If you smoke, quit, keep a healthy weight, be physically active, and eat healthy foods; these are important activities we can do to lower our risk of getting cancer. The added benefit of doing this is that your overall health will be better as well. All of the actions listed above lead to other medical problems like diabetes, heart disease, and high blood pressure.
Cancer is a horrible and terrifying disease. There is so much great information out there, but sometimes it is very difficult to filter out the noise. What causes cancer? Can it be prevented? How do you detect it? What are the odds of survival today? What are the different forms of cancer? What are the best treatments? And what is the best way to support someone impacted by cancer?
In this interview series called, “5 Things Everyone Needs To Know About Cancer” we are talking to experts about cancer such as oncologists, researchers, and medical directors to address these questions. As a part of this interview series, I had the pleasure of interviewing Dr. Lisa Richardson.
Lisa C. Richardson, MD, MPH, is the director of CDC’s Division of Cancer Prevention and Control (DCPC). She is responsible for providing leadership and direction for all scientific, policy, and programmatic issues related to four foundational programs: the Colorectal Cancer Control Program, the National Breast and Cervical Cancer Early Detection Program, the National Comprehensive Cancer Control Program, and the National Program of Cancer Registries. She oversees a well-developed research agenda that includes the National Cancer Prevention and Control Research Network.
Thank you so much for joining us in this interview series! Before we dive into the main focus of our interview, our readers would love to “get to know you” a bit better. Can you tell us a bit about your childhood backstory?
I was born and grew up in rural eastern North Carolina. As an African American girl born in 1962, I did not know anyone personally who had gone to college, let alone gone to medical school. As I was going to high school, I learned there was an African American physician in the small city next to our town. I learned to read when I was 3 or 4 years old, reading anything I could get my hands on. One of my favorite types of books to read were biographies. In middle school, I came across a biography of Elizabeth Blackwell’s life, the first woman in the United States to receive a medical degree. From reading her book and watching TV doctors like Quincy, M.E., I thought that was something I could do. My main objective was to do something that mattered to help the people in my community. Being a doctor would allow me to do that.
What or who inspired you to pursue your career? We’d love to hear the story.
Seeing doctors on TV and reading Elizabeth Blackwell’s biography, I was interested in becoming a doctor. I grew up in rural North Carolina in a very poor family. It may be hard to believe in 2023, but I grew up on a farm where my stepfather was a sharecropper, a legacy of slavery in our country. So coming from that environment, the chances that I would be able to achieve my dream of being a doctor were slim to none. Fortunately, people in my life saw my potential and helped me navigate the educational system from elementary school to high school. One of the most influential people was my high school counselor. She stepped into the role my parents were not able to fill. She helped me with the college preparation process and helped me throughout my career. We remain friends to this day.
On the career side, the people who most influenced me were my Hematology mentors at the University of Florida. They were the smartest, coolest people I had come in contact with AND they saw my potential and challenged me to succeed in my residency and fellowship. Since the University of Florida could only support a combined fellowship, that is how I became an oncologist. I was advised that most of the cutting-edge research was in oncology, so I chose that route. The field of oncology continues to be one of the most innovative fields and I love it.
This is not easy work. What is your primary motivation and drive behind the work that you do?
My path to public health was a circuitous one. In my second year of fellowship, I did a bench research project with my hematology mentor. It was a complete lab fellowship. Though I enjoyed the work, I realized most of the work I was doing might never lead to a clinical breakthrough that would impact patients’ lives. All of the mentors that have crossed my path have encouraged me to pursue my passion.
After my lab fellowship, I pursued an epidemiology degree at the University of Michigan with the Robert Wood Johnson Clinical Scholars Program. The fellowship was life-changing. I got to do work that impacts populations, not just one person at a time. They taught me that the sky is the limit on the influence I could have in helping people. My research as a fellow involved an in-depth evaluation of the National Breast and Cervical Cancer Early Detection Program. Our results from that evaluation led to Congress passing laws to pay for services to diagnose cancers once women had abnormal screening test results. My biggest accomplishment there was that our results were also used to convince Congress to pass a law to allow states to provide Medicaid health coverage for women found to have cancer to ensure treatment was received. That experience led me to the Centers for Disease Control and Prevention (CDC) in 1997. I have spent most of my career in cancer control asking hard questions and seeking answers that will improve the lives of the public we serve.
What are some of the most interesting or exciting projects you are working on now? How do you think they might help people?
I know it’s possible to lower the number of preventable cancers by using proven methods. As you may know, cancer deaths have declined 33% since 1991. This decrease is mostly due to declines in commercial tobacco use, mainly smoking. This work is not done either, almost 30 million people continue to smoke cigarettes. Knowing that we can prevent cancer keeps me motivated every day to come to work to improve the health of all Americans.
