Dr. Selwyn Vickers

One of everyone's greatest fears that he or she might be diagnosed at some point in their life with cancer. I recently had a chance of talk to doctor Selwyn Vickers, who runs a Royal song Kettering Cancer Center, one of the leading cancer centers in the United States, and I had a chance to talk with him about the progress being made in treating cancer. So today we are about I guess, more than fifty years after President Nixon declared

Yeah, I think we have the.

Ability for someone who has a diagnosis of cancer broadly thinking about having a chance for cure has significantly improved. We've gone from all cancer diagnoses probably around the time of that announcement that was around thirty to forty percent chance of cure that we're approaching sixty eight to seventy percent of patients across the board who get the diagnosis of cancer have a chance at five years to being told they don't have a tumor.

So what is the best way to avoid getting cancer? I guess that's the question everybody asked, Well, what is the answer to that?

Yeah, I think the best way to avoid it is obviously healthy lifestyles, avoid smoking, certainly limit red meat to the amount that you eat. Now, all of these statements are no guarantee you won't get cancer, but we do know to some degree that they probably have a role in accelerating or increasing risk. In general, there is no actual way to prevent it. There are certainly things we do can screen early, and if we catch cancers early, we have a really good chance of curing them.

What extent is environmental factors, What extent is it behavioral factors, And what extent is the genetic factors that causes cancer?

Yeah, so it's a combination. There's a small percentage of inherited genes that put you at risk. The most common is BRCA one and two for women with breast cancer, increasing risk of a varian cancer as well, and one or two others those we know and we can detect. There's certain other select genes that are passed on that significantly increase.

Your risk, but that's a small number.

The other genetic aspect are genetic mutations that occur over time because of the environment and age. Those somatic mutations sometimes caused by viruses, caused by cells that are not correcting themselves certainly have a role and actually producing malignant cells that grow on control. And then I think there are certainly environmental exposures, and we are learning more. We know that there are classically ones from multiple chemicals that do it, but it's the broad combination. But I would

So what is the most common cancer that humans get? Is that lung cancer, breast cancer, pancreatic cancer, brain cancer. What is the most common?

So the most common cancers in America are breast and prostate. Three hundred thousand cases of breast, somewhere around two hundred and eighty thousand cases of prostate. Lung is arguably one of the most if not the number one killer.

It's about one hundred and.

Fifty thousand cases, but it is the most lethal large number pancre's cancer. The incidence has increased. When I began my practice, there was about thirty thousand cases a year on average.

Now there are over sixty.

Five thousand new cases of pancredit cancer a year, and so it's approaching a level where it's going to be the second killer, comeless common killer of patients with cancer, even though it doesn't have the numbers. Like breast cancer, we can cure well over ninety percent of breast cancers and well over ninety five percent of prostate cancers are cured.

And now with prospective prostate cancer there's a PSA which is a kind of a blood marker. But we don't have those kind of things for brain cancer or or for pancreatic cancer, right we don't have a market.

We don't.

They are clearly tests that are being evolved based on being able to detect circulating tumor, DNA and other markers, and our ability to have broader ability to manage the data through competition oncology that are giving us gradual insight for early detection. It's not as specific as we want and it's not completely as accurate. So sometimes if I get a positive test, I really don't know which tumor to look for. Sometimes it does give directions, but that's evolving.

But you're right.

We have PSA, we have mammograms, we have colonoscopy, we have cervical screening for certain cancers, and we have CT scans for lung but we don't have broad availability of screening for the large number of cancers that are still killers.

Now, the type of cancers that are killers are ones where you don't know about them until maybe stage four globlastoma, brain cancers, that type, pancreatic cancers, another type, maybe liver cancer.

That's right.

How do you know if you have one of those kind of cancers? What is the best way to go in for an annual cancer checkup or.

What do you do?

Yeah, so it's hard, and that's a question that's perplexed me.

I would love to say, go out and get a cat scan for everybody. We can't do that. We don't have enough cat scanners to screen.

We need a better ability to enrich who's truly at risk. And recent studies now with AI have been able to begin to predict who in the population by virtue of a number of things that they pulled together their medical history, some blood tests, who's at risk for a pank ratic cancer.

Now, pancreatic cancer, that's a disease that Ruth Bader Ginsburg died from and increasingly many people have it. You don't typically know you have until stage four. You are a pancredic cancer surgeon. Why didn't you decide to specialize in that area?

You know? One a couple of things.

Number One, at the time that I trained at Johns Hopkins, we were the leading center for treating patients or pancreatic cancer. And as you talked about, at that time, the leading opportunity to make a difference in somebody's life was surgery. So Number one, I felt, I felt I had great training and had capacity to make a difference by virtue of that skill set. So it was the environment, the leaders there who encouraged us to look at difficult problems and make a difference. So one it was a skill

I soon learned as a surgeon.

After I did my first hundred patients for pancredic cancer, successfully operating on them, I could count on one hand how many were alive at five years, and so I knew that was a bigger problem than just my surgical skills could resolve.

Okay, so I'm always worried about pancredic cancer too. What's the best sign that I might be having pan credic cancer?

