Chapter 12: Returning to MD Anderson and a Focus on Lung Cancer
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Description
In this chapter, Dr. Komaki begins to discuss her faculty career when she returned to MD Anderson in 1988 to become Section Chief of Thoracic Oncology, as there was no position in gynecologic oncology.
An initial project she took on with collaborator….? Was to focus on the use of radiation oncology for prevention. She describes how she became aware of the problem of lung cancer in Texas and the informational presentations she gave in many Texas communities to talk about speak against smoking and discuss post-operative radiation treatments for lung cancer. She describes the events and what she believes they accomplished over the course of 2-3 years. She notes that she saw a decrease in the numbers of Texans coming to her service with advanced lung cancer.
Dr. Komaki also talks about her involvement in a research group focusing on early detection and sketches other lung cancer studies she participated in examining combination treatments.
Identifier
KomakiR_03_20181219_C12
Publication Date
12-19-2018
Publisher
The Making Cancer History® Voices Oral History Collection, The University of Texas MD Anderson Cancer Center
City
Houston, Texas
Interview Session
Topics Covered
The Interview Subject's Story - The Researcher; Joining MD Anderson/Coming to Texas; Professional Path; Evolution of Career; Overview; The Researcher; Research; Prevention; Survivors, Survivorship; Patients, Treatment, Survivors; Cancer and Disease; Discovery and Success
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.
Disciplines
History of Science, Technology, and Medicine | Oncology | Oral History
Transcript
T.A. Rosolowski, PhD:
So how did that work, you coming back to MD Anderson in 1988 then?
R. Komaki, MD:
That was a totally different place, because all those famous attendings were gone. Dr. Fletcher, he had stepped down from chairman, but he was still there and he came to my office every morning. He sat down in my office and he said, “Ritsuko, tell me what’s new about lung cancer treatment,” that’s what he tried to learn from me [since he knew almost everything about the head/neck cancer and the cervical cancer].
T.A. Rosolowski, PhD:
Wow, he really respected you.
R. Komaki, MD:
Oh yeah, he did. And around that time there was nothing to do, no new thing about radiation treatment for lung cancer other than post-operative radiation treatment for positive lymph nodes in the mediastinal. He always liked me and so he sat down. He came to MD Anderson every morning and he left around 2:00 p.m., even when he was no longer chairman.
T.A. Rosolowski, PhD:
Now, I mean you mentioned his focus on lung cancer and I know you and Dr. Cox ended up working a lot on lung cancer later. So what was the status of lung cancer studies in your portfolio at this point, because you were focusing on gynecologic cancer.
R. Komaki, MD:
I know, and I tried to do that, but when I went --I was recruited to [MD Anderson by Dr.Lester Peters to] be section chief of Thoracic Radiation Oncology. There was no position to do gynecologic oncology at that time.
T.A. Rosolowski, PhD:
Oh, okay.
R. Komaki, MD:
Yeah, and Dr. Fletcher, and also Dr. Louis Delclos, who was section chief at that time, so he was doing that. So I was very disappointed not to do gynecologic oncology, but you know, I always like a challenge. When I came here in 1988, there were no really good studies for the lung cancer, and there were so many patients with lung cancer, because people were still smoking. All those ranchers, cowboys, they were smoking, and we had so many squamous cell carcinomas of the head and neck and the lung, because they started to smoke when they were around seven years old and nobody told them not to do it. So I decided to go for prevention. I thought that’s the best way to reduce the mortality due to lung cancer. [But] nobody will read whatever I wrote or nobody will read those books about how to get the lung cancers, so I decided to go to every tiny town of Texas. Before I started to visit small towns in Texas, the American Cancer Society supported me to give my talks in Los Angeles for one week, [about] the role of radiation treatment, because lung cancer patients never had any radiation treatment [in private hospitals of Los Angeles]. Surgeons operated patients with lung cancer and chemotherapy was given before or after the surgery, that’s it. So I gave my talks regarding how we can do a post-operative radiation treatment indication and techniques and how we can reduce side effects of radiation treatment. For unresectable lung cancer, there is a role for radiation with concurrent chemotherapy. One week, I had to give talks in all different places at Los Angeles. I went to John Wayne Cancer Center and I met a very strong surgeon, a very famous guy who operated many patients with malignant melanoma. I was shocked by the fact that nobody was giving any radiation treatment other than palliative radiation therapy for brain mets or bone mets. Of course I emphasized not to smoke and prevention is more important than treatment. After I came back to Houston, I went to Lufkin, Texas, Victoria, Texas, and all those small towns where I told people “Do not smoke “ and told them “Even if you are found to have lung cancer, that’s not the end of the world. [You can get possible curative treatment for the lung cancer].” The drug companies supported me to go there.
T.A. Rosolowski, PhD:
So where were these talks given in these small towns, like what was the venue?
R. Komaki, MD:
Okay. Drug companies usually supported my travels. I went to Lufkin, Texas, with Dr.Scott Lippman, the chair of the Prevention Department, and I was the chief of section of Thoracic Radiation, and Dr. Bernadette Ryan, who was a thoracic surgeon. I don’t know which drug company supported us to go there and to give our talks.
T.A. Rosolowski, PhD:
But was this at a public place or a cancer center?
R. Komaki, MD:
A big cancer center, yeah.
T.A. Rosolowski, PhD:
Oh okay, and anybody could come from the community.
R. Komaki, MD:
Yes, anybody could come and mainly, those patients who were treated at MD Anderson, they try to give a message to the community.
