Name: Blake Cady, M.D.
Age: 70
Position: Director of the Breast Health Center and Chief of Surgery at
Women & Infants Hospital; Professor of Surgery, Brown University Medical School;
winner of American Cancer Society’s 2000 Distinguished Service Award
Background: Chief of Surgical Oncology, Harvard Surgical Service, New England
Deaconess Hospital; Professor of Surgery, Harvard Medical School; volunteer with
American Cancer Society since 1974.
Education: Amherst College, Cornell University Medical College, Boston City Hospital, Sloan-Kettering Institute
Residence: Brookline, Mass.
Family: Married, three children
PBN: What motivates your fight against cancer?
CADY: I’ve been involved in a lot of tobacco control efforts. I was chair of the
Massachusetts coalition that put together the tobacco tax referendum in 1992,
which got a 25-cent increase in the tobacco tax, which has paid for the big Massachusetts
tobacco program.
Are you doing similar work in Rhode Island?
The Cancer Society is starting a “Smoke-free Rhode Island” program, of which one of the issues is a tax to get the price up. We’re going to try to increase tobacco taxes throughout New England by 50 cents a pack so there’ll be less cross-the-border differential, New Hampshire priding itself on stealing customers from surrounding states.
Will higher taxes really stop kids from smoking?
It’s one of the answers. It provides money for programs, policing of storeowners who sell cigarettes. And taxes by themselves cut down consumption. For instance, when Canada boosted taxes by the equivalent of $2.50 a pack, kids’ smoking declined by about two-thirds. What happened is the tobacco industry actively promoted contraband cigarettes and deliberately undercut the effort. They suppressed (Congress and) prevented U.S. taxes from going up, which meant the tax discrepancy persisted and finally drove (Canada) to drop their taxes. Kid smoking went back up again.
Could some of the money be used to medically treat smokers?
That’s a sinkhole. It’s one of the tactics of the tobacco industry, to get all
the money used to pay for care, because nothing will be left for control. Care
of the patients is the responsibility of the insurance industry. In California
they tried to get the money devoted to care of the patients, in which case it
disappeared. And that’s what we don’t want.
Companies make low- and no-fat food products — why not a ‘safer’ cigarette?
Partly because the tobacco industry just doesn’t want to do it. The tobacco industry has had all sorts of opportunities to make a cigarette that doesn’t cause fires, a safer cigarette by cutting down tar, which actually doesn’t solve the problem, because you have to keep up the nicotine otherwise people don’t smoke. You have to smoke more and harder to get the dose, which gives you more exposure. So there’s no safe cigarette.
Are cancer rates in Rhode Island higher than average?
Lowest rates are the people in Utah because they’re Mormons. They don’t smoke and don’t drink much and by and large take care of themselves. You don’t find a lot of fat Mormons. Particular groups like Seventh Day Adventists who are vegetarians have low rates. Hawaii has a relatively low rate. Rhode Island’s not particularly out of line with the rest of New England, where the population’s a little older.
What causes cancer?
The biggest cause of cancer today is smoking. A third of all cancer deaths are
tobacco. Probably a third is diet, total caloric intake. People who are overweight
have a higher risk for breast, colon, uterus, ovary — all those kinds of cancers.
What’s left over are things we can’t define, undoubtedly genetic factors separate
and distinct from familial relationships. Inherited is a very small fraction of
all cancers, maybe less than 5 percent.
How about environmental causes, such as PCBs?
In laboratory animals you can cause cancer by doing a variety of things. But in
terms of population, it’s pretty hard to correlate. There have been plenty of
attempts to look at environmental (factors) in communities. You know, the Waltham
toxic dump. Despite the movie (“A Civil Action”) and despite the book, the data’s
not there. Because the contamination began long before Grace Company came with
the tanning factory. Whenever they’ve looked at cancer case clusters, they’ve
really not found very much. Love Canal, for instance, some of that early data,
genetic analysis of some of the tumors, was faked, so there’s never been clear
documentation. Specific things have been discovered in terms of bladder cancer
and aniline dyes. There are a number of cases of specialized liver cancer in some
of the vinyl chloride workers in the Midwest. There are lung cancers in uranium
miners, but mostly it’s related to cigarettes. Cancer is not as far as we can
tell related to factories and chemical contamination.
