Chapter 06: A Research Focus on Lung Cancer and Views on Evolution of the Field
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Description
Dr. Spitz talks about her research interests in lung cancer in this chapter, beginning with the idea that captured her intellectual interest: only a small percentage of people who smoke develop lung cancer. This led to her major contribution to the field: creation of a lung cancer prediction model that was used for many years (she notes that another, better one is now in use). She then talks about her other roles as a consultant and as a recently appointed member of the National Cancer Advisory Board.
Dr. Spitz then gives an overview of the evolution of the field since the eighties. She notes that in the nineties, the concept of molecular epidemiology furthered the understanding of carcinogenesis. (MD Anderson was one of the first places to operationalize this research.) She then cites technology as an important factor in conducting genome-wide association studies. Now, she says, basic science functional studies are advancing the field and creates the need for epidemiologists to work with basic science colleagues, creating “team science at its best.”
Identifier
SpitzM_01_20161013_C06
Publication Date
10-13-2016
Publisher
The Historical Resources Center, Research Medical Library, The University of Texas Cancer Center
City
Houston, Texas
Interview Session
Margaret Spitz, MD, Oral History Interview, October 13, 2016
Keywords
The Researcher; Discovery and Success; The Researcher; Education; On Education; Research; Disco and succ Understanding Cancer, the History of Science, Cancer Research; The History of Health Care, Patient Care; Technology and R&D; MD Anderson Impact; MD Anderson Impact
Topics Covered
The Interview Subject's Story - The Researcher; Discovery and Success; The Researcher; Education; On Education; Research; Disco and succ Understanding Cancer, the History of Science, Cancer Research; The History of Health Care, Patient Care; Technology and R&D; MD Anderson Impact; MD Anderson Impact
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:
And what did you do when you—and actually, now that we’re at this place, I wanted to make sure that we picked up all of the evolutions of your own research during this time. I don’t think we completed that story.
Margaret Spitz, MD:
No, we didn’t, probably.
T. A. Rosolowski, PhD:
Yeah. So there are a couple of directions we can go, it’s just sort of what next after you stepped down, in terms of administration—
Margaret Spitz, MD:
Well that—
T. A. Rosolowski, PhD:
Or would you like to talk about research? It’s your choice.
Margaret Spitz, MD:
I think we should go back and finish that first.
T. A. Rosolowski, PhD:
Okay.
Margaret Spitz, MD:
So I focused almost exclusively on lung cancer. I did do head and neck cancer, because I was working with Ki Hong, but eventually I turned that over to others. And I was really interested in lung cancer because I realized that only a fraction of smokers developed lung cancer. And how did you identify that fraction of smokers who were at risk for lung cancer? And that was very important. And then the subject of lung cancer screening came up that showed that—there was a program that showed that lung cancer CT screening reduced mortality from lung cancer by 20 percent.
T. A. Rosolowski, PhD:
Wow.
Margaret Spitz, MD:
But the question was, there were about seven million eligible people to screen, and we couldn’t afford that. How do we [identify] the highest risk smokers? I worked, and we developed a lung cancer risk prediction model, which has been changed. Now it’s evolved into better models. But certainly, ours was one of the first to be published.
T. A. Rosolowski, PhD:
Now tell me about that. Because that just seems like an amazing tool to have created.
Margaret Spitz, MD:
Yes, but there are better ones. But we were the ones that showed that the family history was important, that a history of allergies—although that’s not included in the model anymore, but we did show that people who had chronic obstructive pulmonary disease were at substantially higher risk for lung cancer. And that’s now included in a model as well. So certainly we helped push the science forward, and that I’m proud of that.
T. A. Rosolowski, PhD:
So how would this actually be used? I mean, did you put it in the hands of—
Margaret Spitz, MD:
Well, actually, it’s on the website.
T. A. Rosolowski, PhD:
Oh!
Margaret Spitz, MD:
One of our younger faculty, Carol Etzel, helped to automate that model. And it’s got a name. I think it’s called CLEAR, C-L-E-A-R.
T. A. Rosolowski, PhD:
So someone can go on the website and kind of tip boxes and figure out, wow, this is my risk?
Margaret Spitz, MD:
Yes. They can.
T. A. Rosolowski, PhD:
That’s incredible!
Margaret Spitz, MD:
Well, there are better models now.
T. A. Rosolowski, PhD:
Right.
Margaret Spitz, MD:
But certainly we were a little bit ahead of the game, which was great. And I also neglected to say that I had a—I was quite involved with the National Cancer Institute. I had a part-time role there. And Dr. von Eschenbach appointed me to co-chair the Lung Cancer Progress Review Group. And that was a very tough task. I did that with a clinician.
T. A. Rosolowski, PhD:
Why was it difficult?
