Be Seen, Get Screened's Physician Spotlight Q&A series highlights the work of health care professionals on the front line in the fight against colon cancer. In our latest Q&A, we talked to Dr. Mark Lewis, a medical oncologist at MD Anderson Cancer Center in Houston, Texas. Dr. Lewis has extensive experience with the diagnosis and treatment of colorectal cancer - the most preventable, but least prevented form of cancer.
Be Seen, Get Screened: Can you tell us a bit about your professional background and, more specifically, your experience with colon cancer?
Dr. Lewis: I did my medical oncology training at the Mayo Clinic in Rochester, Minnesota from 2009 to 2012. During my fellowship I was privileged to learn from many experts in gastrointestinal medical oncology, perhaps none more so than Dr. Axel Grothey, who is a globally recognized thought leader in understanding the disease and refining its treatment.
Since graduating from Mayo, I have been in practice at MD Anderson Cancer Center in Houston, Texas. In my clinic today, I take care of patients with nearly every type of solid tumor, but, by prevalence, none more so than colorectal cancers.
BSGS: What led to your interest in researching gastrointestinal oncology?
Dr. Lewis: Dr. Grothey impressed upon me that we should not rest on our laurels. Although treatments for colorectal cancer have improved over time, the pace is not nearly fast enough for those currently affected by the disease.
He also cautioned me not to be satisfied only with statistical advancements that lack real-world meaning for patients; I have yet to meet a patient who finds progression-free survival more important than overall survival, although even then there can be quality-of-life tradeoffs, e.g. post-oxaliplatin neuropathy, that aren’t always evident in reports of longer median lifespans.
Furthermore, I think we are poised at an exciting time in oncology between relying solely on the indiscriminate cytotoxic agents of the past and incorporating the more targeted biologic therapies of the future, ‘smart drugs’ that should exploit the specific flaws in cellular machinery that lead to a person’s cancer while, ideally, inflicting less collateral damage on normal tissues.
BSGS: More specifically, you have a lot of experience in tumor syndromes that run in families. Can you tell us more about that?
Dr. Lewis: This answer is unavoidably going to sound self-centered, but I am affected by a gastrointestinal tumor syndrome myself. When I began my training at Mayo I diagnosed myself with multiple endocrine neoplasia type 1 (MEN1), which leads to neuroendocrine tumors in the pancreas and intestines, among other manifestations (I’ve written about the process of discovery here, and it’s also been reported as a medical mystery in the New York Times).
Although MEN1 is not associated with adenocarcinoma of the colon, the diagnosis has, I hope, led me to be more empathetic with patients and families affected by germline mutations predisposing them to carcinogenesis. I do not consider myself as severely affected as, say, a young person with familial adenomatous polyposis (FAP) for whom prophylactic total colectomy is recommended, but I do have some insight into the risk/benefit calculations that go into those kind of preventive surgical decisions.
In my case, unless I opt for complete removal of my pancreas, the tumors currently dwelling there will grow and metastasize to my liver, which is often incurable. For the moment I am monitoring my pancreas closely rather than undergoing surgery of that magnitude, which would be life-changing and probably alter the course of my career too, but only time will tell if surveillance is the right decision.
BSGS: What recommendations do you have for people with a family history of these types of tumor syndromes?
Dr. Lewis: Know, as precisely as possible, what diagnoses have affected your blood relatives; it is also profoundly helpful to know the age of onset, i.e. when they were diagnosed with cancer in the first place. This family history should be transmitted clearly at the initial visit with any new doctor. It does not hurt to write down details in advance of that appointment.
I realize talking about what malignancies have afflicted your loved ones does not make for the most easy conversation at a family reunion or around the Thanksgiving dinner table but it is so profoundly important. I never cease to be astounded at the power of a pedigree to transform our understanding of a given patient’s risk for cancer.
We have to overcome the stigma of talking about cancer, especially in the colon, rectum, and anus. In my mind there is no shame in having such a diagnosis. The only shame is when an opportunity is missed through which a family member’s disease could have been lessened in severity or averted altogether.
BSGS: As a researcher, you’re exposed to a lot of data about the power of colon cancer screening. Can you give us a few takeaways?
Dr. Lewis: It’s really not rocket science. The power of the colonoscopy as both a diagnostic and therapeutic tool, its ability to identify cancer but also remove threatening polyps before they can invade, is indisputable in my mind.
A medical oncologist is the last person that should be making a colon cancer diagnosis. By the time you meet me, it’s often too late in the sequence of disease progression to be curable, although hope remains in some cases with limited metastases. In an ideal scenario, only primary care physicians and gastroenterologists would ever encounter a patient with colorectal cancer.
BSGS: As an avid Twitter user, what value do you think social media provides to healthcare professionals and patients?
Dr. Lewis: It’s an incredible tool for cultivating dialogues. Some of my colleagues view Twitter and other engagement of patients on social media as frivolous but I would caution them not to underestimate the positive transformative ability that well-informed patients can exert upon healthcare, both their own and in advocacy for others.
Whenever I Tweet about colorectal cancer, I try to use the #crcsm (Colorectal Cancer Social Media) hashtag, around which a lively and savvy conversation is ongoing about the disease between physicians and patients.
The Internet sometimes seems to me like an informational Wild West, lawless in the sense that anyone can post anything. When doctors enter the social media sphere, we can direct patients to reliable sources of information and curate the evidence-based medical literature for them.
It’s not about arrogant pronouncements from ivory towers; it’s a two-way conversation about what we know and what they understand. I learn from my clinic patients every day, and have also benefited from insights shared online via #crcsm and other chats.
BSGS: Is there anything else you’d like to share with Be Seen, Get Screened?
Dr. Lewis: There are few more tragic sights in my clinical practice than a 65-year-old grandfather who has just been diagnosed with colorectal cancer after his first-ever colonoscopy, sitting next to his wife who has been undergoing Pap smears and mammograms regularly for decades.
I am a huge advocate for women’s health of course, but the blanket of pink that covers this country in October to raise breast cancer awareness should turn blue in March to elevate the conversation about colorectal cancer and screening colonoscopies. We all have a colon, and we should take care of it as part of routine health maintenance.