Tony Shu Kam Mok, MD, FCRP: Lung Cancer and the Asian Population

Prof. Tony Mok, MD discusses lung cancer and the Asian population at the 14th Annual World Conference on Lung Cancer 2011 in Amsterdam.

The Group Room at the 14th Annual World Conference on Lung Cancer (WCLC) was made possible, in part, by:

 

VIDEO TRANSCRIPT

Selma R. Schimmel, Founder & CEO, Vital Options International:

This is Selma Schimmel for The Group Room at the 14th World Conference on Lung Cancer, WCLC, organized by the IASLC, the International Association for the Study of Lung Cancer; we are in Amsterdam.  And now I’m joined by Doctor, Professor Tony Mok from the Department of Clinical Oncology at the Chinese University of Hong Kong.  Hello, Dr. Mok.

Prof. Tony Mok, The Chinese University of Hong Kong:

Hello.  Thank you for the invitation.

Selma R. Schimmel:

Oh, I’m so pleased you’re here because you are President Elect of the IASLC.

Prof. Tony Mok:

Well, looking forward to work together with the current President and hopefully we can do something positive.

Selma R. Schimmel:

Well, I would imagine that this is a very important collaborative time for you as you work in sync with the current President, who is Dr. Peter Goldstraw, as a way for you to begin to focus on your vision when you…

Prof. Tony Mok:

Well, I guess the importance of the IASLC, the I stands for the international, so we have always been internationally collaborative with both the president elect or past president and the president current, they’re all from three different continents- United States, Europe, and then the rest of the world.

Selma R. Schimmel:

There’s a specific area I’d like to discus with you and that is lung cancer in the Asian population.  We have learned it’s a very distinct disease for these patients.

Prof. Tony Mok:

Well, there’s two points- one, is that we do have a very unique disease entity in a sense that we have a much higher incidence of non-smoker lung cancer, especially in the female population.  And this population has a more specific tie to the well-known EGRF mutation, and more recently the EML4-ALK transgenic mutation.  So in a sense, we have a population with a high incident of this mutation where we can have a very effective therapy for, so we have a big task to select them; so that’s one area.  The second area is the fact that there has been a good effort in the tobacco control in the western country, but on the contrast in places like China and other Asian countries, tobacco control has still got a long way to go.  And there is an increasing number of smokers and also there’s a rising number of lung cancer patients.  So this is another area we need to do a lot of work on.

Selma R. Schimmel:

You mentioned women, and I’d like you to expand a little bit.  We have learned more and more amongst the general population of women that there are real gender biologic issues, perhaps even hormonal implications in regard to women and lung cancer.  In the Asian population, it’s even more complicated than what we already know in other female populations.

Prof. Tony Mok:

Well, this we can look into two different directions- one is environmental, the other one is genetic.  First of all, environmental is about the fact that in Asia in the older days women did not smoke as much.  The incident of smoker among the female population was much lower than the rest of the population was way back a number of years ago.  Now it’s changing, unfortunately, which is bad.  So that’s one, is that we have less, so-called, smoker in terms in the female population.  Secondarily, in environmental exposure there have been a lot of different speculation including cooking oil, which actually there is a high exposure of that in the way of cooking in the Asian population, and also, especially in China, the use of, so-called, a dirty coal; you know, in cooking and warming the house, which also increases the risk of lung cancer.  So that is one area, and then the other area is a genetic susceptibility. Now, this is area still we need quite a lot of research but now they are starting to surface there are certain susceptible genes that may be a little bit more prevalent in the Asian population, but that has not been well defined as of yet.

Selma R. Schimmel:

In the female population of non-smokers, what is the age that you’re seeing the development of lung cancer?

Prof. Tony Mok:

Especially in the mutation-positive Asian female we tend to see them in younger age.  Commonly, they may start into the 40’s and all the way into the 70’s, 80’s.  But the median is into the 50’s, which is younger than the median lung cancer age in the male population coming closer to sixty.

Selma R. Schimmel:

And from the time of becoming symptomatic to when these patients are actually diagnosed, what is that period?

Prof. Tony Mok:

Now, it is hard to get this; this is in a sense that we do not know how long they have had it.  And then, you talk about from the symptom until to the diagnosis, usually can be quite quick.  In a sense, is that by the type you get symptoms the cancer is probably quite significant or in a later stage because the lung is a big organ.  If it is small, early stage disease the patient will be asymptomatic, and then by the time they go symptomatic then usually advanced stage.  Now, that led to one very important area that is about screening.  We just learned some new information that if you screen the smoker from the National Cancer Institute study demonstrating that CT scan screening may reduce mortality in the smoker, but what about a never-smoker?  Should we screen them?  There’s no data on it.  So maybe in the future that’s one other area we have to work on in Asia.

Selma R. Schimmel:

Understanding some of the unique biologic components of lung cancer in the Asian population, how does that correlate with treatment and treatment design?

Prof. Tony Mok:

Well, because of the high incidence of EGFR mutation particularly in the non-smoking population, we have been actually so-called we are encouraging mutation testing very early on because by identifying the patient with the EGFR mutation, and now recently the EML4-ALK mutation, we will have the specific drug tackling them, and that certainly changes outlook for patient tremendously.  Previously, as a lung cancer doctor, the survival of the patient is limited, we don’t give chemo for everyone, but now, with the knowing of the genetic molecular marker and effective treatment, our patients could live for many years.

