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Her Mission: Cutting Deaths From Cancer by Half

TIMES STAFF WRITER

It was 1962, two years before surgeon general Dr. Luther L. Terry would release his landmark report linking cigarette smoking with lung cancer and forever change the nation’s attitude toward tobacco.

“He and I sat with cigarettes in our mouths, working on this report,” recalls Helene G. Brown. “We both quit smoking. That was it.”

In the 35 years since, Brown has been tirelessly fighting cancer as a “political oncologist,” educating the public in prevention and early detection and twisting important arms to raise millions for cancer research.

Now two months shy of her 68th birthday, she can still be found two or three days a week at UCLA’s Jonsson Comprehensive Cancer Center, with which she’s been affiliated since 1982. Her job? To help close the gap between “what we know from research works and how you get it used in the community.”

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For example, she says, “You can’t treat a guy for the flu and not ask if he smokes.”

Having lost her father to cancer, she has a personal vendetta against the disease and a natural rapport with those touched by it. And she is unswerving in her belief that the overall death rate from cancer can be slashed 50% by 2015.

Though UCLA is Brown’s home base, she travels widely to lecture on cancer control and research, has published numerous papers on issues such as cancer quackery and has held important positions with both the American Cancer Society and the National Cancer Institute.

In 1980, Brown was instrumental in getting the ACS to issue its first guidelines on which cancer tests doctors should give patients and how often. “I had no idea how big a deal it was until all of a sudden women who were getting breast cancer were taking their doctors to court” for not recommending mammograms. “I thought, ‘Jiminy Christmas! What have you done?’ But it was a good thing.”

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Today, she’s pushing for people to get more information about prevention and treatment so they can “make the decisions that are the best for them” in matters such as whether they want to know if they carry genes making them cancer-susceptible.

Recently, she was in Washington updating staffs of the new U.S. senators on needs in cancer research, in Chicago talking to oncology professionals on cancer care in the dawning age of HMOs and, back in Los Angeles, meeting with Vice President Al Gore, Paramount executive Sherry Lansing, Jack Valenti, Friends of Cancer Research and 25 top entertainment industry figures.

Brown’s agenda for that meeting: “To ask the Hollywood community if they will reduce the extent of cigarette smoking [in films and on television] when it doesn’t affect the story line” and help put out the message about the importance of cancer research.

“She’s a very formidable woman,” Valenti, president of the Motion Picture Assn. of America, said after the meeting. “She has a passion for things she cares about, which I find quite laudable.”

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Out of the meeting, he said, will come a task force “to enlist celebrities to testify before Congress on the need for more cancer research, to do [public service announcements] about cancer research” and to work with the creative community in identifying “how to get some anti-cancer messages into films.”

Of course, as Brown “retired at the age of 65,” she has to stretch to 12 hours each of the days she’s in her cubbyhole Westwood office, where she’s officially known as director, community applications of research for the Jonsson Center.

But she still finds time to fly off to speaking engagements at the controls of the Cessna airplane she and husband Bob take turns piloting and to take daily walks, play tennis and fit in rowing lessons at the Marina.

Small wonder that, in describing Brown, Dr. Patricia Ganz, director of the division of cancer prevention and control research at the Jonsson Center, chooses “energetic and dynamic"--adding “fun-loving, mischievous.”

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“She’s just a wonderful role model. I think she plays an important role, addressing cancer on a political level, [which is] critical. We need people who are advocating for research, advocating for public awareness.” Ganz mentions, too, that Brown “knows how to give a good sound bite.”

“She’s terrific,” says Dr. Peter Greenwald, director of the division of cancer prevention and control at the National Cancer Institute. “She’s not only knowledgeable, she’s visionary when it comes to cancer control. She has a really deep understanding of how we can push the envelope and hasten the approach to a world without cancer.” And, he adds, she can connect with “the players who really move society and get them to understand the issues.”

At a recent lunch with longtime colleague Emil Berkanovic, a UCLA professor of public health, Brown had a good laugh as he recalled a visit to Los Angeles in the ‘80s by an NCI review group, which was questioning the importance of some local education and cancer screening programs for underserved populations.

As Brown saw it, the NCI was “threatening to withdraw funding unfairly.” Bristling, she stood before the visitors and, pulling no punches, said, “You lied about us and you lied to us.”

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And then . . . boom!--recalls Berkanovic, “There was an earthquake.” Though no connection was established, it is significant that Brown’s funding was left in place.

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Brown came to her calling as a political oncologist through two events that were to shape her life. As a 16-year-old, she would get up in the night to give morphine shots to her father, who was dying of lymphosarcoma.

Then, in 1950, when she’d been married three years, she went to her doctor for a pregnancy test. That day, she had her first Pap smear, a procedure she’d never heard of. If this is a life-saving test for cervical cancer, she asked, why isn’t every woman being given it?

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“If one could have a lifelong romance with cancer,” Brown says, it started that day.

