Inside NYP: Dr. Brendon Stiles

The cardiothoracic surgeon at NewYork-Presbyterian/Weill Cornell Medical Center on his research, losing his father and grandfather to lung cancer, and surgery as a first love.

I grew up on a dairy farm in Virginia and thought I was going to be a veterinarian. Somewhere along the way I decided I liked people better than animals, so I changed my career goal.

I started my medical school training at the University of Virginia but took two years off to come to New York City to pursue cancer research. I focused on lung and esophageal cancer because of my family history. My grandfather died of lung cancer when I was a baby, and my dad was a lifelong smoker. In 2005, he was diagnosed with lung cancer and passed away relatively quickly.

A few years before his diagnosis, I had convinced my dad to get a CT scan to screen for lung cancer, when such programs were in their infancy. He had a couple of CT scans in Virginia, but the results of a pivotal trial proving the efficacy of CT screening for lung cancer hadn’t yet been published, so that screening program was abandoned and my dad stopped getting scans. Five years later, he suddenly felt sick and went to the ER, where he was diagnosed with stage 4 lung cancer. He passed away just two months later.

That experience cemented my resolve to focus on lung cancer, both in the clinic and in my research. I suspect that we probably could have caught and treated his lung cancer had he been getting screened each year, or if we had had better biomarkers to identify his cancer at an earlier stage. As a result, I’m a big believer in screening high-risk patients for lung cancer. To me, we (the medical community) failed my dad on the early diagnosis end. But we also failed him on the treatment end. At the time, we were still using chemotherapy and radiation therapy that had been developed in the 1970s. We didn’t have the targeted therapy and immunotherapy drugs that we have today. These drugs have truly revolutionized lung cancer treatment.

Despite these advances in treatment, lung cancer is by far the number-one cancer killer. Certainly, smoking is the main cause of lung cancer, but nonsmokers get lung cancer, too. The survival rate for lung cancer patients remains abysmal. Survival at five years after diagnosis hovers around 15 to 20 percent for all newly diagnosed patients. Even if we surgically remove a stage 1 lung cancer, 20 to 30 percent of patients will have a recurrence. For stage 2 or 3 lung cancer, over 50 percent of patients may experience a recurrence.

Dr. Stiles (right) and his father, Kenneth, in 2002

I believe that it is research that beats cancer, and which will lead to advancements that can help thousands of lung cancer patients. Our Division of Thoracic Surgery, led by Dr. Nasser Altorki, has been a national leader in clinical research in surgical therapy for lung cancer patients. Arguably, surgery is the original targeted therapy. We think that we can tailor operations and treatment to individual patients, in many cases preserving lung function by performing limited resections (removal) of the surrounding lung tissue. We have also explored trials in which we give short courses of biologically targeted or immunotherapy drugs prior to removing a tumor. We currently have a trial to explore the combined effects of radiation and immunotherapy on early stage lung cancers.

I’m a strong believer that to find cures you need to actually study cancers in people. Certainly, we now have amazing mouse models and cancer cell lines and laboratory tools available for research. But there is nothing as valuable as the material in our biobanks — samples of real patients’ tumors, real lungs, and real blood samples. These specimens, generously donated by patients, really help us figure out what’s relevant and important, and will be the key to determining how to treat future patients.

After all this time, I still love the technical aspects of surgery — there’s nothing as satisfying as taking a cancer out of somebody. The patients are immensely grateful; you make incredible connections with people. So that’s truly my first love.

To me, the most amazing thing about being a cancer surgeon is that you walk into a room never having met a person and, in some ways, you become the most important person in his or her life. Patients want you to be a doctor, not just a surgeon. They want to talk to you. They want to understand what’s happening day to day. And they want someone standing beside them through their battle against lung cancer. That is a lot of responsibility. It’s also heartbreaking when you see a patient whose cancer recurs. Most of the time patients just want somebody to listen to them. As their surgeon, I am honest and try to project quiet optimism. I tell patients that we are going to do everything in our power to get them through this operation safely and that we’re going to be with them each step of the way.

Dr. Brendon Stiles is an associate attending cardiothoracic surgeon at NewYork-Presbyterian/Weill Cornell Medical Center and an associate professor of cardiothoracic surgery at Weill Cornell Medicine. Dr. Stiles is an advocate for lung cancer patients and for cancer research in general. He is chair of the Lung Cancer Research Foundation’s Board of Directors. Dr. Stiles can be found on Twitter, @BrendonStilesMD, where he frequently comments on lung cancer, engaging directly with patients and advocacy groups.