Selma R. Schimmel:

What about culture?  What role does culture play in the perception of cancer?

Prof. Tony Mok:

Oh, that is a complex question.  I mean, in a way it’s that Asia is a very heterogeneous society and it’s really variable from one to the other.  But certainly the stigma of cancer is still stained in a sense that a lot of patients maybe try to hide information, or actually the family will try to hide information from the patient, that still exists.  So…

Selma R. Schimmel:

It’s a feeling of being quote, “damaged.”

Prof. Tony Mok:

Damaged or stigmatized.  And so, we also are probably a little lacking behind in terms of psychosocial support for cancer patients, particularly lung cancer patients in the so-called Asian society, and in that way we still have a lot to learn from western society, which is to encourage positive support of the psychosocial aspect of cancer patients.

Selma R. Schimmel:

What is the integrative approach of cancer therapy in China where there is a reverence for eastern approaches to medicine as well as the integration of western medicine?  How do these two meet?

Prof. Tony Mok, Professor, The Chinese University of Hong Kong

I still remember the interview that you had with me a number of years ago on Chinese medicine.  Overall this year I don’t think it changed that much.  In a sense, it’s that it exists.  There’s a lot of so-called patients who still utilize Chinese medicine or traditional approach but at the same time they also engage in the western treatment.  So when you say combined, meaning they’re co-existing or combined in a sense that you know it is going to be better… unfortunately, to the current day of science that all we can understand is that yes, they may happen concurrently, the relationship may feel good, but there is no data to say that it’s going to make things better.

Selma R. Schimmel:

Do you have to deal with trust issues on behalf of western medicine approaches sometimes with patients?

Prof. Tony Mok:

Trust, in a sense of..?

Selma R. Schimmel:

I would rather take a Chinese medicine approach, I don’t know if I trust this western medicine…

Prof. Tony Mok:

Right.  Actually, it’s not so much of a trust issue, it’s a matter of a choice of the therapy and its toxicity.  A lot of the patient may avoid chemotherapy or western medicine because of the concern of toxicity while traditionally, the Chinese medicine is less toxic, it’s milder and it becomes more preferable.  So to me, I don’t believe that they don’t trust you; it’s just that yes, you can do so much but I don’t like toxicity.

Selma R. Schimmel:

The elderly population who maybe lives in more remote areas, let’s say, will they readily come to a major teaching hospital or will they try alternative therapies on their own first?

Prof. Tony Mok:

Unfortunately, I come from Hong Kong, I don’t have too much rural area in Hong Kong.  But then, if you talk about rural area in China, the fact of the matter is that a lot of them never even know about the existence because they never get a chance or even financial status to come to a major city.

Selma R. Schimmel:

Makes me feel sad.

Prof. Tony Mok:

It is, but then the fact of the matter is, in a lot of those rural areas they don’t get education, they don’t get basic care, they may not even have a warm bed.

Selma R. Schimmel:

Right.  And so, maybe you’ve just answered some of my question about some of the social implications that are the challenges that you face differently than perhaps than someone in…

Prof. Tony Mok:

Well, there’s two differences- number one is the disparity of wealth in the Asian country is still wider than in a western country, is one; and also, the health care system.  The health care system is partly nationalized, I don’t know what is happening in United States or what will happen in United States.  But in China it’s still difficult in that a lot of patients still have to scrape for money in order to obtain good health care.

Selma R. Schimmel:

Thank you for sharing that little bit of cultural insight with us.  I look forward to meeting with you again when you assume your leadership here at IASLC.

Prof. Tony Mok:

And that will be 2 years from now.  Hopefully it will be sooner than that.

Selma R. Schimmel:

And where will the meeting be in 2 years?

Prof. Tony Mok:

Sydney.

Selma R. Schimmel:

The IASLC is an incredibly important organization in unifying the multidisciplinary team that treats lung cancer.  What can we do to encourage membership?  If you wouldn’t mind, talking a bit about why membership is important.

Prof. Tony Mok:

Well, first of all we have to say, ‘what does the IASLC do?’  This is an international organization.  People may perceive us as just organizing the world lung cancer conference but this is only a small part of our job.  We have, number one, education and in that term we have to be involved with the major publication journal – the journal for oncology – and we have been into education on multiple different conferences throughout the year and also, we support other conferences on lung cancer in different countries.  So all this is very important.  And then in terms of the training for the next generation, we have a fellowship program that we actually support, not just from major countries but also from emerging countries, to have further training in the so-called advances in lung cancer.  And now we are also moving on into a number of educating the public through our communication events.  So there’s a variety of events that we try to engage so that we try to change so-called the management of lung cancer, and hopefully our mission statement is to minimize the death related to it.  And as a member we will be able to engage into this process, and as a member you are part of this whole family.

Selma R. Schimmel:

Doctor, Professor Tony Mok from the Department of Clinical Oncology at the Chinese University of Hong Kong.  Thank you Professor Mok.

Prof. Tony Mok:

Thank you for the invitation.  Thank you.

END OF VIDEO

 

 

Comments