-HERON: Well, all of those are fabulous and great points, Sue. And the one thing we know for sure is that cancer does not discriminate and neither should cancer care. That's why Pfizer is working with the cancer community to tackle these issues and identify solutions. For example, we're partnering with the Association of Community Cancer Centers to develop a self-assessment tool for health care professionals to identify areas for improvement in the care of people over 65, and from there, we'll be developing resources to address the many gaps. And we're also very proud to be partnering with patient organizations to expand information and resources, to support the needs of older people living with cancer and their caregivers, including a focus on people of color.

So, I really enjoyed the conversation immensely, but we are at time. So, I'd like to again extend a heartfelt thank you to you, Sue, for chatting with me today.

The bottom line is more needs to be done to address the systemic shortcomings that impact cancer care as we age, and certainly the time is now for all of us to work together to tackle this complicated issue on all fronts. We can, and we must, do better for our families, our friends and our own future.

So, thank you again, Sue.

MS. PESCHIN: Thank you.

DR. RICHARDSON-HERON: That concludes this segment of the program. We'll continue in a moment with a video introducing the next segment. Thank you.

[Video plays]

MS. SELLERS: Good afternoon. If you're just joining us at Chasing Cancer 2020, I'm Frances Stead Sellers, a senior writer at The Washington Post.

Joining me now is Dr. Otis Brawley. He is a former President of the American Cancer Society, and he's now a Bloomberg Distinguished Professor of Medicine at Johns Hopkins. He's here to talk to us in particular about disparities in health care.

And Dr. Brawley, welcome.

One of the things that's--become very clear during this pandemic and at this watershed moment in terms of racial justice is how African-Americans and other minorities have fared so badly in the COVID epidemic.

Can you tell us what gaps this has revealed in the American health care system?

DR. BRAWLEY: Yes, thank you for having me.

The COVID pandemic really exposed a gaping wound in American society, and it's really based on socioeconomics. The people who could not shelter in place, the people who still had to go to work were people who were of lower socioeconomic status. Many of those jobs are held by blacks and Hispanics in many of our big cities. And those people were still exposed to the coronavirus. They couldn't shelter in place. Those folks also had many comorbid diseases that we see folks of lower socioeconomic status have in higher prevalence: diabetes, hypertension, cardiovascular disease.

And this created the perfect storm for people who would get the disease, their living environment--living in dense environments allowed for increased spread. And once they had the disease, they had other illnesses that made outcome more likely to be not good.

MS. SELLERS: Do these same disparities exist in terms of prevention and treatment of cancer, as well?

DR. BRAWLEY: These disparities are the problems that we've been dealing with in the area of health disparities and health equity, and they've really been defined for more than 50 years.

Indeed, one of the things we're really surprised about was some people seemed to be shocked that these disparities were happening in coronavirus. They have been happening in cancer; they've been happening in cardiovascular disease; they've been happening in a number of different diseases over the years.

MS. SELLERS: So, that brings me to a question from Holly Anderson in Minnesota, and she asks--let me read the question: "Are systemic racism and health inequality linked? How do we ensure health equality for all people, regardless of race?"

DR. BRAWLEY: Yes, they are definitely linked. Part of it is based on education. It is a number of different things, and sometimes we try to have band-aid solutions where we just try to fix one thing. It's linked to lack of education, lack of understanding health promotion and health prevention activities. It's not having a job; it's not having access to care. Once one has insurance and access to care, it's sometimes discrimination in getting the care itself.

There are a number of studies out there that show that poor people have lack of access to care for various reasons. There are a number of studies that show the greatest problem is socioeconomic; it's income and education. There are also a number of studies that show that the largest disparate population for cancer is actually white Americans instead of blacks or Hispanics.

MS. SELLERS: So, you mentioned hypertension, diabetes, obesity, these issues that are comorbidities for COVID, but also complicate cancer treatment.