Margaret Spitz, MD:
Jack Ruckdeschel—well, it was because our task was very difficult, A, and B, while we were writing our report and recommendations, the NCI leadership was changed. And the new leader, who was—I’m blocking on his name—he was not very supportive of our recommendations, and most of which weren’t followed. So it was not the brightest. But since then, I’ve had many other roles at NCI, including I worked as a consultant for the extramural program, which is the Division of Cancer, DCCPS, Cancer Control and Population Sciences. But more importantly, I’ve worked with the Division of Cancer Epidemiology and Genetics, which is the intramural program, both when Dr. Fraumeni was in charge, and more recently with Dr. Chanock in charge. I’ve done a lot of work in helping to give strategic advice and direction, and reviewing tenure track faculty and non-tenure track faculty, and mentoring post-docs, and so on. So it’s been a very enjoyable part of my career. I’ve loved it. Now I can’t do any of that, because I’ve just been appointed to the National Cancer Advisory Board.
T. A. Rosolowski, PhD:
Congratulations!
Margaret Spitz, MD:
Thank you.
T. A. Rosolowski, PhD:
Now, in those positions, you’ve also had the opportunity to watch the growth of the field.
Margaret Spitz, MD:
Oh, absolutely. And we all—we know all the epidemiologists. And they know who the good players are and who the bad players are. I tell all my faculty that you have to do your best science. You have to behave collaboratively. You have to treat everybody with respect, because it’s a closed, small community, and people know what’s going on.
T. A. Rosolowski, PhD:
How has the field evolved since?
Margaret Spitz, MD:
Oh, dramatically, because in the beginning, we had just classical epidemiology. When I was hired in the 1980s, it was epidemiology required a pen and paper. All you had was questionnaires. And in the 1990s, the concept of molecular epidemiology evolved, and we were among the first to do it. And that was including biomarkers of risk, biomarkers of susceptibility and biomarkers of exposure, in order that you could understand a little bit about the underpinnings of the process of carcinogenesis. And then in the more recently [still?] with the evolution of technology platforms, we had the ability to do genome-wide association studies. First we did candidate genes, because the technology wasn’t there, so we studied small numbers of genes in small studies. And using PCR-based approaches.
T. A. Rosolowski, PhD:
What would be an example of some of those studies?
Margaret Spitz, MD:
Well, we looked at, for example, one or two genes and lung cancer risk. And most of these studies were underpowered. And we selected the wrong candidates. And they were never replicated, so people call this the “lost decade,” when we were publishing these candidate gene studies. But with the development of high throughput technologies, it was possible to do genome-wide studies. And that really propelled the field forward. And as I said—and Melissa Bondy published a GWAS on brain tumors. I told you about Chris Amos and the lung. We published a head and neck cancer GWAS. We had never smokers lung cancer GWAS. And prostate [ ] and these are all large-scale collaborative studies. No one institution could do it on their own.
T. A. Rosolowski, PhD:
When you’re talking large-scale, how many—
Margaret Spitz, MD:
Oh, thousands.
T. A. Rosolowski, PhD:
Thousands of patients involved.
Margaret Spitz, MD:
And then, Chris Amos, there was an announcement, it was a U19 program for post-GWAS to begin to look at what in the era of post-GWAS, what are the next steps needed in epidemiology? And he did the lung cancer one, and I’m happy to say it was funded. And so we’ve had a prominent role in lung cancer since then, looking at functional studies. And now it’s moved onto much more basic science functional studies, looking at gene expression, protein expression. And a lot of other interesting approaches, such as imputation of genes, and so on.
T. A. Rosolowski, PhD:
What does that mean, “imputation?”
Margaret Spitz, MD:
Well, because when you do GWAS, you identify a locus of interest. And this locus might contain several genes. And the locus might not be in a functional part of the gene. So we have to look and see, what is the gene involved? And what is the functional relevance of the locus? And that’s the way the science is moving now. So it’s very much more basic science than it’s ever been before. And you have to now work with basic science colleagues. You have to work with people who would know genomics, and bioinformatics and statistical genetics. So it’s team science at its best. And that is why we developed this new training program to train twenty-first century epidemiologists, because very few of them are being trained with the skills needed to conduct these very complex, high-dimensional-driven data and collaborative programs. And also, we have to change the culture at academic institutions, where they have to recognize the value of team science, because you might not—you have to be a team player, and you can’t lead all the teams. So they have to recognize someone who’s in the middle of a team science paper that’s published.
T. A. Rosolowski, PhD:
Interesting. Now when you say, “we,” are you talking about Baylor? Or are you talking in general about the field?
Margaret Spitz, MD:
Well, the “we,” the Baylor has developed the training program. But “we” is much more in the general epidemiologic sense.
T. A. Rosolowski, PhD:
Right.
Recommended Citation
Spitz, Margaret R. MD and Rosolowski, Tacey A. PhD, "Chapter 06: A Research Focus on Lung Cancer and Views on Evolution of the Field" (2016). Interview Chapters. 1590.
https://openworks.mdanderson.org/mchv_interviewchapters/1590
Conditions Governing Access
Open