One project I am particularly proud of is our work to improve colorectal cancer screening. My passion is driven by the fact that colorectal cancer is preventable. Screening works to identify polyps in the colon and rectum. If these polyps are removed, cancer is less likely to develop. In addition, if cancer has already developed, the cancers are smaller and easier to treat. We fund work where health systems put in place what works (learned from research) in practice in their clinics to increase the number of people screened for colorectal cancer. We work with clinics that care for people who might not otherwise get access to screening services, people who are seen in federally qualified health centers and community health systems. One of the things I am most proud of is all the lessons we learn from our work is published as well as toolkits being developed to share our lessons. I always tell staff in our division that once we find things that work, we have to package and scale so that everyone can benefit from what we learn. That is the least we can do as public servants.
For the benefit of our readers, can you briefly let us know why you are an authority about the topic of Cancer?
I have life experience, medical training as an oncologist, and have worked at the CDC developing and studying our work to learn and share with others. In my lived experience growing up and as an oncologist, I have seen relatives die of cancer when those cancers were preventable such as lung cancer. As a provider, I know we need to place more focus on prevention. No matter how many wonderful, groundbreaking cancer treatments we develop — without prevention, cancer will continue to impact our families and communities. Treating cancer is not the only way to solve this problem. The work I do at CDC changes lives. In my current role as the director of CDC’s Division of Cancer Prevention and Control, I work closely with local, state, and national level experts in cancer prevention and control. CDC helps people who have had cancer live longer with a better quality of life. I provide leadership and direction for all scientific, policy, and programmatic issues related to four foundational programs: the Colorectal Cancer Control Program, the National Breast and Cervical Cancer Early Detection Program, the National Comprehensive Cancer Control Program, and the National Program of Cancer Registries. I have authored and co-authored more than 175 journal articles and oversee a well-developed research agenda that includes the National Cancer Prevention and Control Research Network.
OK, thank you for all of that. Let’s now shift to the main focus of our interview. Let’s start with some basic definitions so that we are all on the same page. What is exactly cancer?
Cancer develops when normal cells in our body become abnormal, divide and grow out of control. What is most interesting is that this happens all the time, but our immune system is able to remove most of these cells before they can set up shop in the body to cause problems. Many of the newer treatments for cancer turn the immune system back on to get rid of the cancer. Cancer can happen in any organ in the body, which means there are more than 100 different types of cancer and most of them are named for the part of the body or type of cell in which they start — for example, lung cancer begins in the lung.
What causes cancer?
When I am talking with students and fellows, my favorite question to stump them is to ask: what is the number one risk factor for getting cancer? Almost no one gets the answer right away. It is getting older. There is a rapid rise in the incidence of new cancers starting in the mid-40s to mid-50s. This is why our screening recommendations are based on age. Screening test works better when there are more cancers in the population (prevalence). Having said that, there are multiple factors that lead to cancer including what we eat, how physically active we are, and whether we are overweight or have obesity to name a few. Cancer can also be caused by genetic abnormality that runs in families. When a gene is identified in a person with cancer, we are able to test family members to see if they are at risk for the cancer. Even if we are not able to find a specific gene, a family with lots of cancers of one type or multiple types would be classified as having familial cancer. Knowing if people have lots of family members with cancer helps the people who take care of them develop plans of follow-up to find the cancers early when treatment is more effective. The most impactful environmental factor that causes cancer is commercial tobacco. The Surgeon General’s Report in 1964 reported the connection between cigarette smoking and cancer. Almost all of the progress we have seen in decreasing deaths from cancer is due to preventing people from starting to smoke and helping people who do smoke to quit. A true public health success.
What is the difference between the different forms of cancer?
Cancer arises in different cells and organs in the body. The traditional classification is by whether the cancer arises in the blood, bone marrow or the lymph nodes (hematologic cancer) versus solid organs (such as the lung). This classification allows pathologists and other cancer specialists to stage the cancer, which determines the prognosis. Solid tumors are staged by how widespread the cancers are at diagnosis. Hematologic cancers tend to be widespread in the body because blood and lymph nodes are all over the body. As we move into the future, cancers are being classified by genetic changes rather than by organs. This revolution is happening because of treatment advances. New drugs being developed today and in the future target these genetic changes regardless of the organ or cell the cancer comes from.
I know that the next few questions are huge topics, but we’d love to hear your thoughts regardless. How can cancer be prevented?
