POST January/February 2015

POST: Right. But doctors have this obligation to do no harm. I’m sure it’s
got to be very difficult for them to abide …
WY: They have an obligation—they do have an obligation, but there are
some (doctors) who treat with radiation or chemotherapy who are swept
away by the patient’s desire to try to do something. And then, of course,
you have these anecdotal situations where people actually get better.
I think the main problem we have right now is that we just don’t know
enough about how to predict how the individual cancers are going to
behave. And we’re at a disadvantage because we can’t get the patient
statistical numbers or we can’t give the patient enough information to let
them know exactly what their prognosis is with or without treatment.
POST: It sounds like the screening technology has come so far that it’s
detecting things that might never have been detected before and might
never have caused a problem. Now, so much is being detected, but we’re
not detecting quite enough that we can discern which is really going to
cause a problem or not. It seems like we’re nearing a tipping point where
we’re going to be able to discern how an individual cancer will behave.
Are we years, decades or …?
WY: No, I think it’s more like years. I think within five years, there’s going to
be a lot of breakthrough in terms of figuring out how to figure out the DNA.
I mean the DNA field is just bursting wide open at this point. We may have
a lot more information in five years that will help us sit down with patients
and say, “We have a pretty good idea what’s going to happen with and
without treatment. These are the treatments, here are your chances of
making it through treatment without any problems.” I mean we keep getting
better and better at it, but right now a lot of it is we’re just going by
the seat of our pants in terms of how the tumor is going to behave with
treatment, whether or not we should even do it.
POST: So (after a biopsy shows cancer) once you refer them to the surgeon,
what are the chances (the patients are) going to be operated on?
WY: We don’t send them to the surgeons unless they need surgery. I’ve
never sent a patient to a surgeon and have them not be operated on,
because we’ve already made the …
POST: Once you discover cancer, I mean, at what point do you send
patients to them? Once you find out it’s malignant, even though you don’t
know its propensity to grow or how it will behave, you still …
WY: Well, if we make the diagnosis, I was just telling you why we don’t
feel a patient should not be treated, because we don’t know enough
about the DNA of that particular tumor to know whether this is going to
be the person who, you know, has it go directly to the brain or lung or
liver or whatever.
POST: You don’t know at which end of the spectrum they’re going to be.
WY: That’s right. We don’t know because we don’t have that DNA knowledge,
nor does anybody in the government. And it’s so irritating to hear
them say, “Well, not all of these need to be treated.” Well, the only way
you find that out is by following the patient to the end of her life. You know,
don’t treat anybody and follow them all to the end of their life and find out
who died, who didn’t. There’s no way—you can’t say to the patient, “You
might be one of the lucky ones,” because you don’t know if they are.
POST: But in five years maybe.
WY: I’m hoping that within five years, people can get DNA testing of their
tumor that will tell them—give them a pretty good idea—about what they
should do.
—Mary Stone
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