Margaret I. Cuomo, MD Interview by Grover Gardner
GROVER GARDNER: Welcome to Downpour.com’s interview series. I’m Grover Gardner, and today it’s my pleasure to be speaking with Margaret I. Cuomo, author of A World without Cancer. She is a board-certified radiologist and for many years was an attending physician in diagnostic radiology in New York. She dedicated much of her practice to the diagnosis of cancer and AIDS. Margaret has contributed several written works about health to Huffpost Healthy Living and is also a public speaker on health, education, and leadership. Blackstone Audio published the audio version of A World without Cancer, narrated by Coleen Marlo, simultaneously with the hardcover on October 2, 2012. Thank you for joining us today.
MARGARET I. CUOMO: It’s my pleasure.
GG: This is your new book, A World without Cancer: The Making of a New Cure and the Real Promise of Prevention, which was released earlier this month. Can you tell us a little bit about your research and also about how the book’s been received so far?
MC: I’ll be happy to. A World without Cancer is my personal journey with cancer as a doctor and a diagnostic radiologist, experiencing some of cancer’s horrific effects on the lives of my own family, friends, and patients. I interviewed over sixty cancer experts, patients, doctors, cancer researchers, but also policy-makers, heads of pharmaceutical companies, cancer advocates, and more, and all of their perspectives are reflected in A World without Cancer. The response has been very positive because there is a lot of uplifting information in the book—things that we can do. Over fifty percent of all cancers can be prevented by applying what we know right now, and so A World without Cancer goes into detail about that and also what we need to do better.
GG: What motivated you to write this book right now?
MC: After so many years of experiencing cancer on a personal level and a professional level, I wanted to delve into it and find out how we got to where we are now. And I did. The research in the book defines that, clarifies it, and indicates—very clearly I think—where we need to go in order to make a real improvement, a real leap in progress with cancer.
GG: What are some of the new strategies and approaches that you talk about?
MC: You know the expression “everything old is new again” or “everything new is old again”? There are so many things that we should know—common sense—that have implications, a lot of implications, for improving … decreasing our risk of cancer. By that I mean attention to our diet—and I’ll go into detail in a moment—exercise, limiting alcohol, ending smoking, and taking vitamin D. These are all things that each of us can do to decrease our cancer risk and to live a cancer-free life. Other things require help from outside sources. Environmental toxins that increase our cancer risk can be eliminated, but that’s where industry and government have to partner with us. And more of the current government spending on cancer research can be dedicated to finding safe new ways of detecting cancer in its earliest stages and also to ending cancer once and for all. So the point is that much more can be done to prevent cancer and each of us has a critical role.
GG: You talk about the pharmaceutical industry, government, the physicians, and their roles in the fight against cancer. What specific areas are most in need of improvement to bring a halt to the cancer epidemic?
MC: There are a number of things. We’ll start with government since you raised that issue. I researched the current budget for the National Cancer Institute, which is our major institution dealing with cancer, and when you look at the budget, only 2% of it is dedicated to cancer prevention. The overwhelming majority of cancer funding is going to finding ways to develop new treatments. People will always need treatment for cancer because not everybody will be able to prevent it. Not everyone will have it detected in its earliest stages. And we need to help them—absolutely. The purpose of A World without Cancer is not to set up a battle between treatment and prevention, but the current approach is extremely unbalanced. We need to focus more on prevention, and in one of the reports, the NCI stated that prevention has probably the most hope for ending cancer, so we need to focus more on that. And then there’s industry. I was very pleased to see that in August 2012, Johnson & Johnson became the first major consumer products company in the United States that, by the year 2015, is going to remove all harmful chemicals from its consumer products. That was a huge initiative, and that means its subsidiaries, like Aveeno, Clean & Clear, Neutrogena, all of those product lines will be free of harmful chemicals, even chemicals that are known to be carcinogens, like formaldehyde. Currently, consumer product companies are able to use these things. Johnson & Johnson stepped forward, and I hope that other major consumer product companies will step forward as well, and follow the shining example of Johnson & Johnson. It is a partnership. We have to do our part as individuals, government has to do its part to focus on prevention, industry has to do its part to remove all harmful chemicals from its products.
GG: There was a recent study that came out—the rather controversial Stanford study about organic foods. A lot of people have questioned this, particularly the idea that organic foods aren’t really that much healthier for us, and yet there’s a lot of feeling that avoiding pesticides is very important in preventing cancer and other illnesses. What was your reaction to that study?
