In this week’s episode of The Cancer Letter Podcast, editor and publisher Paul Goldberg, and associate editor Jacquelyn Cobb revisit two of last week’s most-read stories: the growing recognition that early-onset colorectal cancer requires a new diagnostic mindset, and the life and legacy of Maura Gillison, the scientist whose discovery that most head and neck cancers are driven by HPV transformed the field.
This episode is available on Spotify, Apple Podcasts, and Youtube.
The cover story follows Jenna Scott, who was diagnosed with stage 4 colorectal cancer a year after giving birth to her son. Her cancer was repeatedly missed because its symptoms—rectal bleeding, abdominal pain, nausea—overlapped with those of pregnancy and the postpartum period. Researchers say her experience is indicative of a larger phenomenon: early-onset colorectal cancer increasingly appears to be a biologically distinct disease, affecting younger, otherwise healthy patients and often presenting at a more advanced stage.
“It’s a time of patient advocacy, which has been going on really through most of my career, but patient stories really need to get out and be told,” Paul said. “I think that is a bit of a change now because at this time when science is in jeopardy, hearing from patients is very, very important.”
This episode of the podcast also covers the legacy of Maura Gillison, who died on June 21 at age 61. Her groundbreaking research established that HPV causes the majority of head and neck cancers, fundamentally changing how those cancers are understood and treated.
“I’m going to steal a factoid that you mentioned earlier, Paul, but it’s like 70% of head and neck cancers are caused by HPV. So, the magnitude of the effect is really huge here. The numbers are huge,” said Jacquelyn.
Stories mentioned in this podcast include:
- Early-onset colorectal cancer is behaving like a new, biologically distinct disease, researchers note. One woman’s pregnancy shows how this distinction matters
- Maura Gillison, who identified the role of HPV in head and neck cancer, changing the standard of care, dies at 61
- Is it time to re-assess the practice and practicality of screening colonoscopy? Modeling data in ACS guideline support greater use of noninvasive tests to ease system strain, save lives
- More than 50 million Americans remain unscreened for colon cancer. New guidelines offer another option
This episode was transcribed using transcription services. It has been reviewed by our editorial staff, but the transcript may be imperfect.
The following is a transcript of this week’s In the Headlines, a weekly series on The Cancer Letter Podcast:
Jacquelyn Cobb: This week on The Cancer Letter Podcast.
Paul Goldberg: Also, it’s a time of patient advocacy, which has been going on really through most of my career, but patient stories really need to get out and be told. And I think that is a bit of a change now because I really, to maybe even push it off even further off subject at this time when science in jeopardy, hearing from patients is very, very important. So that’s kind of where we are in this. And by the way, if you look at our stories that are perpetual bestsellers, most of them are that kind of a story. They’ve been exceptional for us to do them, rare, very rare, but now they’re becoming a little more frequent.
You’re listening to The Cancer Letter Podcast. The Cancer Letter is a weekly independent magazine covering oncology since 1973. I’m your host, Paul Goldberg, editor and publisher of The Cancer Letter.
Jacquelyn Cobb: And I’m your host, Jacquelyn Cobb, associate editor of The Cancer Letter. We’ll be bringing you the latest stories, groundbreaking research, and critical conversations shaping oncology.
Paul Goldberg: So let’s get going.
Jacquelyn Cobb: Hi, Paul. How are you?
Paul Goldberg: Hi, Jacquelyn. How are you?
Jacquelyn Cobb: I’m doing good. Glad to be back on the podcast after a two-week hiatus kind of, for myself at least, not for the podcast. How was your weekend?
Paul Goldberg: It was great. It was great. I also spent three of the past three weeks in Vermont working, alas.
Jacquelyn Cobb: Yes.
Paul Goldberg: But it wasn’t even a working vacation. It was just really-
Jacquelyn Cobb: Just work.
Paul Goldberg: … being in Vermont and doing some biking here and there between stories and hanging out. And the mushroom season has begun, so I had to come back.
Jacquelyn Cobb: Oh, I didn’t know that. That’s cool, Paul.
