The Funding Gap

We spend more than $26,000 in federal research funds for every person who dies of breast cancer, and less than $1,500 for every one who dies of lung cancer. That's pitifully inadequate, considering lung cancer kills almost twice as many women as breast cancer does. One of the main reasons for the lack of funding: Lung cancer carries a stigma. When a woman is diagnosed with another type of cancer, most people don't ask, "Well, were you sedentary? Did you eat red meat? Have unsafe sex?" But when she's diagnosed with lung cancer, often the first question is "Did you smoke?" It drives me crazy! That question causes so much shame that I've had patients try to undergo treatment without ever telling their friends or family. Nobody deserves to be diagnosed with a deadly cancer, and nobody should feel they have to fight it alone. And, by the way, if you have lungs, you can get lung cancer. —Lecia V. Sequist, M.D., associate professor of medicine at Harvard Medical School and medical oncologist at Massachusetts General Hospital in Boston

The Racial Gap

Black women are dying of breast cancer at higher rates than white women, even though the incidence of the disease is higher in white women. And that racial gap is only getting worse. A 2014 study found that 1,710 black women die every year because they don't have the same access to cancer screening or treatment as white women, and when they do get care, it's usually not as good. This racial disparity exists for almost every cancer. If you have a single population dying of a disease at a much higher rate than everyone else, it's a state of emergency! You'd think it'd raise red flags, but little work has been done on how to fix it. Sometimes I cry; other times I feel paralyzed, because the problem is so big. Part of it is socioeconomic: More than a quarter of all black people in the United States live below the poverty line. So even if a woman gets a mammogram, what happens if they find a mass? How can you tell her she has to choose between getting the necessary treatment or feeding her kids? Another part of it is cultural: Some black people have a historically rooted mistrust of doctors. For them, "clinical trial" is a charged term. Research shows that patients who are seen by physicians of the same race feel more involved in their care, which may lead to better outcomes. Yet only about 3 percent of oncologists and 6 percent of medical students are black. I'm doing what I can—speaking in community centers and churches and fighting for workplace diversity. But we all have to do better. —Karen M. Winkfield, M.D., assistant professor of radiation oncology at Harvard Medical School and radiation oncologist at Massachusetts General Hospital in Boston

Lengthy Drug Trials

To get one new drug for cancer on the market, it currently takes 15 to 20 years, up to nearly $2 billion and thousands of patients. That's too long and too much. When a woman comes in and has an aggressive cancer, she doesn't have a decade or two to wait while we get our act together. I want to make cancer-drug trials shorter, smaller and less expensive. We're already doing it with the I-SPY 2 TRIAL, in which we're testing five to seven drugs at once. Normally, if a woman discovers a mass, she gets it removed immediately, then gets chemo. But that tumor is one of the only indicators we have to see if a drug works. Removing it first precludes us from learning anything at all about how it might respond to therapy. So, in my trial we've reversed the order of treatment: chemo first, surgery second. In the future, researchers will conduct trials to determine when we can avoid surgery altogether. Change can be scary, but it's too risky to stand still. Every day I think, Some woman will be diagnosed with cancer today, and she needs us to be smarter and faster. But to make that happen, you need to play your part, too. Demand change from doctors and drug companies. Always ask, "Is there something better?" That's how we get the culture to move more quickly. And if you've been recently diagnosed, join a clinical trial if one is right for you. Only 3 to 5 percent of eligible adults do, and that's not enough. We really need to do a better job of getting information on every person who is diagnosed and treated. —Laura Esserman, M.D., principal investigator of the I-SPY 2 TRIAL and coleader of the breast oncology program at the University of California in San Francisco

No Global Database

I'm frustrated, because some doctors may have already found more effective ways to treat certain types of cancer, but because all of their medication records, lab tests, notes, pathology and radiology reports are locked away in their patients' electronic medical records, others can't learn from them. Without sharing that data, it makes it difficult for doctors and researchers to identify trends or connect essential dots. Which means, now, when an oncologist is faced with a particularly complicated case, she can only see data from the handful of patients in her own clinic, not from the thousands of patients across the country. In fact, if she wants more information, she literally has to pick up the phone and call another doctor for advice. I find that absolutely maddening! We have all this good cancer data, and we'e not using it. It's just sitting there, untapped. But I'm hoping to help change that. As data coordinator at Flatiron Health, I'm working with nurses, oncologists and engineers from Google and Facebook to find new ways to collect and organize all that critical information, scrub it for privacy, and make it all widely available to, and searchable by, doctors, patients and researchers. We'e so excited about what we might find in it that Google Ventures just invested 130 million dollars into our company. I absolutely believe we will find cures for cancer one day, and when we do, it'll be partly due to the new technology we're applying to it. —Katharine Larrabee, data coordinator at Flatiron Health, where she's helping create a massive global cancer database

Photo Credit: Courtesy of Subjects