How do you see the health care system adjusting to trying to adjust--deal with these very fundamental issues, often that exist in the population before people ever see a doctor?

DR. BRAWLEY: Yeah, this is actually a long-term problem, and many of us believe that we need to focus more on preventing these diseases versus early detection and diagnosis once they happen. I'm not against early detection and diagnosis of the diseases, but there's not been enough emphasis in the United States on preventing them from starting to begin with.

If you look at Europe, Western Europe especially, and Canada, they do a much better job in preventing these problems from ever happening. And then, of course, you don't have to pay the incredible expense for treating them.

MS. SELLERS: So, that brings me to an audience question from Kurt Nemes in Washington, D.C. who asks, "How does race and ethnicity affect incidences and survival rates of cancer?"

DR. BRAWLEY: Well, they correlate. People who are black in the United States have a lower survival rate and a higher death rate is actually, in epidemiology, the more important factor to measure. The death rate for blacks is higher in cancer, it's higher in cardiovascular disease, higher in diabetes.

Certain Hispanic populations--certain Hispanic populations--also have higher death rates in those diseases, as well.

And then, the thing that we never talk about is poor whites, especially in Appalachia and the southern United States. They also have higher rates of death from these diseases.

MS. SELLERS: Right. So, some people talk about very high-tech advances, the very expensive high-tech advances we're making in cancer being more available to people who are well-insured and who are well off.

What can we do to make sure that cancer treatment is not reserved for the wealthy?

DR. BRAWLEY: You know, I worry a great deal. I'm not at all opposed to improving cancer treatments, but I am very concerned about the fact that a number of people don't get those treatments.

The best example I've ever known is a colleague of mine a few years ago did a study and showed that 7 percent of black women in Georgia who are diagnosed with an early stage curable breast cancer get no treatment once diagnosed with that.

Now, that 7 percent get no surgery in the first two years of diagnosis, I should say. That is research that we got in the 1890s that they're not getting in 2005. And so, you know, I love the idea of new drugs and new treatments, but we have to make sure that everybody can enjoy those new drugs and new treatments. I just gave you an example of an old treatment that works that people aren't enjoying today.

MS. SELLERS: Right. And right now, we're hearing so much about people who are avoiding hospitals, avoiding doctors' offices because of the fear of the environment and COVID in that environment.

Do you worry about late diagnosis of cancers? Do you even worry about a death toll to come because people have avoided early screening and early treatment?

DR. BRAWLEY: You know, we've actually been able to model that and in March, April, and May, we really shut down clinical treatment of cancer and we shut down screening for cancer. We are now concerned that in 2022-2023, we're going to have a 2- to 3-percent increase in death rate from breast and colon cancer because of that shutdown.

Interestingly, it's not as much the delay in screening; it's the delay in diagnosis and treatment that's going to end up costing us some additional lives, perhaps 10- to 15,000 additional cancer deaths in 2022 and 2023. We have about 600,000 a year in the United States, by the way. But it's the delay in treating that is causing the problem.

You know, when we say women should be screened for breast cancer, we say every one or two years. If they put it off by three or four months, that's not going to make a big difference in our statistics.

Now, if we continue delaying screening well into the summer and beyond, then we worry about screening, but right now the problem is there's people who have a symptom and are afraid to go to the doctor and get diagnosed. There are people who have been diagnosed who are afraid to get treated.

MS. SELLERS: So, age is a significant risk factor for cancer. Do we see disparities in terms of socioeconomic or racial disparities also in the older age group when it comes to cancer treatment and cancer--

DR. BRAWLEY: Well, all older people--when we say "older," we're talking about people in their 70s and 80s--all older people have a challenge with cancer. Poor people have a greater challenge with cancer when they are old.

MS. SELLERS: What have we learned about the health care system and how it functions from COVID? And how will that help us treat cancer better in the future, or how may it help us?

