I spoke to Bruce Ratner about his efforts to save lives.
Everyone knows I’m passionate about the importance of early detection in many cancers. And yes, I know my friends call me the Screen Queen. Needless to say, I was so happy when my friend Bruce Ratner (real estate developer, former NYC Consumer Affairs commissioner, and now cancer activist) wrote a book about this very subject called Early Detection: Catching Cancer When it’s Curable. His wife, Linda Johnson (president of Brooklyn Public Library), has been at his side every step of the way. I recently talked to them over Zoom about the book and their efforts to save lives. Our conversation has been lightly edited for length and clarity.
Katie Couric: Bruce, tell me why you wanted to write this book.
Bruce Ratner: Well, I had the kind of experiences that nearly all of us have had: Unfortunately, in my case, my closest relatives died of the disease. My brother, my mother, and my grandmother all died of cancer. My mother was at a relatively young age. And I realized when my brother got sick with stage four cancer eight years ago that he wasn’t going to be cured. I asked the doctors at Memorial Sloan Kettering, “What if we’d caught it early?” The doctor said it would’ve made all the difference. So that was eight years ago when I decided I was going to work on a subject that is near and dear to our hearts: early detection. And the important thing, I think, is that we’re all in this together.
We’ve all faced cancer, either personally or with others. We understand the pain of it — for the patients and the families. Your concept very early on with colon cancer — catching it early — and your bravery in televising your own colonoscopy on national TV made a huge difference. So I said to myself, maybe I can have some impact by writing a book about the early detection of cancer; it’s essentially a policy book that talks about how we might improve the situation.
And what did you discover, Bruce, in the process of writing this book about the effectiveness of early detection for a wide range of cancers?
BR: I think what I now know and what many doctors know is if you catch cancer early, you have a high likelihood of survival. Probably 90 percent on average. If it’s not detected until stage four, because that’s when the symptoms show, your likelihood of surviving decreases dramatically. So that’s the first thing I learned. The second thing I learned is that there are only five tests for early detection, and they’re for cervical cancer, breast cancer, prostate cancer, lung cancer, and colon cancer. And yet there are at least 50 cancers.
I also learned that in the case of lung cancer — which is the leading cause of cancer death in the U.S., accounting for about 1 in 5 of all cancer deaths — only 5 percent of people eligible to get a screening actually do it.
Let’s talk about lung cancer because you’re right, it’s the number one cancer killer. And I think it needs to be discussed more openly. I’m embarrassed to say I didn’t know there was a screening people could be getting for lung cancer. Can you tell us what that is?
BR: It’s called a low-dose CT scan, which is a scan of the chest. The amount of radiation is about the same as a mammogram. It probably takes about three minutes in a low-dose CT scanner. The recommendation is that you get it every year. It’s available in any hospital or radiology center. It takes nothing to do. Now, the problem is you need a prescription, unlike mammography, where you don’t need a prescription. And doctors aren’t so willing to give it, which is really wrong. A general practitioner will often say, “Oh, you haven’t smoked for 15 years, don’t worry about it.” So getting the prescription is not so easy for many people especially if you have limited access to healthcare. Many people don’t even know about the test.
Linda Johnson: There’s also misinformation out there. Many people are told or believe that if they haven’t smoked for 15, 20, or 30 years, they don’t need to worry about it. And that’s just not the case.
BR: The American Cancer Society did an incredibly brave thing last November by saying that anybody who has smoked a lot in the past, even if it’s 30 years ago, should get screened. And 20 percent of lung cancers are in people who didn’t smoke. So we need to solve that problem, too.
Does insurance cover it, or do you have to pay for it out of pocket?
BR: Thank you for asking that question. If you’re a smoker or have smoked in the last 15 years and you’re between the ages of 50 and 80, insurance will pay for it. If you happen to have smoked 25 years ago, even if your doctor gives you a prescription, it won’t necessarily be insured. It depends on your policy. And Medicare and Medicaid will not pay for a low-dose CT scan, so that’s got to change.