You know, the signs of cancer are often due to something simple. But if you were to think about the things that you might worry about, particularly as you get older. We don't naturally just lose weight when we get older. So one notice that.

Yes, a sudden Yes, a sudden weight loss.

So you want to ask the quest question, why am I dropping weight even though I've been trying for the last five years and nothing's happened. New onset diabetes that for some reason now I don't have a history of it. I'm over sixty five and I'm developing diabetes that and then subtly, although not early on, it's the case where either somehow my urine turns dark or I begin to have some shades of change and my eyes or my thumbnails that begin to look a bit of a yellow what we call jarndice.

Now you've said weight loss is a sign sometimes something isn't good, but I know it's not directly in your area. But ozempic, which is now a very popular drug to produce weight, some people say that it might cause some type of tumors. Are you an advocate of ozempic for everybody or for some people?

Yeah.

I think as the new golp one inhibitors, which are these drugs that really affect how we feel about being full, become further advanced, I think it's going to be an overall sea change for American health care, including cancer, because we know obesity over time has a significant impact increasing

Talk about your background. Where were you born?

So? I was born in Demopolis, Alabama. It's in the small town in the black belt of Alabama, a rural farming area where my parents were educators.

Now, your parents were extremely well educated for blacks in the South at that time. How did they get so well educated?

Yeah, So on my father's side, it was really a parents who themselves had limited education. My grandfather with a fourth grade education, who didn't learn how to write and read until he was in his forties, who really felt his children needed.

A college education.

And on my mother's side, her mother in the nineteen twenties at the travel two hundred miles to an academy to start it by Presbyterians in the southern part of Alabama to get her high school degree, and then went to summers to get her bachelor's degree. So they had foundations of understanding the value of education and the ability, particularly for a Nigro in the South, to have a chance to advance their lives and careers.

When you grew up in a segregated environment, isume So you were the only child of your parents. Yes, so did they say we're putting all our hope in you, and we want you to be a pancreatic cancer surgeon.

No, they had no clue what I might be.

I think they simply wanted me to do the best I could in anything I took my interest in. Clearly, achievement in high school and undergrad was really sort of the first thing that they looked for and expected of me, and I tried to do that because I realized the legacy of both grandparents and even great grandparents who studied with book A. T. Washington, that I had a significant responsibility.

So were you a superstar in high school?

You know, I was a good student. I would say this. I grew up in a town called Huntsville.

It really offered the best education that I could get in Alabama at the time. But when I arrived at Johns Hopkins, I was probably behind ninety five percent of my classmates.

And what I've been exposed, you must have done okay at Johns Hopkins undergrad because you got on the Johns Hopkins medical school.

Yeah, I had to catch up. It took me about a year to catch up.

And you know, there were classes my classmates had who went to prep schools I was taking for the first time. I hadn't had calculus when I arrived, and they'd all had calculus, and so the level loved thing of the playing ground took me about a year for that to occur.

Once the playing.

Ground became level, I found that I compete just as well as they could.

When you went to Johns Hopkins Medical School, which is one of the most famous medical schools in the country, up in the world, was it very integrated at the time, were mostly white.

So there was a surgeon there who was from Alabama, a guy named Levi Watkins, who became a mentor and friend, and he grew up in Alabama where my grandmother and my mother went to the college where his father was president, and Levi went to Tennessee State, Vanderbilt and then Johns Hopkins. Stayed on faculty, but challenged Johns Hopkins that it clearly

After you graduated, what did you do?

So after I graduated, I made the transition to realize I wanted to be a surgeon, looked around the country, and decided to stay in Baltimore because I thought Hopkins had the best surgical training of that time.

But ultimately you went back to Alabama.

That was a hard decision. I had an offer to stay on faculty at Hopkins. I'd been there for in Baltimore for sixteen years, and briefly accepted a job to stay, but then change my mind to go to Alabama, in part because I felt I wanted to go back home into a new environment.

Now as a great surgeon, sometimes you might say I don't need to go be into administrative parts of hospitals. I just want to be a doctor, just do surgery. What prompted you to want to get out of just doing surgery to be an administrator and a hospital leader.

Yeah, I think it was again watching others who did it well.

I had a.

Dean who recruited me from Birmingham, Alabama, to Minneapolis, Minnesota, which is a big jump to convince me to move my family, but she did several things that showed me the power of a leader at a significant level to affect the.

Career of other leaders.

And after I'd helped build a growing Department of Surgery at the University of Minnesota. I thought I could serve in that role. In particular, I realized over time that my training as a surgeon brought a set of credible things to the table. One, if surgeons have a measure of emotional intelligence, not much of our training reinforces that.

So he rose up in Minnesota. Why did you go back to Alabama? Which had racial issues?

UAB is a unique place.

It's a bit of an oasis of academic excellence, broad diversity. It's the most diverse Carnegie Tier one research university in the country. It's done more transplants in African American than any hospital in the world.

So I felt the.

Compelling opportunity to continually drive the mission of that institution in spite of the landscape socially and politically that I thought it could have a significant impact on that part of the world.