DR. BRAWLEY: Well, we've learned a lot about our health care system and our public health system and what some of the warts are. Keep in mind, if we had the health care system of Germany and had reacted to the COVID infection the way the Germans did, we would have right now 36,000 deaths instead of 120,000 deaths.

If we had the health care system of the South Koreans and had reacted the way the South Koreans did, we would have somewhere around 1,500 to 1,800 deaths instead of 120,000 deaths.

So, this is very indicting of our health care system and our public health system. And in New York, for example, some people died purely because the hospitals were overwhelmed and overrun and in extremis.

MS. SELLERS: So, when you're comparing those health care systems, you're talking about something closer to a socialized model. Of course, Britain, as well, is suffering--it has a socialized model and is suffering during this epidemic. But what specific changes do you think could happen here? We have a very fractured public health care system. A lot of the risk factors you talked about earlier on for cancer get lost at that level.

Where do you want to see investments in the future in this health care system to improve--

DR. BRAWLEY: Well, when I talk about a health care system, I'm talking about an entire system from prevention through early detection and screening, all the way into treatment.

In our system, we're so focused on treatment and don't focus on actually preventing disease and early detection.

In Germany and South Korea, what they had was very aggressive finding of people who had coronavirus, very aggressive sectoring them off from the rest of the population so that they did not spread it. They had very aggressive public health early on that prevented problems. Now, we don't have that public health problem; and then, we don't have good treatment once people get disease, as well.

MS. SELLERS: So, what are the most exciting developments you have seen recently in cancer? And the second part of this question, what are you most excited about in the next five to ten years that you see coming in cancer treatment?

DR. BRAWLEY: I see a number of things that make me incredibly excited. You know, over the last 40 years, we developed a great deal of molecular biology that allow us to understand exactly what cancer is and what's going on with cancer. That's incredibly exciting.

That molecular biology, by the way, allowed us to figure out that we had a coronavirus as a problem and allowed us to trace the coronavirus. Some of that laboratory technology for cancer is helping us understand the coronavirus, as well.

In terms of treatment, some of the immunotherapies that we have are really a game-changer and are helping to save lives. And I'm someone who's, in the past, criticized people for being too excited about small, incremental changes, but some of the immunotherapies are actually good in terms of treatment.

I'm incredibly excited about what I perceive to be an increasing interest in prevention of cancer. I really do believe that our cancer prevention efforts in the United States need to be increased dramatically and will, in the long term, help us. Now, I'm asking people to plant a tree that they will never be able to enjoy the shade from, but if we start practicing prevention today, in 2035-2040, we will have less cancer.

We have evidence that show that a third to 50 percent of the cancers in the United States today could have been prevented if we had practiced good cancer prevention in the 1980s.

MS. SELLERS: Well, I guess you don't get to be an oncologist and go into this field unless you have some sense of hope. And it seems as if your hope is based in greater prevention moving ahead.

DR. BRAWLEY: I am much--my hope is based in prevention and based in the fact that I think people are now starting to appreciate it, but I also have hope for treatment. The immunotherapy work, some of the new technologies, even some of our chemotherapies, as we learn more about the molecular biology of cancer, we're actually designing drugs that are able to interfere with the molecular processes of cancer.

So, I'm excited for that, too, but I think the big bang for the buck in the long term is going to be with prevention.

MS. SELLERS: Dr. Brawley, thank you so much for joining us today. It was fascinating and I'm glad we could end on a positive note, there, with some ambition and optimism about what could lie ahead for us.

DR. BRAWLEY: Thank you.

MS. SELLERS: Thank you very much for joining us.

Thank you, Dr. Mukherjee, who joined us earlier this afternoon for a wonderful talk, as well, about cancer.

We have lots more coming at Washington Post Live in the next few days, including an interview, an exclusive interview with House Speaker Nancy Pelosi; and also, an interview with Arianna Huffington, the CEO of Global Thrive. You can find all the details at That’s

Please stay tuned. I'm Frances Stead Sellers, and thank you for joining us, today.

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