MC: Grover, I’m glad you brought that up because what the Stanford study did was it looked retrospectively at various studies around the world through a few years and focused on nutrition—what is better for you nutritionally. But if you read that report very carefully, it says that in many cases it found that people who ate organic produce had many fewer side effects due to pesticides. It’s all about the pesticides and the genetically modified organisms that are in conventional fruits and vegetables and other products, as opposed to organic. Growers of organic products are not permitted to use any pesticides, chemical pesticides, that are harmful—they use natural products—or any genetically modified organisms in their growing process. And that’s the key. When we look into these pesticides, over four hundred of them have been considered to be harmful by the International Agency on Research for Cancer, and many of those are used in growing our conventional crops in this country. So that’s what it’s all about. It’s about the pesticides, it’s about the genetically modified organisms. It’s not about which tomato has more vitamin C, the organic or the conventional. That’s where the confusion lies. It’s all about what is used to grow these crops.
GG: I was recently reading The Emperor of All Maladies and it was so striking to me how slow, agonizingly slow, the journey has been for treating cancer and how many blind alleys we’ve gone up and down. And yet we have made some progress. In your mind, what are some of the most positive things that have happened in cancer treatment and prevention in the past fifty years or so?
MC: There are a number of things. The one thing I think every cancer researcher or every clinician would agree upon is that the earlier you catch the cancer, the better your chances are of eradicating it, curing it. And that’s true for almost any cancer. We have not been as successful in treating the solid tumors—as we call them the common cancers—like breast, prostate, lung, colorectal, as compared to one kind of leukemia called CML that has been nearly cured by a chemotherapeutic agent, a drug called Gleevec. That really has changed everything. Gleevec changed the profile of CML. But that’s a very specific kind of leukemia. It has a single chromosomal abnormality, and that is not the case in the situation dealing with breast, prostate, lung, colorectal, the more common cancers. They are several orders of magnitude more complex than that kind of leukemia. So when we talk about the solid tumors, the common cancers that we deal with every day, unless we catch them very early, we’re still dealing with a situation where we’re submitting patients to toxic therapies—chemotherapy, radiation, surgery—the same trio that has been used for over forty years. And because we all know someone who has experienced cancer, we are aware of how debilitating the treatment itself can be. The worst thing of all is that secondary cancers can arise from the treatment. That’s outrageous.
GG: You attack one form of the cancer, but you’ve weakened your system to the extent that other opportunistic things come in, like infection.
MC: I’m saying that you are also vulnerable to second cancers.
MC: Robin Roberts is one of the more prominent people in our community right now that is undergoing treatment for myelodysplastic syndrome, which is a direct result of the cancer treatment she received for her breast cancer.
MC: So we put the patients in a very vulnerable position.
GG: How does the United States fare in terms of rankings—in terms of cancer cases, as opposed to the rest of the world? Is it out of control here? Are we in worse shape than other parts of the world?
MC: We like to think because we dedicate more money than any other nation that we should have better statistics in terms of our quality of life, how long we live, etc. But the very upsetting news is—and this is something that I learned in researching A World without Cancer—is that we are thirty-seventh in the world for our life expectancy. Our rate of obesity is off the chart. We are at epidemic levels and it is growing. If you look at the CDC’s website, it will show you a map that will terrify you because it shows in color how the obesity rates have increased across the country in the past few years. Obesity is a risk factor for cancer. That’s a little known fact I think. We think of obesity in terms of heart disease and diabetes, and that’s true, but it also is a risk factor for cancer. So when you ask me how do we fare, we do not fare well, and that’s why I point out in my book, no matter how much money and effort we dedicate to treatment, we have to focus on preventing cancer, and that means preventing obesity and preventing all of these poor choices we make that are going to increase our cancer risk.
GG: When people read your book, Margaret, what’s the thing that you most want them to take away?
MC: I would like people to feel positive about the fact that cancer is the most feared disease and part of that fear is based on the feeling that we have no control over it, but the good news is we do have control and cancer is not an inevitability for us. Over fifty percent of all cancers can be prevented by applying what we know right now, and I detail that in A World without Cancer. Much more can be done to prevent cancer and each of us has a critical role, whether we are adults or children, whether we are members of the media or medical community, government, industry, or pharmaceutical company, we can all contribute to a healthier environment, a stronger, more vibrant society, and ultimately to a world without cancer.
GG: In what other parts of the world is cancer not an issue for the bulk of the population?
MC: That’s a good question, and I really focused on the United States and some of Europe for my information, but I will tell you that those parts of the world that have the so-called Mediterranean diet, a plant-based diet, and less exposure to industrial toxins, environmental toxins, are always going to have a lower risk of cancer in general.
GG: So there really are parts of the world where this is not so prevalent.
GG: And so we know that we can change our own vulnerability to cancer.
