CultureMap: How hard is it to stick around an institution when you're not top dog anymore?

John Mendelsohn: I've worked with some fabulous people and together we've grown (the cancer center) in almost every parameter you can imagine. I think it's time for a change. I had the good fortune of being able to move into a role as co-head of our new institute of Personalized Cancer Therapy where the goal is to, over the next five years, do research taking a patient's tumor and in real time measuring the genetic aberrations in that tumor and prescribing some of the new experimental drugs designed to attack those abnormal genes. We have very good evidence this will increase response rates to new drugs.

CM: How revolutionary is this?

JM: It's pretty new in cancer. In infectious diseases, we began doing this 100 years ago. It's important to remember that in 1900, the most common cause of death was pneumonia and then tuberculosis. We developed chemical agents that were specific for the germs that cause these diseases. In cancer, the work doing research to design drugs to act on the products of genes that cause cancer began around 1980. The laboratory at University of California San Diego (which Mendelsohn co-headed) was one of of the first to postulate (the idea). So you might say I'm circling back to the kind of work I did then.

CM: Do you think we'll find a cure for cancer in your lifetime?

JM: We're going to improve the cure rates, there's no question. But will we ever eliminate cancer? No. We certainly haven't eliminated pneumonia. We're not going to get rid of germs; we're not going to get rid of cancer. Right now, if you're under 85, cancer is the most common cause of death in the country and it's the most common cause of death from a disease in the world. I think we will be able to move it down from No. 1, but we will not be able to eliminate all cancers because malfunction of genes is part of the deal. It's going to happen.

CM: How have survival rates changed?

JM: When I was born, a third of cancer patients lived five years. Today two-thirds of cancer patients live five years and the great majority of those have their disease eliminated. The number of deaths from cancer are going down, but we're a growing population and more and more people are living longer. After about age 55 or 60, the incidence of cancer goes up dramatically. We certainly have increased cases of cancer because we're living longer, but the deaths are declining in spite of that, which means we're making progress.

CM: How are we going to get the death rate of cancer down?

JM: Half of the work has to be done by developing more sophisticated treatments and doing fundamental molecular genetic research, but the other half depends on people who are healthy and who are at risk of getting cancer. We have to change their lifestyles. About 30 percent of all cancer deaths would disappear if we all quit smoking. And if we all quit smoking and stayed trim and exercised and had a balanced diet and routine checkups I believe that would account for the other 50 percent in increased cancer deaths.

In our society we tend to try to live with freedom without restriction and hope that medicine will develop a pill or an inoculation or a procedure to take care of problems. That's not only not intelligent but it's also expensive.

CM: Looking back at the past 15 years, what are you the most proud of?

JM: We have honed this cancer center into an organization that is able to give the best evidence-based and research-driven care any cancer patient could want. We have tremendous expertise and strong research programs that are available to bring new science to the patient when standard therapy doesn't work. We work in a very collaborative way here. We're a very caring place. Even though everyone here either has cancer or is afraid to have cancer, it's a place of hope.

CM: M.D. Anderson has grown so much during your tenure. How large do you think it should be?

JM: Right now were seeing about 100,000 patients a year, 30,000 new registrations a year. We have 18,000 employees and almost 12 million square feet. The numbers are big. The growth has been driven by demand. Patients are looking for expertise. We're committed to grow. As patient care grows, we continue to grow in research, education and prevention.

The growth rate has to slow down. You get to a certain size you lose your efficiencies and you run the risk of being depersonalized. So far we've not depersonalized people. People worry about coming to M.D. Anderson because it's such a big place, but once you've settled into your breast clinic or your sarcoma clinic or your breast clinic and get to know your team, it's quite personal.

CM: Will future growth take place at the Texas Medical Center location or elsewhere?

JM: Over the past few years, we've developed regional care centers in four areas in greater Houston. That program may expand. Because this is a team approach, it's hard to duplicate that intensive collaborative environment away from the mother ship. But once the treatment plan is set up, a lot of what we do can be done without requiring the patient to come to Holcombe Boulevard.

CM: We've seen so many changes in the fight against cancer over the last 15 years. Will we see as many or more in the next 15 years?

JM: I think we'll see more. I've never seen change do anything but grow faster or blow up. I don't think we're going to blow up.

There are going to be advances in surgery. We now operate with robots and with tiny instruments so you don't have to make huge incisions and complication rates are going down. We are learning to use radiotherapy in more sophisticated ways, with imagining technology. We're learning how to harness the immune system. You don't hear much about immunotherapy. But I think in the next 15 years it is going to become much more important. We now understand the immune system well enough to begin to manipulate it. It's already an important component in fighting cancer.

CM: I noticed a photo of George Foreman on your wall.

JM: He gave us $1 million and seven dollars. Why seven? He said, "A lot of people give you a million dollars; no one has given you a million seven." And he was right. He gave it to us because we took good care of one his aunts, who was not well off. We didn't know she was related to anybody. He said, "You treat everybody the same at M.D. Anderson. I appreciate it and I want to give you a gift for that reason." That was very generous.