New ASCO President Reflects on Value of Mentorship and Addressing Health-care Disparities

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Given my growing interest in health-care disparities, the position was a perfect fit. I felt I would be able to make a difference in Washington’s large underserved African American population.

— Sandra M. Swain, MD

Sandra M. Swain, MD, Medical Director of the Washington Cancer Institute at the MedStar Washington Hospital Center in Washington, DC, and ASCO President for the 2012 to 2013 term, is a leading authority on breast cancer treatment with a global reputation in cutting-edge clinical research.

The daughter of a career Navy officer whose duties allowed his family to experience many postings throughout the United States and internationally, Dr. Swain graduated as valedictorian from a small Catholic high school in Florida. She was accepted to the University of North Carolina (UNC), where, intrigued by anatomy and physiology, she had decided to major in physical therapy, until one of her neighbors, a young woman about to enter law school, suggested she become a doctor—after all, she “certainly was bright enough.”

Dr. Swain’s counselor at UNC agreed with her neighbor’s advice, and she switched her major to premed, setting the course for a distinguished career marked by extensive clinical trial investigations that have expanded our knowledge of adjuvant therapy for breast cancer and molecular targeted therapy for advanced and inflammatory breast cancer.

Finding a Mentor in Medical School

Thanks to her academic excellence at UNC, Dr. Swain successfully gained admission to the University of Florida College of Medicine, where she was mentored by Warren E. Ross, MD. This relationship was pivotal in helping focus Dr. Swain’s developing interest in oncology. “I liked oncology because you treated the whole person; it was a fascinating systemic approach, not just one procedure, or one organ. Following Dr. Ross’s advice to seek out the strongest residency program possible, I did my residency at the Vanderbilt University Medical Center, which had an excellent oncology program,” said Dr. Swain.

However, in the 1980s, medicine—especially oncology—was a male-dominated field. The Vanderbilt program was one of only two remaining medical schools in the country that still had a grueling every-other-night call, and Dr. Swain recalled, with humorous irony, a bit of offhand advice given to her by Vanderbilt’s Chair of Medicine: “Sandra, why don’t you just go into family practice?”

Fortunately, Dr. Swain had kept in touch with Dr. Ross and followed his sage guidance instead: “Anyone who is anyone in oncology did a fellowship at the NCI,” she remembered. Dr. Swain applied to the NCI and was accepted for a medical oncology fellowship during a period of seminal change in cancer care and research.

Walking with the Giants at NCI

Even though more than 30 years have passed since Dr. Swain’s NCI fellowship, she counts that period as a transformative point in her career.

“It was a wonderful time to be at NCI, especially working in Dr. Marc Lippman’s laboratory alongside Dr. Robert Dickson, whose breast cancer research truly advanced the field. Although I decided not to pursue bench research, the 2 exciting years I spent running clinical trials with Dr. Lippman at the NCI accelerated my clinical trial career,” said Dr. Swain.

Dr. Swain recalled a time when the early giants in the field, such as Drs. Bernard Fisher and Gianni Bonadonna, were leaving their footprints in oncology research. “I remember my very first presentation; it was in Paris at a meeting on adjuvant chemotherapy. Dr. Lippman couldn’t make it and he asked me to fill in for him; naturally it was a huge opportunity, but I was so nervous I could barely speak. Dr. Bonadonna was to introduce me and he calmed me, saying ‘how lucky I was to be so young and passionate about my work.’ His composure had a soothing effect, and the presentation went very well,” Dr. Swain said. More than 25 years later, at that same Paris meeting, Dr. Swain was honored with the Claude Jacquillat Award for Achievement in Clinical Oncology.

“I also presented results from our clinical breast cancer research at Bernie Fisher’s NSABP [National Surgical Adjuvant Breast and Bowel Project] meeting, which was an additional shot in the arm for an upcoming researcher like myself. Bernie was another mentor, someone whom I saw, and still see, as an uncompromising role model for someone setting out to do rigorous clinical research,” said Dr. Swain, adding that she views her long relationship with the NSABP as being part of an extended family.

Focus on Health-care Disparities

Dr. Swain is proud of her tenure at the NCI, where she served as the Deputy Director of the Medicine Branch and Chief of the Cancer Therapeutics Branch. However, feeling her career needed a more global reach, she left the NCI about 5 years ago to assume the directorship of the Washington Cancer Institute. “Given my growing interest in health-care disparities, the position was a perfect fit. I felt I would be able to make a difference in Washington’s large underserved African American population,” Dr. Swain said.

When Dr. Swain began as Director of the Institute, she noticed a pattern in the weekly breast cancer conference. “Participants presented case after case of African American women who were diagnosed with early breast cancer and never followed up for treatment; consequently the next time we saw them the cancer was advanced. Although the incidence of breast cancer in African American women is lower than the national average, mortality is significantly higher. So I wanted to tackle this issue,” Dr. Swain said.

Dr. Swain’s subsequent work in organizing early intervention strategies was funded by a grant from Susan G. Komen for the Cure®, an organization she holds in high regard for its commitment to sponsoring on-the-ground cancer initiatives that make a difference in health-care disparities. “Along with access to screening and early interventions, I also saw a huge need in boosting clinical trial accrual rate in African Americans. To that end, I wrote a Challenge Grant, and actually got NIH funding [only 2% are accepted] to set up an intervention initiative to increase clinical trial participation among African Americans. We made a video of the project, which is being shown at this year’s ASCO Meeting,” Dr. Swain said.

New ASCO President Wears Many Hats

Along with her administrative duties and work in health-care disparities at Washington Cancer Institute, Dr. Swain is an active board member of her own hospital’s board and the NSABP, and still sees patients one day a week. “And ever since I’ve been in Washington, I’ve always had an NCI fellow working with me; I love that part of my work. In fact, I have 8×10 black-and-white pictures of each fellow lining the walls of my office. I’m known to be tough on them, but it is an incredible experience, watching them develop into skilled oncologists,” Dr. Swain said.

Dr. Swain is also involved in developing a regional oncology plan with Georgetown University and four other hospitals in the MedStar system, a large project with multiple downstream health-care benefits. Asked how she manages such an ambitious agenda, she replied, “It sounds exhausting, but I relish the challenge to ensure global health equity, which can truly make a difference in the world of oncology. That’s one reason why I’m so excited about my ASCO Presidency, during which I’ll be pursuing solutions to global health-care inequities,” Dr. Swain said.

How does this ultra-busy oncologist spend her few hours of leisure time? “I like the cinema, but not escapist movies—no fantasy or sci-fi. I like stories built on complex human drama, like my job. When I treat patients with cancer, they open up and tell me personal things about what they’re going through. It’s a sacred responsibility to be part of that intimate experience,” Dr. Swain said. ■

Disclosure: Dr. Swain reported no potential conflicts of interest.