And how long did you run? UAB So I was there for nine and a half years, almost ten years. So when Memorial Sloan Kettering approached you, did you say, Look, I'm a great surgeon. I got what I want right here. This is my native state. I don't need to leave.

Were you intrigued, No, it was more of the former, Like you said, it was I have a good place, have a good job, I've built a level of trust in the community, i have a compelling mission, and I think I need to really think.

Very hard about leaving it.

And I would say there are very few places that would intrigue you to consider it leaving, and Memorrison Cattering is one of them.

So as you rose from a small town only child in Alabama to where you are now, you must have encountered a fair amount of racial prejudice.

Yeah, I had my share of it.

I learned early on from one of my mentors at john Hopkins. He was one of the faculty there, and he reminded me that people will often have difficulties with you, but don't make their problem your problem. And so one of my early experiences of taking care of a patient who had a liver cancer or in this case of bioduct cancer, they struggled that there was a black surgeon saying that they needed half of their liver out. I

So when you join Memorial Sloan Kettering, what you want to do is expand the coverage of moreel Sloan Kettering and make sure more people were able to get the services. What progress have you made so far in that.

I have wanted Memorial Sloan Kettering and be a cancer center to the world, both culturally, ethnically.

And geographically.

And there have been great efforts that have occurred, some of them before I got here. One of the efforts by our legislative team was to get our state to really drive manage Medicaid, manage care in New York, to actually negotiate with Morrisloan Kettering so patients with Medicaid broadly could access us. We've had that law enacted and patients now broadly are able to come to us. Our Medicaid

So, as the head of the Slung Cattering Cancer Center, your biggest problem is getting enough money to do the research and give the patients the care they want. So you're always raising money or that's not your biggest problem.

You know, it's not my biggest problem, but it is a problem. There is no doubt the cost and healthcare is significant, not only for our patients, but for the science and for the drugs.

So it is a significant.

Part of what I do is putting resources on the table so that our scientists, our clinical trialists, and our physicians are able to do their job and make discoveries.

So I'm Memorial Sloan Cattering. What it does is it does research and then also does patient care. Yes, and there's an advantage, you would say, to patient care because you have people doing the cutting edge research.

Yes, cutting edge research that's connected to doctors who are looking to answer questions as well as take care of people.

You also have students at Moral Sloan Cattering. You have a graduate school for students, is that right.

Yeah, So the Gersonal School is really one of the outstanding biomedical grad programs in the country. That our students are focused in our labs largely on basic science and cancer research. We also have almost two thousand fellows and residents who rotate the Memorial Hospital, so we have a robust educational program, although we don't have a distinct medical school, great graduate school, great training programs, nearly one hundred different fellowships at Memorial.

Suppose somebody says they have a cancer that's i'd say, not a very good kind of cancer, not that any good cancer, not that any cancer is good. But suppose you have somebody's very serious stage four gleoblastoma. The advantage of coming here is you can really make a difference at stage four for somebody.

Yeah, so the advantage of coming here broadly. So Number one, the outcomes are different even at stage one. For coming to a Memorial at a stage four, we certainly have the better chance of often prolonging life and having a chance to getting access to the most novel therapeutics, with no guarantee that we're willing to cure you, but we're going to give you every chance there is in the space of cancer to make a difference in your tumor.

So, how does somebody become a patient somebody walks off the street and says, I think I don't feel well, maybe I got a cancer. How do people get to be a patient here?

So number one, you can refer yourself and call and we will help make that diagnosis a Number two, your physician who you've seen as a primary care doctor can refer you here.

Either way.

I suppose somebody says, I don't have any health insurance. What do you do?

We have services to take care of people who don't have financial ability.

So when you are doing pancratic cancer surgery, you're not doing surgery now, are you.

I still do some ser surgery.

Yeah, they let me come in the operating room by permission special occasion.

But if you're only doing it occasionally, can you still do surgery and really be up to speed on everything?

Yeah?

So I do it regular enough to know that what I do that the outcomes are not affected. So I have to As a low volume surgeon, you have to watch closely, and I typically operate with my other surgeons so that I have other senior surgeons who are part of the picture as well.

What does it take to be a great surgeon?

It may sound trite.

Perseverance, resilience in practical terms, being able to take a blow and not having it become a permanent deformity, and grit, the ability to really turn lemons into lemonade, and to not both let discouragement or disappointment from the prior patient prevent you from taking care of the next patient.

You see, you're relatively young by my standard, so this is something you expect to do for another decade or so something like that.

Yeah, I would say that would be the goal. There are some things that I want to see accomplished that memorial. It's a place of phenomenal people and talent more than ever, as we talked about people getting older and the incidents of cancer really growing, I think we have a special role for the society, not only in New York and America, in the world than the role that we play around discovery and what I think is in golden age of cancer treatment.

Did your parents live to see your success? You're obviously an extremely successful person. Did your parents live to see this?

You know? My mother did to a degree.

She saw a large part of success as it relates to both my family. She lived to see my four kids born, which was immnt since I was an only child. I think she certainly desired a larger family, and she saw some of my success as an academic surgeon, particularly for people in her purview who I treated and operated on. I just saw a man two or three weeks ago with my father who I did a pancredic cancer procedure

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