Paul Goldberg: Oh yeah. I went out and picked a bunch of mushrooms. I picked mushrooms, what will you do?
Jacquelyn Cobb: You’re like a serious forager, like a knowledgeable forager, right?
Paul Goldberg: Yeah, it’s a Russian thing. But knowledgeable means I haven’t killed anybody yet.
Jacquelyn Cobb: Yeah. Or yourself, right? Or the other thing, right? The other thing that will not be named. You’ve not gotten the wrong mushroom or gotten the mushroom you didn’t expect. Yeah.
Paul Goldberg: No, that would not happen.
Jacquelyn Cobb: It could, right? Am I overblowing the fears of foraging?
Paul Goldberg: Yeah, it depends on how many chances you take and I take none.
Jacquelyn Cobb: Got it.
Paul Goldberg: So you can’t be adventurous.
Jacquelyn Cobb: Yeah. I mean, you can, but it’s risky.
Paul Goldberg: As a mushroom person.
Jacquelyn Cobb: Yeah.
Paul Goldberg: But anyway, we’re off track.
Jacquelyn Cobb: Yes. As always, as always. I will take us through last week’s headlines.
Paul Goldberg: Good. Good.
Jacquelyn Cobb: We had a cover story that I had been waiting for. I was looking forward to, let me say, for a while, a couple weeks, maybe a month or so. When Claire came to me to say like, “Hey, I have this story sort of in the works.” I was like, “Oh my gosh.” I didn’t even really need to hear more because I was just so convinced it was going to be incredible. And last week it was, as always. So the story is that early onset colorectal cancer is behaving like a new biologically distinct disease is the headline. But the way that Claire brought it to me was that there’s this phenomenon that pregnancy symptoms have a pretty big overlap with young early onset colorectal cancer symptoms. And so that these symptoms are getting overlooked in young pregnant women and that the subpopulation is missing earlier diagnosis and that’s horrible.
And Claire spoke with a patient and got a really narrative experience or narrative story out of it and it’s just incredibly moving and we can dive into that more as well. But just really fun to be able to talk about it and to finally have… Even just as a sidebar, we have this incredible art that Cyrus did, an artist. And it’s one of these big feature stories that I think we both, Paul and I get, well, everybody in the team, but gets really excited about. And it’s really what we love to do. It’s a joy is what I’m trying to say.
And then the rest of the issue was really strong as well. Paul, I’m excited to talk about the story behind the story with this as well, Paul, but you wrote a obituary for Maura Gillison who identified the role of the virus HPV in head and neck cancer, which totally changed the standard of care. And of course, I’m going to steal a factoid that you mentioned earlier, Paul, but it’s like 70% of head and neck cancers are caused by HPV. So the magnitude of effect is really huge here. The numbers are huge.
And then we had two guest editorials, one from what was formerly Exact Sciences is now Abbott and the other from Guardant, two companies that are involved in early detection of colorectal cancer through blood testing. And so they both wrote their own perspective about this new ACS guideline that supports sort of this greater push, greater use for these non-invasive testing for colorectal cancer instead of colonoscopy or these more invasive methods that are amazing and effective, but for increased access and things like that. So definitely read those two, I would say. If you’re going to read one, read the other, they’re complementary.
And yeah, so really, really fun, concise issue. There were also some important cancer policies, but I would love to… I don’t know, do you want to start with Maura Gillison, Paul, or do you want to start with-
Paul Goldberg: Let’s start with colorectal cancer story because the cover story was really quite something. To me, the really jarring thing was to hear colorectal cancer oncologists say that their waiting room looks very different now than the way it did a few years back, a couple decades ago, or there was hardly anybody who is under 50. Now about half are. So is it a different disease and what causes it? And I don’t think there’s an answer.