Cancer prevention is one of the toughest topics to discuss with the public. Most of us think that cancer is going to happen no matter what we do. I will admit that we don’t know all the causes of cancer, but we do know of some actions we can take to lower the chances we will get cancer. First, cancer is linked to commercial tobacco product use, not protecting our skin from the sun, the types of food we eat, whether we are physically active, and whether we have a healthy weight. Research has shown that these factors may contribute to at least 40% of all cancers. Age plays a role here as well. Even though getting older is the biggest risk factor for getting cancer, we know that improvements in our diet, being physically active, not smoking, and keeping a healthy weight can lower our risk of cancer, regardless of how old you are. It is never too late to live healthier.
Another tool we have to prevent cancer is screening. Two of the recommended screenings for cancer, colorectal and cervical screening, find problems in the cervix, colon, and rectum that can be removed and the chance of getting cancer is less. As we examine the data for new cancers and deaths for these two cancers over time, there is a clear correlation between the introduction of screening and few of these cancers developing and people dying from them. The other benefit of screening for cancer is cancers are found before they spread, making treatment easier and more likely to work.
Another important invention are vaccines to prevent cancer. The human papilloma virus (HPV) causes almost 100% of cervix cancers. The vaccine prevents infection with HPV greatly decreasing the chance that other cancers will develop as well. The vaccine is recommended for adolescents, boys and girls. Some older people may qualify for the vaccine as well. I would recommend speaking with their healthcare provider to see what is best for each person. Whenever I’m asked by parents of young children if their child should get the HPV vaccine, my response is always the same: HPV vaccine IS cancer prevention.
How can one detect the main forms of cancer?
We currently have screening tests for four types of cancer (lung, colorectal, breast, cervix) where the evidence is strong enough to recommend using these tests to find the cancer early and in the case of cervical and colorectal cancer, to remove lesions that might become cancer. Most cancers are not diagnosed by screening tests, they are found when someone has a symptom or concern that leads them to see their healthcare provider. In this case, the symptoms may be a sign that the cancer has spread. My best advice is to be aware of what your body is like and seek help when something changes. Research is ongoing in looking for new ways to find cancer early thereby saving more lives. If you and your doctor are concerned about cancer or another condition, you may undergo various tests such as a blood test, X-ray, MRI, or biopsy to work out what is going on. Most symptoms are not caused by cancer, but you should seek care to rule that out.
Cancer used to almost be a death sentence, but it seems that it has changed today. What are the odds of surviving cancer today?
In broad strokes, the 5-year survival rate for cancer in the United States for people diagnosed with cancer between 2013 and 2019 is 71%. To put that into perspective, 5-year survival was only 62% for people diagnosed between 1990 and 1992. We have made a lot of progress, but differences remain —
Women have a slightly higher survival rate than men;
Non-Hispanic Asian and Pacific Islander people have the highest 5-year survival rate, while non-Hispanic American Indian and Alaska Native people have the lowest.
By the type of cancer: men with prostate cancer have the highest 5-year survival whereas pancreatic cancer remains very low; women with thyroid cancer have the highest 5-year survival while pancreatic cancer is the lowest.
Much of the progress noted is due to early detection, better access to care, and better treatments for cancer. All of these factors are critical to improving how long people live with cancer. As an oncologist, we have had to pivot to more people living longer. The pivot from people are going to die with and of cancer to people are living after treatment and living with metastatic cancer that we are able to treat for years. Your question is spot on, the public, including physicians, saw cancer as a death sentence. We poured all of our energy into saving lives. We are in the “now what?” phase. The work we have to do now is to help people have a good quality of life as they live longer. Our priority in public health is to address health and wellness in people who have survived cancer.
Healing usually takes place between doctor visits. What have you found to be most beneficial to assist a patient to heal?
One of the most sobering comments I hear from people who have or have had cancer is that when they reach the end of their treatment, they feel like they have been abandoned by the system that took care of them during their treatment. The question is, “How do we continue to support people who have been through such a traumatic experience?”. In oncology as in other parts of medicine and life, mental health support is critical. I would recommend joining a support group of likeminded people who understand what you have experienced. The good news is that these groups exist online as well as in person. CDC has materials for people who have had cancer and their caregivers and providers to help with this transition.
Continue listening and asking what’s most important to them while they’re healing and preparing for their next steps. While their treatment or surgery may be complete, healing has just begun. Help people understand their options by using plain language. Make decisions together. Research shows that people are more satisfied with their health decisions if they make them together with their provider. Even though informed and shared decision-making are the buzzwords of today, people we care for still want our input to make decisions about their care. This leads to more satisfaction with their decision and better quality of life.
Since close to 20% of new cancers occur in people previously diagnosed with cancer, it’s important we continue working on improving equity in cancer care and addressing the unique needs of this large and growing population.
