On the Early Days of Breast-conserving Therapy and the Unique Relationship between Oncologists and Their Patients

Get Permission

It is exceedingly gratifying to help patients through their day-to-day struggles, whether I’m delivering curative or palliative therapy. The bond between oncologists and their patients is very meaningful.

— Jay R. Harris, MD

Jay R. Harris, MD, Chair of the Department of Radiation Oncology at the Dana-Farber Cancer Institute and the Brigham and Women’s Hospital, Boston, helped pioneer the use of breast-conserving therapy in women with early-stage breast cancer. When asked why he chose to pursue a career in radiation oncology, Dr. Harris, who was a math major at Cornell University and also has a master’s degree in statistics, recalled an encounter that he had while attending Stanford University School of Medicine. A strong-willed female student sitting next to him, who had attended clinics with pioneering radiation oncologist Henry Kaplan, MD, as part of the oncology elective, told him that because of his background in math, he would “really love radiation oncology.” It took Dr. Harris almost 3 years to realize that she was right, and soon thereafter, that woman with strongly held opinions about his career path became his wife.

After graduating from Stanford, doing an internship in medicine, and spending 2 years in the Army, Dr. Harris went to Boston to complete his radiation oncology training at the Joint Center for Radiation Oncology at Harvard Medical School. “At that time, Boston was one of the first places in the country where breast-conserving therapy (lumpectomy followed by radiation to the breast) was being done, and I was fortunate to be part of clinical studies that helped shape this approach into a more effective and less toxic treatment,” said Dr. Harris.

Breast-conserving Therapy Once Seen as Controversial

Although breast-conserving therapy is commonly accepted as a best practice today, in 1977, when Dr. Harris completed his training year, it was a source of controversy in most parts of the country. According to Dr. Harris, the atmosphere surrounding this emerging practice was nothing short of hostile, particularly among the nation’s leading breast surgeons.

Controversy aside, Dr. Harris and his colleagues knew that dramatic clinical changes always endured growing pains along the way to acceptance. “Our intent was to try to objectify the issues that were being challenged. We took pains to discuss the problematic issues, pointing out when procedures didn’t have perfect results and giving a balanced perspective, not just cheerleading the new approach. Importantly, studies of our complications and failures identified ways to minimize these problematic issues. The approach and the treatment worked, and eventually we were seen as serious, legitimate investigators who improved the results of breast-conserving therapy,” said Dr. Harris.

More recently, Dr. Harris has been involved in studies looking at how local therapy works in the context of biologic subtypes of breast cancer. “In 2008, the Journal of Clinical Oncology published our results on the importance of biologic subtypes to the outcome of breast-conserving therapy, and we have since updated the data. We then carried our deeper understanding of the relationship between biologic subtypes and local treatment into assessing this relationship in the context of increasingly effective systemic therapy,” explained Dr. Harris.

Importance of Physician–Patient Relationship

Radiation oncology is a highly technical discipline that involves an understanding of the relevant clinical trials, physics, and extremely complex machines. It levies intense demands on practitioners trying to keep abreast of advances in the field, while simultaneously sorting though the myths and facts of radiation oncology as they counsel and treat vulnerable patients with cancer. And it is patient contact that keeps Dr. Harris’s oncologic fire aglow. “It is exceedingly gratifying to help patients through their day-to-day struggles, whether I’m delivering curative or palliative therapy. The bond between oncologists and their patients is very meaningful,” said Dr. Harris.

During his medical internship, Dr. Harris remembered spending a lot of time dealing with compliance issues, such as patients who refused to take blood pressure or diabetes medications, a duty rarely necessary in oncology practice. “Oncologists don’t usually need to spend their valuable time on patient compliance. This is a very focused and demanding field. Every patient has a potentially deadly disease and wants all the indicated treatment we can deliver,” said Dr. Harris.

Of course, the life of an oncologist is also fraught with the reality of what occurs when the outer limits of medicine are reached. “Sometimes things don’t work out; tumors progress and patients die. This field is not for everyone,” said Dr. Harris, “But my mental calculation has always been that I am doing the best I possibly can, keeping at the cutting edge of new information, continually learning. And as long as I do everything in my power for my patients, I can remain comfortable with how things turn out.”

Mentoring Young Oncologists

Aside from a heavy volume of patient care, Dr. Harris’s workdays as a department chair and clinical investigator are as varied as they are full. He is also in charge of the residency program, unusual for a department chair. “A major focus in my career has turned toward mentoring residents and our junior faculty. It is an immensely satisfying legacy to have trained multitudes of bright young radiation oncologists who in turn have and will help shape the field,” said Dr. Harris.

“I remember sitting next to the chairman of medicine at the Brigham and Women’s Hospital at Harvard Medical School. At one point he turned to me and said, ‘If I had to do it all over again, I would become an oncologist because the translation of basic science to improve therapeutics is most evident in oncology.’ And that statement was coming from a world-famous cardiologist,” said Dr. Harris.

‘A Special Kind of Trust’

Dr. Harris is proud of his two sons. As he puts it, “They have glitzy jobs.” His son Dan, a correspondent and weekend anchor for ABC News, has covered the war in Iraq and Hurricane Katrina. His other son, Matt, is a managing director for Bain Capital Ventures. But Dr. Harris doesn’t believe that they could possibly have the same job satisfaction that he has. “The relationship between oncologists and their patients is unique. It is built over time, and a special kind of trust is needed. That’s why I love my work as a radiation oncologist,” said Dr. Harris. ■

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