MC: We know that, and we know what environmental toxins are carcinogenic. There are many organizations internationally that focus their efforts on identifying those, and we know it. We just need more surveillance of that in our own country, and we need the partnership. We need the good stewardship of our government and industry to rid consumer products of these harmful toxins. Even if you take your clothes to the dry cleaner, perchloroethylene—called “perc” for short—is a known cancer risk. It increases our risk for cancer, and yet many places continue to use it. I tell people if you must use a dry cleaner that uses perchloroethylene, when you come home, take the plastic bag off the clothes, let them air out, don’t put them on your body or in your closet immediately. These are little measures we can take that add up in the long run, and even things like our plastic containers that contain our foods or canned goods—all of our canned goods nearly—contain a substance called BPA, which has also been linked to cancer. This past July, the FDA said, “Okay, no more BPA is permitted in baby bottles, plastic bottles, or baby sippy cups.” What about the rest of us? (laughs)
MC: If it’s harmful for young children, isn’t it harmful for older children, adolescents, and adults? Of course it is. That’s why I say we need the good stewardship of government and industry.
GG: Now, people say, as I’m sure you hear often, “Oh, you know, my grandmother ate things out of a can.” Or, “She didn’t worry about this or that.” Or, “I’ve eaten such and such all my life and I don’t have cancer.” And, “Why should I worry about this?”
MC: Well, unfortunately we all have to worry about it. I had a grandfather who smoked every day of his life and never developed lung cancer. Those people do exist and don’t follow the book. That happens. But we can’t afford to take that risk, can we? When we know something is a clear risk factor, especially tobacco, that’s been proven over and over again. Even secondhand smoke and thirdhand smoke now is considered extremely harmful. We cannot afford to take those risks with our own lives. So it would be foolish for us not to apply those strategies to our lives which we know can decrease our risk for cancer.
GG: Where do genetics come into cancer?
MC: That’s a good question, and the happy answer is that it’s not as much of a factor as many of us would believe. The minority of cancers are caused by our genetics, maybe five to ten percent. Some of the more well-known are the BRCA1 and 2, causing ovarian and breast cancer. There are some known genetic factors, but the great majority of them are not related to genetics. And even if you have a genetic predisposition, it doesn’t doom you to cancer, so the outlook is brighter than I think many of us realize.
GG: You really would emphasize that we need to focus on environmental factors?
MC: We need to factor in everything. A wise physician said to me, “Think of your health and your ability to fight cancer as the instruments playing in an orchestra. They all have to be in tune. They all have to play in harmony in order to create beautiful music.” And the same thing applies to our risk for cancer. We have to apply all strategies: the diet, the exercise, decreasing our environmental toxins. All of them go together to decrease cancer risk.
GG: What are some of the top books that you would recommend to people about cancer, prevention, and diet?
MC: I would say to people that Michael Pollan has gone a long way to elucidate for us a healthful way of eating, and we understand that, through his work and others, that it’s plant-based, a plant-based diet. So I would recommend the works of Michael Pollan and any book that’s going to tell you how to eat healthfully. That’s always helpful. In terms of the history of cancer, I think The Emperor of All Maladies is a wonderful book, but it leaves you on a negative note because it makes it seem that cancer is an inevitability, and it is not an inevitability. There are strategies, as we’ve mentioned, that I outline in A World without Cancer that can really change our cancer risk, can decrease it.
GG: Well, this has been fascinating. Thank you so much for talking to us about the book today. We’re very much looking forward to the audio version coming out and more people gaining knowledge from it.
MC: Thank you very, very much. I appreciate it.
GG: Thank you. Thank you for joining us for this exclusive interview with Margaret I. Cuomo. You can find A World without Cancer and all of Blackstone Audio’s titles at Downpour.com.
This interview was recorded in October 2012.
Disclaimer: This audio and transcript have been edited slightly from the original recording for quality and readability.
A World without Cancer
A provocative and surprising investigation into the ways that profit, personalities, and politics obstruct real progress in the war on cancer—and one doctor’s passionate call to action
As a diagnostic radiologist who has watched patients, friends, and family suffer with and die from cancer—and who was deeply affected by the enraged husband of one particular patient—Dr. Margaret I. Cuomo has been inspired to seek out new strategies for waging a smarter war on cancer.
About 1.6 million new cases of cancer are diagnosed a year, and more than 1,500 people die each day. We’ve been asked to accept the disappointing strategy to “manage cancer as a chronic disease.” We’ve allowed pharmaceutical companies to position as breakthroughs cancer drugs that extend life by mere weeks and may cost $100,000 for a single course of treatment. Where is the bold leadership that will transform our system from treatment to prevention? Have we forgotten the mission of the National Cancer Act of 1971 to “conquer cancer”?
Through an analysis of more than forty years of medical evidence and interviews with the top cancer researchers, drug company executives, and health policy advisers, Dr. Cuomo reveals the intriguing answers to these questions. She shows us how all cancer stakeholders—the pharmaceutical industry, the government, physicians, and concerned citizens—can change the way we view and fight cancer in this country.