Jacquelyn Cobb: Not yet. Yeah. And I also think just to piggyback off that, it’s not just incidents rising. And I could be misremembering the details, but there are signals and again, this is sort of this new phenomenon that I feel like researchers and clinicians are trying to sort of parse out. There’s a lot of unknowns, but the colorectal cancer that appears in these early onset patients seems, again, this is all just hedging as hard as I can, but it seems like it’s biologically distinct. So it’s in a different part of the colon. I forget exactly the details now, I’m sorry, but it has differences on a biological level, not just, “Oh, we’re seeing the same cancer in a different population.” And I feel like that’s sort of what… It was really interesting because when Claire, again, when I said Claire came to me originally with the story, I was so excited and it seemed like this really straightforward, although tragic feature of this is a missed population.
But I think it was last week or two weeks ago, she came and she was like, “Hey, I’m doing these interviews. And it seems like the researchers are trying to say there’s actually a little bit more here that there really is an unanswered question of this needs to be treated differently beyond just a population level.” And that was I think really interesting. And I don’t know if I’m rambling too hard, Paul.
Paul Goldberg: Yeah, no, it’s an astonishing story and it just read incredibly with just this ease.
Jacquelyn Cobb: As always with Claire, she’s gifted truly.
Paul Goldberg: Yeah. Yeah. She’s kind of pushing us into stories that I’ve always kind of hesitated to do, which is that kind of a classic feature structure where you start with an anecdote and the person and you follow that anecdote and the person across. And we have done them incredibly rarely. We do them a little bit more now. I don’t know. My concern with that kind of a story has always been that I’m not a physician and we don’t have a physician on the staff. So when you’re writing a story by the patient, it’s a whole lot safer to not. And even with the Cancer History Project, right?
Jacquelyn Cobb: Yeah, you always ask Debbie Doroshow.
Paul Goldberg: It’s always better to have a physician do an in-depth interview than a non-physician, like a historian who’s more trained to do it.
Jacquelyn Cobb: Yeah, exactly, with training.
Paul Goldberg: And for me, I know what I don’t know or try to know what I don’t know. And this is where I don’t know, but I feel very, very comfortable with this story that’s said. And it’s also interesting that there’s this incredible way of readership on this story. I mean, people are grabbing it off our website and that’s important and it’s a great story. Well, we’ve done those, but it’s just we’ve seemed to be doing them a little bit more than we used to.
Jacquelyn Cobb: Well, I think you make a good point. I feel like Claire kind of had that style. She came to The Cancer Letter with that style and she’s shown that she just kind of has her own… Is that the right word? She can bring that and then also have it. And I mean, not to give too much of the editing process or behind the scenes or whatever, but I feel like we did bring in, there were a lot of… We did a full… Or not we, Claire and then you as editor did a full reporting story, like a normal TCL reported story. And then it was almost like it was in the service of this patient’s story rather than… I feel like with Debbie Doroshow, it’s like we are trying to understand this patient’s story through the patient’s story almost alone. It’s like that’s sort of the training required. And I think that Claire brings us into this a little bit newer, a little bit, not scary, but a little bit more vulnerable place. But she pulls it off and I think it’s really to our benefit and it’s-
Paul Goldberg: Oh, absolutely. I was by no means… Yeah, one of the reasons.
Jacquelyn Cobb: She’s bringing something new. Yeah.
Paul Goldberg: Yeah. Of the reasons we have this podcast is we can kind of pull back the curtain about what happens here and how we make decisions. And this is sort of one of our internal questions that we always ask. Is it necessary to start the story with a patient? And also it’s a time of patient advocacy, which has been going on really through most of my career, but patient stories really need to get out and be told. I think that is a bit of a change now because I really, to maybe even push it off even further off subject at this time when science in jeopardy, hearing from patients is very, very important. So that’s kind of where we are in this. And by the way, if you look at our stories that are perpetual bestsellers, most of them are that kind of a story. They’ve been exceptional for us to do them, rare, very rare, but now they’re becoming a little more frequent.
Jacquelyn Cobb: Well, would you like to talk about your story? I feel like we have a lot of behind the scenes to share on that too.
