Q. You’re about to become a key leader of cancer researchers across the country. What got you interested in cancer research in the first place?
A. If you want to change things in medicine — on a one-to-one level — it’s great to take care of patients, but if you really want to make a difference, you [need to] understand fundamentally how things work. [I also found] a question that just wouldn’t leave me alone: I was interested in why people get cancer, and also particularly why some families get cancer.
Q. What are some of the most interesting things we’ve learned about genetic predisposition for cancer since the war on cancer began nearly 40 years ago?
A. We’ve learned about specific genes for some of the more common cancers: colon, breast, and some childhood cancers. It’s been harder to find genes that increase risk a little bit. Ideally, some of that genetic work will lead to ways to stratify the population, so not everybody will have to have mammograms every year [for instance].
Q. There are other factors that cause cancer besides genetics. How does our contemporary lifestyle play into our cancer risk?
A. Lifestyle definitely matters. If you look at families that all have the same mutation — if you look at women born in the early part of the 20th century, they got their breast cancers 10 years earlier on average than their granddaughters do. [The granddaughters] live in a world where everything has changed: what we eat, how old people are when they have their children, even the age at when periods began, because we’re better nourished. It is not only about your genes. They are destiny, but they are not completely your destiny. It’s harder to figure out the lifestyle factors but they certainly count.
Q. So, now that we know so much about genes and behavior, why aren’t we curing or preventing more cancers?
A. Changing behavior turns out to be a whole lot harder than figuring out which molecule interferes with which gene. It’s not that people don’t want to, it’s just very hard to do. Patients always ask me: Isn’t there going to be a way to fix that gene? That’s going to take a while.
Q. There is a lot of controversy right now over screening tests for prostate and breast cancer.
A. For many people it’s counterintuitive that more screening is not always better. I think especially the patients I see are people at higher risk. They always feel they would be safer if we would just look more often but that’s not always the case. The more you look, the more you find, but not all you find is worth finding.
Q. Cost is obviously a huge national issue right now both for patients and for basic research.
A. My worry is that in the effort to try to handle the cost there will be less support for clinical trials research. The US has been the leader in biomedical research for decades, and we seem to think we’ll stay there. But other countries are catching up and we can’t let them get ahead. Not to be egoistic here, but this has been a great place to make huge contributions to the world. Nobody’s going to want to cede that because we can’t afford to invest in it.
This interview has been edited and condensed. Karen Weintraub can be reached at [email protected]
Dr. Judy Garber
Today, Garber, who runs a center for genetics and prevention at the Dana-Farber Cancer Institute, takes over the presidency of the American Association for Cancer Research, the foremost professional organization for cancer scientists.
Courtesy of Dana-Farber Cancer Institute