Her quest for information about the Pap test led her to the UCLA Bio-Medical Library and to local offices of the American Cancer Society. “I found out the Pap smear had been tested and ready for marketing in 1938,” yet 25,000 to 30,000 women were dying each year in the United States of cervical cancer. “No one had told them about it.”

There were several reasons. Some doctors were still skeptical about its validity, she says, and “We were all poor. To tell a woman that she needed a test that cost $7.50 or whatever might have driven her to another doctor.”

Brown pressed on. In 1955, she was instrumental in arranging for an American Cancer Society film, “Time and Two Women,” to be shown free at theaters statewide. A terrible film, she says, but it did the job. Women queued up to see it and started demanding Pap smears.

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Five years later, half of all women in the country had had at least one Pap test--up from only 8% a decade earlier--and mortality rates had plummeted. Today, the annual mortality rate is 5,000.

Helene Brown--with no formal medical training--had embarked on a career in public health. She had learned, too, that “you can save lives through politics.”

Meanwhile, she was slowly earning a bachelor’s degree in accounting--with a biology minor--at UCLA, with time out to have two sons and to work part time in the auto accessories and hardware store her husband had taken over from her father.

“I’d always been interested in science,” she says, but “I was a child of the Depression, and accounting was something that could get you a job.” In the early ‘60s, she returned to UCLA for postgraduate studies in public health and later became a lecturer in the department--but never got that higher degree.

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Medical school never really occurred to her, she says--and, she adds, she has no regrets.

“I wanted a family. I got married at 18. If I had my life to live over, however, I’d like to be an epidemiologist,” studying links between disease, diet and lifestyle.

Not having medical credentials, Brown says, “has never stood in my way. I have a history of accomplishment. And I don’t pretend to be something I’m not.”

“Don’t let the fact that she chose not to go to medical school fool you,” says John R. Seffrin, CEO of the American Cancer Society, who’s worked with Brown for 15 years. “She is very learned and innately brilliant. . . . She can dialogue with the scientists as well as with the practitioners and has an uncanny ability to represent people in terms of understanding what the community wants to see happening.”

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Beyond that, Seffrin adds, she is current and forward-looking, “imaginative and creative and enthusiastic by nature and committed beyond all believability.” (A 45-year ACS volunteer, Brown chairs Seffrin’s advisory committee.)

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Brown and Seffrin co-chaired the ACS’ Horizons 2013 project, which in 1995 brought together 65 experts on cancer and related fields and asked them to hammer out possible scenarios for cancer prevention and control in the 21st century. Out of this evolved the recently published book “Horizons 2013: Longer, Better Life Without Cancer.”

The bottom-line question posed to the experts: How much can age-adjusted cancer mortality be reduced by 2013, when the American Cancer Society will mark its centennial? The consensus: 45% is possible.

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But these experts do not paint an entirely rosy picture. They express concerns about cutbacks in medical research, rationing of medical care by HMOs and multitiered care. “The rich are going to survive,” Brown says, “and the poor aren’t. And I don’t know what you do about that, until you get a single-payer [government] insurance system.”

Their best scenario envisions environmental cleanup, new drugs that will block metastases, simple home tests for cancer, far less toxic chemotherapies, ways of repairing “faulty” genes before a single cell becomes cancerous and technology enabling doctors to interact with patients around the world by computer, video and telephone.

Brown thinks a 50% reduction in mortality is achievable “if we get a couple of breakthroughs, if more people stop smoking,” if vaccines are developed for virus-related cancers, if people eat more healthfully.

The NCI’s Greenwald considers a 50% goal “very realistic,” but only if “we keep up an aggressive research program” focusing on early detection, prevention and cancer control. The ACS’ Seffrin calls it a “possible dream--if we can capture the people’s imagination, we can make it happen.”

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Capturing peoples’ imagination is part of what Brown been doing for more than four decades. On a wall of her office hangs a framed photo, the nude torso of a woman giving herself a breast exam. The legend: “The Gentle Art of Self-Defense.”

Brown laughs, explaining that it’s an image from the ‘70s, “when I felt you had to be intrusive in order to get people’s attention.”

Today, she doesn’t need in-your-face tactics to get noticed. Rolling off her tongue are the names of “good friends” who are friends of cancer, including Lansing, Rhonda Fleming Mann, Sen. Connie Mack of Florida, Sen. Dianne Feinstein of California.

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And, she has learned, “You can raise more money from the government in one day than you can raise with volunteers in a whole year.”

She fumes because she knows that, together, the ACS and the NCI can fund only 20% of the valid research projects brought to them. She’s convinced that “the people are interested in things our leaders are not talking about. Biomedical research is shortchanged in the federal budget. It’s less than 1%. It’s been that since 1975.”

From Westwood, Brown oversees the Southern California cancer information service, (800) 4-CANCER, which fields 200 calls a day from patients and their families. Often, callers “just need a little support,” need to be told they’re not doomed. Others ask in-depth questions about clinical trials and drug protocols.