Paul Goldberg: Oh yeah. No, the great thing about a great obituary is it’s a great story always. The worst thing about a great obituary is the news peg and kind of reading it. I mean, I have met Maura Gillison, I’ve spoken with her, but I didn’t really know her. I sort of wish I did because she just seems to be a truly fascinating physician scientist. She also seems like someone who really could be the subject of a 20,000-word piece. We probably should return to her contribution through the Cancer History Project, which is kind of our vehicle for saying we screwed up and didn’t really do a long enough… Well, I only had a few days.
Jacquelyn Cobb: Yeah. I feel like you did an awesome job, Paul, for what it’s worth.
Paul Goldberg: Thank you. But I wish it were a 15,000-word piece instead of a 2,000-word piece because there’s so much, so much. So anyway, here’s this young researcher who early in her training asks a question. Is it really so that a lot of that head and neck cancer is caused primarily if not exclusively by alcohol and tobacco? And the answer she discovers very quickly is HPV. And that kind of rolls out this spectacular career and questions that are still not answered. Some of it on the molecular level, some of it on epidemiological clinical trials type of level. And seeing what she was able to do from the basic science piece to the epidemiology piece is like, yeah, what an amazing contribution by someone who was really pretty young. I mean, 61, that’s kind of obscene. It should be illegal for people to die at 61.
Jacquelyn Cobb: I agree.
Paul Goldberg: Yeah. I don’t know what we’ll do about it, but it’s-
Jacquelyn Cobb: I don’t know who will arrest, but I agree.
Paul Goldberg: And whom, right?
Jacquelyn Cobb: Well, yeah. Thank you. Yes. Yeah, no, it’s horrible. And I guess, when you said she was pretty young, you said she was a young trainee when she asked this question?
Paul Goldberg: Yeah. As it happens, yes. She just was in a lab working at Chi Dang’s, I guess, lab. It’s in the story, but yeah, she was just figuring out what this is. And the interesting thing is that she was not shunted aside as a… This is a kind of a tribute to this community. She was not shunted aside as a young underexperienced naysayer, but instead had a spectacular career, which included the Karnofsky Award, and the CPRIT Scholar, and MD Anderson, and Ohio State. I’m out of order here on how it all went. Hopkins, but I’m actually in reverse chronological.
Jacquelyn Cobb: There you go.
Paul Goldberg: I’m actually, it’s a mishmash what I just did. So I feel terrible. But it’s kind of interesting that breadth of questions that she’s asking and she’s pivoting. It feels like it’s an intellectual journey in terms of telling it. I hinted at it in the obituary, but I didn’t really tell it because you really need about 15,000, 20,000 words to tell that story, maybe even an entire book. Because it’s kind of a classic medical orthodoxy is, “Oh yeah, it’s caused, any idiot knows that it’s caused by alcohol and tobacco.” Well, eh.
Jacquelyn Cobb: Yeah.
Paul Goldberg: Bring in somebody. Yeah. Yeah.
Jacquelyn Cobb: And it’s not just, oh, not all of them are caused, but it’s 70% is caused by HPV. And I don’t know, not to… I know you were kind of… I don’t mean to interrupt, but I just wanted to circle back to what you mentioned, this idea that she was doing sort of maybe not basic science, but she was doing lab work. And then just to see the magnitude of impact on an epidemiological level, I feel like, like you’re saying, it’s just such a good reminder for people when basic science or lab work is like, it doesn’t… The value in and of itself I feel like is a little bit under question, or it’s kind of like, why are we studying the eyes of turtles? That’s very much I feel like a push or a piece of the conversation. And I just wanted to reiterate, I think what you said, Paul, is that I feel like this is a really good reminder to anybody that we don’t know for sure when we’re doing lab work.
Scientists don’t know for sure what’s going to impact huge swaths of human beings and their health. We can’t predict that, but it can. There are many examples and this is one of them where 70% of all head and neck cancer patients, and I’m not up on the science, but it’s like these people can get a vaccine. It’s not like, oh, they get a treatment and it’s a huge impact. Yeah, I guess I just wanted to reiterate that.
