Dr. Bryant Lin, a Stanford University School of Medicine physician and professor, has never smoked, but in early May 2024, he received a life-altering diagnosis: stage IV lung cancer.
Lung cancer rates have declined precipitously in the last several decades. But they’re rising among Asian Americans with no smoking history. Lin was aware of the concerning trend; it’s one of the emerging medical issues he’d hoped to facilitate a better understanding of when he founded Stanford’s Center for Asian Health Research and Education six years ago. “But I never would’ve thought that I would have this cancer,” Lin tells Yahoo Life, “or become the poster child for my center working on this cancer.”
Now, as Lung Cancer Awareness Month draws to a close, he’s sharing his cancer journey and transition from doctor to patient, to inform more people about the risks of the disease and the symptoms to look out for.
An unusually quick diagnosis
For about five or six weeks this past spring, Lin had a lingering cough and his throat felt tight. At first, he thought it was just allergies and tried a series of inhalers. But the cough persisted, so he texted a colleague who is an ear, nose and throat (ENT) physician. The ENT ordered a chest X-ray, which showed opacity in the lungs, indicating infection or cancer. A throat examination showed nothing wrong with his vocal cords, so Lin had a CT scan and a bronchoscopy to look at and take a biopsy of his lung tissue.
It took less than two weeks for Lin to get diagnosed and begin treatment, about eight weeks after his cough started. Most patients aren’t so lucky. One small study found that lung cancer patients didn’t start treatment for an average of 138 days after their first symptoms began. That’s not lost on Lin. “I can just call people up and say, ‘Let’s get this done,’” he says. Dr. Heather Wakelee, Stanford’s chief of oncology, who studies lung cancer in never-smokers, has been treating Lin.
A bad mutation makes a good target for treatment
Lin has a form of the disease sometimes referred to as “never-smoker” lung cancer, because if someone is going to get the disease without using cigarettes, his — non-small cell lung cancer — is the most likely form they’ll develop.
Cancer is caused by a malfunction in how cells divide and multiply. That initial malfunction can be triggered by damage from chemicals such as tobacco smoke; inherited DNA, such as BRCA mutations; or mutations that can happen during cell division. Lin’s lung cancer is driven by a mutation that can occur when a protein on the surface of some cells, called the epidermal growth factor receptor (EGFR), goes haywire and starts dividing out of control. “About 50% of nonsmoker Asians [with lung cancer] have this mutation, and less than 20% of non-Hispanic whites have it,” says Lin. “We don’t really know why Asians get this mutation more than other groups.”
EGFR mutations can make cancer more aggressive. And because it’s often the only mutation in a never-smoker’s lung cancer, the disease can be harder to treat because it’s less distinct from noncancerous cells and tissues, Wakelee tells Yahoo Life.
But there is a silver lining to having the mutation. “Luckily it makes me a candidate for targeted therapy,” says Lin. Now, he takes a relatively new daily pill, called osimertinib, which attacks the mutated cancer cells. And because it so precisely targets the cancer, it has fewer side effects. As a result, “I feel great, and I’m lucky that I’m doing so well clinically and in terms of quality of life,” Lin says, though he also has to undergo more side-effect-inducing chemotherapy every three weeks. “The downside is that eventually, the cancer can develop resistance to this targeted treatment,” which could happen in a year, or two, or less or more, adds Lin. But some advice from a former colleague who also had cancer helps Lin maintain a balance of realism and optimism: “He said, ‘You just have to live long enough for the next treatment to work,’” Lin says.
What Lin has learned from cancer — and how he’s teaching others
It’s been said that doctors make the worst patients. To avoid the pitfalls of knowing too much, he was advised not to spend too much time looking at prognosis numbers. “As a doctor, you tend to look at the survival curves, and most people tell me not to do that,” he says. “And that’s good advice, because otherwise you would never start treatment.”
Being a patient has made Lin’s empathy grow as he’s gotten to intimately know how challenging insurance, treatment options and the bureaucratic side of cancer can be. “I’m a doctor, I’m, like, an expert in how the medical system works, and yet there are all these weird hurdles you have to jump,” he says. “Then you imagine people who come to the [medical] system who don’t speak English or don’t have good insurance or a job they can take off from, all of these things are incredibly difficult.”
Instead, Lin, who is not religious, has found surprising comfort in spirituality. “Once I got diagnosed, people from all different backgrounds and walks of life — patients, colleagues — have reached out and offered to pray with me, chant with me, light a candle for me, pray for me,” says Lin. “That was very comforting.” Lin, who is from Boston, says this connection to faith is like being a Red Sox fan and underpins his attitude toward facing cancer: “Optimism, tempered by reality.”
The empathy others have shown him and the challenges he’s faced while battling cancer have deepened Lin’s appreciation for what his own patients go through, and they’ve inspired the new course he’s now teaching at Stanford, with himself as a case study. One class focused on spiritual care in the context of cancer. Another was on at-home nutrition and cooking. “As a doctor, you have an awareness but not necessarily a visceral understanding of what a patient goes through,” he says. “The data, the science — as a patient, that’s like 2% of your day. The rest of the day you’re dealing with your life, so we structured the class around that,” in the hopes of teaching students that “it’s very important to have empathy and an understanding for what [a patient’s] journey looks like.”