From your experience, what are a few of the best ways to support a loved one, friend, or colleague who is impacted by cancer?
First, listen to the person who had or has had cancer to understand what their needs are. It is ok to ask your loved ones and friends what they need from you whether it is emotional support, help with daily tasks, or coming to the chemotherapy room to keep them company.
Take your cues from your loved one to understand how they talk about the cancer. One of the common ways we talk about cancer in our culture uses military-style words like “battle,” “fight,” “warrior,” and “beat”. We think these terms empower, motivate, and encourage positivity, but they may be having the opposite effect for many people with cancer. Using these metaphors implies that if a person fights hard enough and/or long enough, he or she will be able to “win the war against cancer.” If the cancer comes back, some feel like they have failed, not that the cancer did not respond to our treatments. I love the way one of my professors describes how we should talk about this in general. He says that “our treatments fail our patients, our patients don’t fail the treatments.” Cancer, like other medical conditions, is a complicated disease and will not be stopped by a “stronger will.” Cancer cannot be stopped by sheer determination.
Words matter, be sure to be a good listener to meet the needs of people who have cancer. Sometimes all they want is for someone to listen.
What are a few of the biggest misconceptions and myths out there about treating cancer that you would like to dispel?
Thank you for that question. Many people think having cancer is a death sentence. The 5-year survival has improved for almost all cancers. My advice to people with a new cancer diagnosis is to be sure to wait until all the information on the cancer is known to see what the treatment plan is going to be. I also recommend bringing a family member or friend to the doctor visits to have another pair of ears listening to what the oncologist is saying. Taking notes or recording the conversation will also help the person understand what questions to ask at the next visit. Knowledge is power. As people go through their treatments, they should share their concerns with their healthcare team so they feel comfortable with the decisions being made.
Thank you so much for all of that. Here is the main question of our interview. Based on your experiences and knowledge, what are your “5 Things Everyone Needs To Know About Cancer? Please share a story or example for each.
Cancer is primarily a disease of older people with half of cancers being diagnosed in people over 66 years old. This is why it is so important to attend your wellness visits as you get older. Get the recommended screenings when they are due. Know your body and bring anything to the attention of your doctor and healthcare team to be sure that if your symptoms are caused by cancer, it can be found early when treatment works the best.
Some cancers are preventable with screening and vaccinations. For example, almost most colorectal cancers begin as precancerous polyps or abnormal growths in the colon or rectum. These polyps can be present in the colon for years before invasive cancer develops. Colorectal cancer screening with colonoscopy can find polyps so they can be removed before they turn into cancer. In this way, colorectal cancer is prevented. Screening can also find colorectal cancer early when treatment works best.
Cancer is complicated and each person reacts uniquely to their diagnosis. The words we use as providers when speaking to our patients are so important, and the simpler the better.
If you smoke, quit, keep a healthy weight, be physically active, and eat healthy foods; these are important activities we can do to lower our risk of getting cancer. The added benefit of doing this is that your overall health will be better as well. All of the actions listed above lead to other medical problems like diabetes, heart disease, and high blood pressure.
Cancer can happen to anyone. Many different factors come together to cause cancer, and it’s not always something you did…or didn’t do. As an oncologist, I feel that no matter what may have caused the cancer, we have a common starting place when someone is diagnosed, we are going to work together to treat the cancer and help the person with cancer thrive. No matter what phase of cancer experience you are in, the most important thing I tell people is that it’s more important how you live your life, not waiting to die.
You are a person of great influence. If you could start a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 😊
I would start a movement; it would be to help people understand the connection between our everyday life and what will be coming. The public really does believe that cancer cannot be prevented. I want to be clear, there are many things we don’t know about how cancer develops so that limits what advice we can give you to lower your risk. But we know a lot.
Close to three years ago, we started a project with the CDC Foundation to empower people to get the knowledge they need to guide their care: Empowered Health. This program was inspired by the question: what if we could empower people to take control of their health by working with their providers? The desired impact would be:
improved health outcomes
improved sense of wellbeing
increased self-esteem, independence, and control
more satisfying interactions with their healthcare team
Cancer was the second leading cause of death in the United States in 2022, and I would like to see the Empowered Health program become a movement that could help people prevent, treat, survive, and thrive before, during or after a cancer diagnosis.
How can our readers further follow your work online?
I would love for your readers to learn more about what CDC is doing to help all Americans be cancer free at cdc.gov/cancer. And for more resources on the power and benefits of making decisions together with your healthcare team, visit EmpoweredHealth.org. and follow them on Instagram.
Thank you so much for these insights! This was very inspirational and we wish you continued success in your great work.