Paul Goldberg: No, it’s just so spectacular. She finds the thread and she just keeps pulling the thread and pulling it, and pulling it, and pulling it, and pulling it. And she could have kept pulling it for a very, very long time if not for cancer. So totally amazing person, totally missed opportunity for me not to have met her or talked to her often. I clearly have spoken with her based on the story that I find in The Cancer Letter, but she wasn’t like somebody whom I often call and say, “Hey, what the heck’s going on? How’s life? Da, da, da, da, da.” So it’s very… Yeah. No, what is a celebration? It’s interesting also that stories like that end up on the top of the trending stories-
Jacquelyn Cobb: It is the top, right?
Paul Goldberg: … immediately. Oh yeah. And it will be for a very long time. And we are going to have to return to this through the History Project. By the way, the other story, I think story two right now trending is Joe Fraumeni, Which is another situation where the only thing wrong with a good obit is the news peg. What a career. Ned Sharpless said that there’s a guy who belongs on Mount Rushmore of oncology and he does. So it’s very interesting. And the piece was just beautifully written by Steve Chanock. And to give you a little bit of a foreshadowing, we’re going to do an oral history about him. It will be done by Otis Brawley and Steve Chanock. And that will be in the Cancer History Project. But we really have to return to Maura Gillson. I mean, probably four or five episodes is what I’m envisioning-
Jacquelyn Cobb: Yeah, like a series.
Paul Goldberg: … of CHP, Cancer History Project. But anyway, that’s pretty eventful week, wouldn’t you say?
Jacquelyn Cobb: In a shortened week. Yeah, it was very… Yes. But we got it done. Yeah, I’m very excited for the Maura Gillison. I’m just a little bit stuck on what you said, Paul, about the… I guess you said you didn’t tell it, but to me when I was reading that story, it’s like you told the story, but I agree. I’m eager to hear more about the behind the scenes. Yeah, so I’m excited for that. I guess I’m just daydreaming.
Paul Goldberg: Yeah. I mean, I told what I knew and that’s just hints, hints, hints. And that part’s not going to change.
Jacquelyn Cobb: No, no. It’s accurate. Yeah. Yeah.
Paul Goldberg: Yeah. It’s just that it’s the bones of the story. It’s not the whole story.
Jacquelyn Cobb: Yeah, I want more meat. Exactly.
Paul Goldberg: Yeah.
Jacquelyn Cobb: I’m going to need more meat.
Paul Goldberg: It’s so many questions to ask right now.
Jacquelyn Cobb: Yeah.
Paul Goldberg: And actually her friends are trying to put together money to finish her work at MD Anderson, which is taking things to a whole different level and that’s in the story as well. There will be a remembrance event for her and it should be very interesting to see what happens, how her work would be completed. But this is somebody who probably had another 20 years of a pretty spectacular career and should have, but we were all cheated out of it.
Jacquelyn Cobb: Well, thank you, Paul. This is an awesome story. And just to give you some kudos, it had to be done. I’m so glad you did it. You’re glad you did it, but you got it done in what, three days or something? Just wanted to give you some kudos.
Paul Goldberg: Oh, thank you. Yeah, that was quite a week, a short week.
Jacquelyn Cobb: And is important.
Paul Goldberg: Yeah. Yeah. I’m so glad we were able to do it.
Jacquelyn Cobb: Yeah. Well, thank you for being with me on the podcast, Paul.
Paul Goldberg: Thank you.
Jacquelyn Cobb: I will see you next week probably. And yeah, listeners, I will see you next week for sure.
Paul Goldberg: Right, right. And this is a great time to be a journalist.
Jacquelyn Cobb: It is. Thank you for joining us on The Cancer Letter Podcast, where we explore the stories shaping the future of oncology. For more in-depth reporting and analysis, visit us at cancerletter.com, with over 200 site license subscriptions you may already have access through your workplace. If you found this episode valuable, don’t forget to subscribe, rate, and share. Together, we’ll keep the conversation going.
Paul Goldberg: Until next time, stay informed, stay engaged, and thank you for listening.