“Whenever there’s cancer in the news, those telephones jump out of their skin,” she says. That happened in January after the NCI issued new guidelines leaving the decision on annual mammography for women 40 to 49 up to women and their doctors. Those who called (800) 4-CANCER were advised, “Check with your own doctor regarding your own risk factors.”

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While accepting that this is the official advice of the NCI, which funds the hotline, Brown isn’t happy about it. “When you tell women to go ask their own doctor, you might as well tell them to ask their own doctor about everything. I’m not sure that’s what women are looking for.”

Brown is national co-chair of ASSIST (American Stop Smoking Intervention Study Trial), a 17-state NCI and ACS-funded effort to make those states smoke-free by 2000. In California, she’s an advisor to the State Department of Public Health’s Tobacco Control Program, a comprehensive anti-smoking project funded from the state tax on cigarettes, which this year is projected to generate $500 million at 37 cents a pack.

Says Brown: “The result is, our cigarette smoking prevalence is the lowest in the country"--16% of the over-18 population, compared with 24% nationwide.

Among the tobacco industry representatives Brown has publicly debated is Walker Merryman, vice president of the Washington-based Tobacco Institute. Merryman says he suspects her figures are skewed “because of the massive amount of anti-smoking publicity that’s been paid for by this program. Smokers simply will not tell the truth anymore” about their habit. He points, too, to smuggling of cigarettes from Mexico and from tax-exempt military bases.

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Do people lie to pollsters? Says Brown: “I don’t think he can prove it, and I can’t prove it doesn’t happen.” As for smuggling, she says, “I don’t think there’s enough money in it to make people bother. I think it’s a red herring.”

The telling statistic, she adds, is that “we were together and even with the rest of this country [on percentage of smokers] until this program came along.”

Merryman acknowledges, “One would have had to have been a cave dweller for the past 30 years to [not know] that smoking is a risk factor for cancer and other diseases,” but he says the Tobacco Institute’s position is that it’s up to adults as individuals to decide whether to smoke.

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In mid-November, headlines trumpeted, “Cancer Death Rate Drops for First Time.” Crediting progress in prevention and treatment, the NCI reported that, between 1990 and 1995, the overall death rate from cancer, the second-leading cause of death in this country after heart disease, had declined about 3.1%. “I think today it may be closer to 5%,” Brown says.

Even though cancer “seems rampant,” she says--and incidence will increase as 70 million baby boomers reach the cancer-prone ages of 55 to 65--many cancers are now both preventable and curable. More than 5 million Americans are alive five years after diagnosis, and, the ACS’ Seffrin says, the majority of the 1.3 million cancers that will be diagnosed this year are preventable.

Genetic testing for susceptibility will play an important role in the future but, Brown says, will bring with it both ethical and practical problems, such as: Should people know if they have defective genes when not all of them will get cancer? Is it ethical to test for a disease you can’t prevent? Who’s going to pay for these tests? How will this impact health insurance? “The whole federal budget wouldn’t support having genetic tests on all of us.”

Brown ponders, too, such issues as cancer in the aging and “whether they are getting treated by their physicians as people who have 20 to 30 more years of life.” Should an 80-year-old woman with breast cancer have every available therapy? Absolutely, Brown says.

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She envisions a day when the majority of cancer patients will manage their disease, just as most diabetics do today, and live long and full lives with drugs and therapy: “One would live at detente with cancer.”

As for that ACS centennial in 2013, don’t bet against Helene Brown still being on the front lines. “I have good genes,” she says. Her mother, who’s 96, recently retired from her part-time bookkeeping job.

“Wherever the action is, you can find Helene,” Seffrin says.

(BEGIN TEXT OF INFOBOX / INFOGRAPHIC)

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Helene G. Brown

Background: Born May 3, 1929, in the Bronx; moved with her parents to Los Angeles in 1945. Lives in Sherman Oaks.

Family: Married for 50 years to Bob Brown, whom she calls “Robert the Perfect.” They met as students at UCLA, and, she likes to say, “He had a car, so I married him.” Two sons--Jeffrey, who now owns his father’s marine sales business, and Bryan, an automobile mechanic and propane company operator in Portland, Ore.

Passions: Volunteerism, public health education, relaxing with her husband and traveling--often in the couple’s single-engine Cessna.

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Affiliations: Past national vice president, American Cancer Society; senior lecturer, School of Public Health, UCLA; former L.A. County commissioner of public health.

On the stigma of cancer: “If cancer were a painless disease, I don’t think you would have that connotation. I think that’s right around the corner.”

On assisted suicide: “I’m a big believer in that--with the proper controls, so you don’t get rid of a person because it’s expensive to keep him. To be alive and to live are two different things.”

On medical care for the uninsured: “Doctors have to give away some of their services. It would work if the state provided liability insurance for Good Samaritan medicine.”

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