Tracing Breast Cancer Luminary’s Path to Oncology, from Hungary to Houston

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I was the director, the pharmacist, the chair of internal medicine, head of surgery, gynecology, cardiology, radiology, lab medicines…everything. It was basically a one-doc show.

— Gabriel N. Hortobagyi, MD, FACP

Gabriel N. Hortobagyi, MD, FACP, ASCO Past President (2006-2007), grew up under the oppressive regime of communist Hungary during the Cold War. “As college-educated intellectuals, my family was among the ‘politically undesirables,’ and if we had not escaped Hungary, neither my two sisters nor I would have been allowed to finish high school,” Dr. Hortobagyi said. “Instead of becoming a doctor, I might have ended up digging ditches in the streets of some rural town.”

During the height of the Cold War, the Hortobagyis were rounded up and placed in an internal concentration camp, sentenced to forced labor. When Joseph Stalin died 3 years later in 1953, they were released, but their lives were still in the grip of the dictatorship. “We were not allowed to live in Budapest, the capital. Even though my parents were highly educated, the regime consigned them to the most menial work,” Dr. Hortobagyi remembered.

Early Dreams Fulfilled

There were no doctors in the family to serve as an inspiration for Dr. Hortobagyi’s future career. He recalled that his mother had dreamed of becoming a physician, but the culture of Eastern Europe in the early 1900s had other ideas for women. As a child, Dr. Hortobagyi was a voracious reader of science, “And as far back as I can remember, I always wanted to become a doctor,” he said. Fortunately, his father’s resolve and serendipitous connections helped the family escape Hungary, allowing Dr. Hortobagyi to follow his aspiration of becoming a doctor. “I went to the National University in Bogotá, Colombia; the first and only medical school I applied to,” Dr. Hortobagyi said.

Dr. Hortobagyi graduated at the top of his class, but after completing his mandatory rotating internship there was yet another requisite prior to receiving his medical license. “In Colombia, before getting a medical license, every med school graduate is required to serve for 1 year in an economically challenged area of the country. The government selects the place and off you go, probably to be the only doctor in that particular sector,” Dr. Hortobagyi said.

Running a ‘One-doc Show’ in the Andes

Dr. Hortobagyi was sent to a far-off town of about 35,000 people (Pacho, Cundinamarca), nestled in the foothills of the Andes mountain range. He said that his government service turned out to be an incredible proving ground for a young doctor like himself. “There was a 100-bed hospital and I was the sole physician. My staff consisted of one nun who was head nurse and a couple of nuns who were basically licensed vocational nurses. I was the director, the pharmacist, the chair of internal medicine, head of surgery, gynecology, cardiology, radiology, lab medicines…everything. It was basically a one-doc show,” Dr. Hortobagyi said.

“At first it was a bit frightening. It wasn’t like an internship or residency; there was no safety net, and all I had were my textbooks to consult. I remember doing surgery with only a licensed vocational nurse holding an ether mask to the patient’s nose or giving IV thiopental sodium (Pentothal), a short-term anesthesia, so I had to work very quickly,” Dr. Hortobagyi said. “I learned to think on my feet, to improvise with the tools at hand.”

In addition to running the hospital, Dr. Hortobagyi had to service three smaller communities on a weekly basis. “Fortunately, this was before the extensive paperwork and documentation we see today, so I was able to make morning hospital rounds of 100 patients in 2 hours, and then hop a bus to one of those outlying communities and see patients,” Dr. Hortobagyi said. This “fly-by-the-seat-of-your-pants” experience accelerated and honed his transition from intern to doctor, he noted.

On the other side of the mountain range where the hospital was situated were Colombia’s largest emerald mines. “Between mining accidents and emerald smugglers shooting and stabbing each other, I got plenty of emergency surgical experience. But after the initial adrenaline rush, I began to feel restless and I began yearning for a situation where I could grow as a doctor and make more of an impact,” Dr. Hortobagyi commented.

A Career-changing Experience

After receiving his medical license, Dr. Hortobagyi began applying for training positions in the United States in earnest. When he was accepted at St. Luke’s Hospital, part of the Case Western Reserve University Hospital System, he “got on the first plane to Cleveland, Ohio, to begin my second medical internship, during which a wonderful group of mentors introduced me to the exciting world of the research lab. However, at that time there was not much activity in oncology in Cleveland. There were a couple of hematologists treating leukemia and lymphoma and an endocrinologist who treated breast cancers, mostly with major ablative surgery,” he said.

During his second year at Case, Dr. Hortobagyi drove to a 1-day American Cancer Society symposium in Columbus and had a career-changing experience. “One of the speakers was ASCO Past President Dr. Emil J. Freireich. His talk was a watershed event for me; it was the first time I had heard anyone talk about actually curing cancer,” Dr. Hortobagyi said.

Driving back to Cleveland, Dr. Hortobagyi was faced with a reality check. “I knew that I wanted to become an oncologist, but there was no training program in Cleveland. It was 1971 and the oncology field was just emerging; I wrote to the few existing cancer programs, one of which was run by Dr. Freireich at MD Anderson. Then I got in my car and got on the highway, making interview rounds to places like Rochester, New York, Memorial Sloan-Kettering in New York City, and Boston University. But just before I went to Houston, a message arrived from Dr. Freireich saying that I was expected to report for duty at MD Anderson. That was it. No interview. So on the appointed date I reported to Dr. Freireich and grew up with the institution,” Dr. Hortobagyi said.

Leader in Breast Cancer Research

Dr. Hortobagyi is currently Chair of the Department of Breast Medical Oncology and Director of the Breast Cancer Research Program at The University of Texas MD Anderson Cancer Center, where he has been serving the cancer community since the day he was hired by Dr. Freireich.

Although Dr. Hortobagyi’s contributions to breast cancer research and treatments have received worldwide honors, he still recalls his first published paper. “It was the early days of immunotherapy, and we had primitive tools compared to what we have today. But we thought we were really on to something. We later disproved the results, but I still remember the exact moment I got the acceptance letter from Cancer, which at that time was the number one oncology journal. It seemed to signal the beginning of something,” Dr. Hortobagyi said. ■

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