T.A. Rosolowski, PhD:
So some patients came too.
R. Komaki, MD:
Right.
T.A. Rosolowski, PhD:
So it was like a whole event.
R. Komaki, MD:
That’s correct. I still remember, there was a woman, she was 88 years old with smoking history, and she was operated on by Dr. Bernadette Ryan, thoracic surgeon. Dr. Ryan was treated by them like a god or a goddess by that community. So I asked, “Bernadette, what kind of cancer of the lung did she have?” She said, “No, that was not cancer, that was benign tumor.” So I said “Okay that’s fine, but they had to find out what’s in it when it was removed. Did they ask you about the histology?” Anyhow, she did a good surgery and no complications and of course that was not cancer, so this woman lived forever, but the patient was so appreciative because she was treated at MD Anderson without collapsing lung or any complication. So Dr. Ryan became very famous in Lufkin, TX. Basically, we tried to give a message to all different places: smoking is bad for lung cancer, and even if they were found to have cancer or some spot in the lung, there is hope. You know around that time, 1988, cancer of the lung equaled to death. There were so many people who didn’t want to do any treatment for the lung cancer.
T.A. Rosolowski, PhD:
They didn’t want to know probably sometimes.
R. Komaki, MD:
They didn’t want to know [about their lung cancer since they thought that there was no cure.] So we had to let them know prevention and early detection and adequate treatment, and they can be cured, or not to cause the cancer of the lung, that’s the most important thing, so that’s why we had to give a message.
T.A. Rosolowski, PhD:
So how long did you guys do these programs?
R. Komaki, MD:
We did this for two or three years.
T.A. Rosolowski, PhD:
Oh, okay. What was the effect?
R. Komaki, MD:
I think it effected very well, because when I came here in 1988, there were so many patients who came with advanced cancer of the lung. Many of them were wearing cowboy hats and boots, those are ranchers from all over Texas. I asked them, “When did you start to smoke?” Oh, I was seven years old, I picked up cigarette from my brother and I started to smoke, and they were totally addicted. You don’t see them anymore, because we pounded and pounded “Do not smoke”. I was on the board of director of the International Association for the Study of Lung cancer (IASLC) and our goal was that anybody who is going to be the president of that society, he or she should not smoke. I think that Dr. Cliff Mountain, who was the chair of Thoracic Surgery here, but he smoked and he was the president of the society. [After his presidency of IASLC, no smoking for the president of IASLC was set up in Japan.]
T.A. Rosolowski, PhD:
Yikes.
R. Komaki, MD:
The first time I met with him at the conference in Tokyo, he was smoking.
T.A. Rosolowski, PhD:
Now am I remembering correctly, because yeah, he did quite a lot of research on lung cancer.
R. Komaki, MD:
Oh yes, and he gave me all the specimens from 220 patients, whom he operated on: stage one, some are stage two, operable patients, specimens, and [I asked Dr Luca Milas and Dr. Kian Ang to teach my post- doc fellows to analyze all specimen for the biomarkers]. Dr. Cliff Mountain was a smoker, and he had at least two or three heart attacks and a bypass operation, and he died of cardiac problems but not due to the lung cancer.
T.A. Rosolowski, PhD:
Wow
R. Komaki, MD:
But you know, among our group, this International Association of the Study of Lung Cancer group, a thoracic surgeon, Bob Ginsberg, who was born in Canada and he came to the United States as chair of Thoracic Surgery at the Memorial Sloan Kettering, he died of lung cancer. Yeah, he had the brain mets and he died. He kept smoking even though he was a member of the society. There were a lot of myths: even if they smoked, some people they don’t develop lung cancer, and it’s all genetic susceptibility. I think we accomplished our message that smoking is the worst thing for cancer, or COPD, chronic obstructive lung disease, and cancer of the bladder like my father had --a heavy smoker, and maybe cancer of the pancreas, head and neck cancer. They had to stop smoking. We did so much campaigning, the smoking cessation, and then we moved to early detection, and now we are trying to get any early detection. I was with this early detection group by the spiral CT scan. If we can find the ditzels [by the spiral CT scan], what are you going to do? Are you going to do a biopsy that might collapse the lung, or repeat the CT scan in like three months or six months or what’s the safe dose of the CT scan? But because of the spiral CT scan, which has a very low dose of radiation, it’s safe to get the spiral CT scan, which shows so much detail of the structure of the lung. We had a randomized study, CT scan versus x-ray, chest x-ray.
T.A. Rosolowski, PhD:
Was this a study that you began kind of in those early years?
R. Komaki, MD:
Right, right.
T.A. Rosolowski, PhD:
Okay, interesting.
R. Komaki, MD:
Yeah, and that was published in New England Journal of Medicine, and it was a positive study, those patients... (inaudible), he was still at MD Anderson, we started to enter our patients from MD Anderson. It took a long time to publish it, ten years.
T.A. Rosolowski, PhD:
Oh really? Why did it take so long?
R. Komaki, MD:
Because we needed follow-up. Those are tiny, tiny spots and to grow and then adequately biopsy it and the results --the end point was survival, not the tumor growth. The end point was survival, so it really took ten years to publish it, and that was a positive study.
Recommended Citation
Komaki, Ritsuko MD and Rosolowski, Tacey A. PhD, "Chapter 12: Returning to MD Anderson and a Focus on Lung Cancer" (2018). Interview Chapters. 1293.
https://openworks.mdanderson.org/mchv_interviewchapters/1293
Conditions Governing Access
Open