How does mind-body connection relate to cancer?
I am not convinced you can take a highly anxious or very depressed patient and
successfully treat the depression and turn around their disease outcome. There
is some data that patients that get behavioral medicine get techniques of dealing
with anxiety and live a better life. There’s marginal data about whether they
live longer. There’s no data that I know of that they’re cured. The curative treatments
to cancer are number one, surgery — three-quarters or 80 percent, maybe even
more. Second is radiotherapy, sometimes as an addition to surgery, sometimes alone.
Third is chemotherapy. The big thing that may come along is anti-angiogenesis,
(which works) by shutting off the blood supply so the cancer dies. It doesn’t
necessarily go away entirely, but it shuts off its ability to grow. If all the
animal models get translated into human treatments, that would be very exciting.
But that’s still way off.
Would it be better if all of Rhode Island’s expertise and technology were concentrated
into one cancer center?
Everybody wants to have a cancer center because it sounds glamorous. It’s a marketing
business of some sort. An NCI (National Cancer Institute) designation is a separate
issue that requires a certain amount of staffing, money, certain levels of talent
and number of patients and everything else. But you don’t have to be a cancer
center to have expertise. It helps, but it’s not essential. We’re not a designated
cancer center but we’ve got as much expertise in this unit as anybody in New England
or across the country.
Should different hospitals in Rhode Island focus on different specialties?
Could you go to a business community and say, I want you, Mr. Smith, to run a
hardware store to sell only X products? And you Mr. Jones, across town, to sell
only Y products? That’s not human nature for an institution to focus only on one
thing, and it’s not necessarily helpful. It’s usually better to have a little
competition. Just in medicine as in business.
Has your income as a doctor decreased?
I (spoke to) a young woman the other day, a surgeon. In her institution in
Boston, they cut her salary by 25 percent. No, docs are not making as much money.
The people that have been cut most severely were the ones that were the big high
rollers to begin with. The worst problem is the general practitioner or family
doc who doesn’t provide a technical service, they basically have a hard time making
a living. I’ve known of several docs who despite all their experience and everything
else take home less money than a head nurse in a hospital .
Do you ever worry that you’ll get cancer?
Well, doctors have a habit of dying of the diseases they take care of. Neurosurgeons
tend to die of brain tumors. I knew a urologist who specialized in taking care
of a funny kind of cancer of the renal glands, and he got it himself. Most of
them are coincidences, though. Living causes cancer. A quarter of the population
will develop cancer at some time. It’s one of the byproducts of living older.
So, take your pick. Live with the risk of cancer or jump off a bridge when you’re
35.
What about stress and cancer?
I’ve never been convinced that the poor guy living in the bush in Africa who can’t
get enough to eat from one day to the next is under less stress than somebody
sitting at a computer. People say they’re under terrible stress so they smoke
cigarettes. So somebody comes in with a pre-cancerous lesion in the breast smoking
two packs of cigarettes a day. I have to say, ‘Lady, you’ve got to get real.’
You know, the public’s not always aware of some of the risk behaviors that they
undertake. If everybody ate a decent diet and nobody smoked you’d get rid of over
50 percent of the cancers and more than 50 percent of the mortality from cancers.
If you got rid of tobacco — smoking — you’d reduce cancer rates by at least
a third. You’d essentially eliminate lung cancer, get rid of two thirds of bladder
cancer and a sizable portion of esophageal cancer. Even skin cancer is higher
in smokers than in nonsmokers. In breast cancer, screening will solve most of
the problems. Screening actually has the opportunity of preventing breast cancer
because you can find pre-invasive cancer and prevent it from becoming invasive.
You could probably eliminate at least 60 percent of colon cancer deaths by doing
screening. So if you put everything together you could probably eliminate about
75 percent of cancer deaths.
Then you’d be out of work.
There are other things to do.