Let’s talk about the group that is ultimately responsible for establishing screening guidelines: The U.S. Preventive Services Task Force.
BR: They’re like gatekeepers. The American Cancer Society has studied this issue incredibly well: They’ve collected the data on why the lung scan must be insured, and they’ve submitted a letter to the USPSTF asking them to require coverage. It’s going to take two or three years for that agency to get to it, which is terrible, but that’s what it is. So we need to apply more pressure. The American Cancer Society has done the work: They collected all the data, they’ve written the letter, and they’re putting pressure on the USPSTF, but it’s going to take more than that. I think it’s going to take members of Congress. It’s going to take just the kind of work you’re doing on the dense breast issue, which is not easy work.
Editor’s Note: I’ve helped introduce legislation on Capitol Hill that will require insurance companies to pay for secondary screenings (breast ultrasound or MRI) for the 42 percent of women 40 and over who have dense breasts for whom mammogram only is not sufficient to detect early breast cancer.
Meanwhile, the USPSTF has a record of failure, in my opinion. They just came out with an outrageous recommendation for breast cancer screenings: They brought the recommended mammogram age down to 40 — which is great — but they recommended screenings every other year, and that’s a disaster. Interval cancers are found between screenings. Two years is too long. As you and I know, some breast cancers are slow, but unfortunately, some are aggressive. If you develop an aggressive cancer but don’t catch it for two years, you’re going to be in trouble. Interval breast cancers have a mortality rate of three times higher. So we know that [screenings] need to be every year in the case of breast cancer.
As you mentioned earlier, we need to have a massive campaign because I think people aren’t necessarily educated about the need for early detection. What else can be done to increase the compliance rate for a lot of these tests?
BR: I wrote the book as a platform to try and accomplish some of these things. So you’re absolutely right: You need mass publicity as well as targeted outreach. One of our initiatives is in the Bronx, where the mammography rate is 50 percent, versus in the Upper East Side of Manhattan, which is closer to 80 percent. So we’re working with hospitals, for example, Jamaica Hospital in Queens, which is a great place. And they’re going to start looking through their health records to contact former smokers. They’re going to see who’s up to date on mammography. And they know how to reach out to their constituency. It’s not just Congress, it’s not just media, it’s not just the USPSTF, it’s really the actual hospitals, the radiology centers. RadNet is the largest owner of radiology centers in the country. In New York City alone they have 60 centers. So we’re talking to RadNet about devising a questionnaire so that when somebody comes in and has a broken finger or whatever, they’re asked if they’re up to date on their screenings. We’ve got to talk to people at every touch point. And that’s really what I’m working on.
LJ: The whole idea behind the Ratner Early Detection Initiative, which is what we’ve been calling our efforts, is to work on initiatives with different models. Bruce spoke about the one at Jamaica Hospital. We’re talking about doing one in Brooklyn, where mammography is lagging well beyond the other four boroughs. We want to figure out what it takes to get people up to date on screenings in the hopes of building a model that’s replicable outside of New York City. If you can solve the problem in a place as complicated as New York City, the theory is that we can have an impact elsewhere. We’re talking about using sports figures, influencers, and libraries to reach people who shy away from the various healthcare institutions to increase health literacy.
When it comes to breast cancer, Black women have a 40 percent higher mortality rate, which just is unconscionable. How can we reach everyone and make sure they’re screened?
BR: There are so many disparities. A primary problem is the amount of time from diagnosis to treatment, as well as completing treatment. We cannot have patients waiting 120 days to get treated — that is a critical time. And secondly, we need patient navigators to take the person from the initial screening all the way through what I call the “cancer labyrinth.” It’s difficult enough for well-informed people to figure out what to do, but for somebody who doesn’t have experience or a general practitioner, the labyrinth is almost impossible. We need to overcome the obstacles that cause higher mortality rates for African American women with breast cancer. But unfortunately, it’s never one thing. I wish there were a magic bullet but there’s not. It’s all of us working together to close these disparities through multiple touchpoints — from patient navigators to media platforms to hospitals. For me, it’s all about having an impact.
