Mesothelioma expert Dr Raja Flores on the state of treatment for this often neglected disease
Dr Raja Flores is chief of Thoracic Surgery at The Mount Sinai Medical Center in New York, where he also directs the Thoracic Surgical Oncology Program. As a leading expert in the study and treatment of malignant pleural mesothelioma, Dr Flores wrote a frequently-cited study titled "Extrapleural Pneumonectomy versus Pleurectomy Decortication in the management of malignant pleural mesothelioma" which reviewed the effectiveness of two of the most common surgical treatments for pleural mesothelioma over a sixteen-year period.
In addition to his research, Dr Flores has taken an innovative approach to treating mesothelioma. One approach he has pioneered is intraoperative chemotherapy for mesothelioma, which uses a heated chemotherapy wash during surgery to kill cancer cells that may remain in the thoracic cavity. Another method he has helped to popularise is the use of video-assisted thoracoscopic surgery (VATS) to explore the thoracic cavity with a minimal invasion technique.
What is your background and current role?
I was born and raised in the meatpacking district of Manhattan during the 1980s. I was raised by my single mother. I credit my basketball coach from the neighbourhood for influencing me to stay in school. I decided to become a doctor after seeing the violence while growing up. After completing all my education I went on to have a successful career at Memorial Sloan-Kettering Cancer Center and I am now chairman of the inaugural Department of Thoracic Surgery at the Icahn School of Medicine, Mount Sinai Health System.
What does your day-to-day work involve?
It involves performing surgeries and collaborating on research projects to find cures for lung cancers. I also teach residents and fellows the basics of lung cancer, oesophageal cancer, and mesothelioma surgery. I serve on several committees and address all administrative aspects of the department.
Why is mesothelioma of particular interest to you?
Most of the patients that suffer from mesothelioma are blue-collar workers and I identify with these patients and their families. I was raised in a blue-collar family and I had to work from a young age. I had a variety of jobs; as a doorman, worked in a deli, and loaded trucks for UPS. My mom was a single parent and worked as a secretary. The patients and their families remind me of how it was when I was growing up.
Do you think there is good awareness of the disease and potential symptoms among healthcare professionals and the public?
I think the professionals and the public have very little awareness about mesothelioma. The primary education regarding mesothelioma comes from law firm ads seen on television or billboards. There is not enough funding to support the mesothelioma foundations that want to bring a heightened awareness of the disease to the public.
What are the current challenges in mesothelioma research and treatment?
The current challenges are the needs for more funding and the need for that money to be directed to the specialists who see mesothelioma patients. This funding can then be used for much-needed research.
What do you consider the biggest recent advance for mesothelioma patients?
The main thing is to diagnose it early. Because lung cancer has no symptoms in its early stages, more than 85 percent of the men and women who are diagnosed with lung cancer are diagnosed in a late stage, after symptoms occur and when there is very little chance of cure. Early lung cancer CT scans are now standard of care.
After a diagnosis is made, surgery is the next step. Mesothelioma patients who are diagnosed at an early stage are more likely to have long-term survival. We have more effective surgical techniques now and more knowledge determining which technique to use.
Aside from drug therapy, are there any other interventions that could improve the disease's bleak prognosis?
At this time no. We need to continue to work on finding drugs or novel therapies in a surgical setting in order to improve prognosis. The only way we can do this is with funding.
Should healthcare systems consider screening for lung cancers in general, given that early diagnosis is crucial to best chance of survival?
Absolutely! In the US, under the Affordable Care Act, most private insurers must cover the cost of yearly lung cancer screening in people considered at high risk: aged 55 to 80, with a 30-pack-year history of smoking, and either a current smoker or quit within the last 15 years. Medicare also covers the cost of lung cancer screening in people considered at high risk, although the age range is slightly different (55 to 77 years). We know what the risk factors are and the earlier we can perform surgery, the better the chances are for a long-term survival.
What are your goals for the future?
My goals are to increase early screening for lung cancer and to continue to find lung cancer early and performing surgery which results in better outcomes.
What keeps you awake at night?
Thinking about the suffering and pain patients go through and that so much more needs to be done to find treatments and cure the disease.