Monica Morrow, MD, Tumbled Gender Barriers to Build a Career in Surgical Oncology

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Monica Morrow, MD

Monica Morrow, MD

Breast cancer surgeon Monica Morrow, MD, came from a town in the far northeast reaches of suburban Philadelphia. “I guess because there were only two girls in our family, I was the son my father never had, and he reared me that way. When we were playing catch, if I missed the ball and got hit in the face and began to cry, my father would tell me to throw the ball back,” said Dr. Morrow, adding, “Those childhood lessons helped me later in my career as a surgeon.”

Early Influences

Asked about the early influences in her decision to pursue a career in medicine, Dr. Morrow replied: “My father was from a family of physicians, but when Pearl Harbor was attacked, he joined the Air Force. And when he returned at the end of World War II, he announced he was too old to go through 4 years of medical school.”

Although there were no direct personal influences in her career path, Dr. Morrow explained that early on, she had a keen interest in the inner working part of the body. “When I was 6 or 7, I brought the heart and lungs of a cow that my father had obtained from our local butcher to school for show and tell. It didn’t sit too well with my teacher. And when I was a bit older, I was playing in a wooded area and found a dead cat in a creek. I spent about an hour poking it with a stick to see if I could break it open to see what was inside. Fortunately, the skin held because if it had opened up, it might have put me off medicine,” joked Dr. Morrow.

Accelerated Medical Program

Toward the end of high school, Dr. Morrow began looking at colleges. “I was accepted to one of the early women’s classes at Princeton University. Then my father found out about this accelerated 5-year combined medical program at Penn-State Jefferson Medical College. Getting through college and medical school in 5 years as opposed to 8 sounded like a good idea, so I entered the program in 1971,” said Dr. Morrow.

Cramming 8 years’ worth of schooling into 5 years was challenging. “I started college in the summer immediately after graduating from high school and continued straight through the following summer, then I started medical school that fall, going back to college to finish up some liberal arts credits during the summer between the first and second years of med school.”

Asked to reflect on her decision to take the accelerated path, she said, “From an academic standpoint, it worked out fine because most of what you learn as an undergrad doesn’t have a heck of a lot to do with what you do in medical school. That said, if I’d realized in advance how much fun college was going to be, I’m not sure I would have taken the accelerated program.”

Career in Surgical Oncology

“In medical school, I decided to become a surgeon. I think I came to that decision because there really are certain truths about personality types associated with different medical specialties, and my personality type definitely fit with being a surgeon. I couldn’t think of anything more horrifying than spending the entire day making rounds. I liked the immediacy of surgery and the satisfaction of instant results. I also enjoyed the physical act of surgery,” said Dr. Morrow.

At that time, noted Dr. Morrow, surgical training was a minimum of 5 years, but as she’d compressed her undergrad and medical school into 5 years, the training period did not seem daunting to her. Dr. Morrow entered her surgical residency in 1976 at the Medical Center Hospital of Vermont in Burlington. “Toward the end of my residency, I decided to pursue a career in surgical oncology. It was during a period of widely differing attitudes about how doctors discussed a cancer diagnosis. Some people didn’t want their relatives told they had cancer, fearing it would be too upsetting. Even some doctors were hesitant about discussing cancer,” admitted Dr. Morrow.

“I chose breast cancer because it’s a common disease and affects the whole spectrum of age, from very young to very old.”
— Monica Morrow, MD

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Dr. Morrow entered a surgical oncology fellowship at Memorial Sloan Kettering Cancer Center in 1981, during a surgical paradigm shift led by Bernard Fisher and others who were conducting the National Surgical Adjuvant Breast and Bowel (NSABP) Project B-06 study. This trial looked at the difference in survival between women treated with the total mastectomy and those treated with minimal breast-conserving surgery and radiotherapy.

Breaking Gender Barriers

Dr. Morrow’s entry into surgical oncology was also at a time in which surgery was not only a male-dominated profession, it was a discipline loaded with male-dominated attitude. “I was the first woman to complete a surgical residency at the Medical Center Hospital of Vermont, and there were no women surgeons on the faculty during my residency. I believe I was the second woman to complete a surgical oncology fellowship at Memorial Sloan Kettering. It was a very different environment, for sure. Male surgeons felt free to say and do all kinds of things that would be totally inappropriate today. Happily, even though they were all guys, when you’re training, the strong sense of camaraderie displaces the other stuff, other than the time they decided they all wanted to drink beer out of my shoes.”

Dr. Morrow continued: “One time I was in the operating room, and there was a very annoying medical student who was shamelessly kissing up to the older surgeon. When he complimented the surgeon on his elegant work, the surgeon stared across the table at me and said, ‘There’s nothing elegant in the OR when a woman is present.’ There wasn’t a lot of subtlety back then.”

Why Breast Cancer?

Asked why she chose breast cancer as a specialty, Dr. Morrow replied: “Observing physicians advance the field through clinical research, in particular, Roger Foster, MD, who was participating in NSABP trials in Vermont, greatly influenced my career decision. Also, surgical oncology was such a broad field that it offered a lot of opportunities. At the beginning of my surgical career, I treated a variety of cancers, but over time, I was faced with the choice of knowing a little about a lot of cancers or knowing a whole lot about one cancer. That’s when I narrowed my practice to breast cancer. I chose breast cancer because it’s a common disease and affects the whole spectrum of age, from very young to very old. Moreover, breast cancer treatment was already becoming the most evidence-based of all cancer types, and I’m a data person.”

Changing Philosophies

Dr. Morrow noted that during the time of her surgical fellowship, there was no 80-hour-week maximum as there is today. “You arrived at the hospital in the early morning and did your rounds. During those days, to make sure there were enough patients to fill the OR [on Monday], we’d admit about 30 patients [on Sunday] because you didn’t know how many were going to be open-and-close unresectable cases and how many would be surgically treated. This kind of philosophy is inconceivable in today’s environment. It was a huge amount of work, but it was also when I was first exposed to the beginning of multidisciplinary cancer care,” said Dr. Morrow.

In 1998, Dr. Morrow became Associate Professor of Surgery at the University of Chicago, where she met Samuel Hellman, MD, who had just become the university’s dean. “It was really through Dr. ­Hellman’s influence that I began thinking of breast cancer as a disease rather than a surgical procedure.”

“We have learned that doing less in certain clinical settings is safe and effective.”
— Monica Morrow, MD

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After leaving the University of Chicago, Dr. ­Morrow’s career as a breast cancer surgeon matured, as she served as Professor of Surgery at Northwestern University Medical School, Chair of Surgery at Fox Chase Cancer Center and Professor of Surgery at Temple University School of Medicine, and in 2008 she joined the faculty of Memorial Sloan Kettering Cancer Center, where today she serves as Chief of Breast Service and the Anne Burnett Windfohr Chair of Clinical Oncology. Dr. Morrow has published widely, and her extramural activities in research and board memberships are as voluminous as they are esteemed.

Less Is Often More in Breast Cancer

Asked for a glimpse into the advances in surgical breast cancer, Dr. Morrow replied: “We have come a long way in our understanding of breast cancer biology and have learned that doing less in certain clinical settings is safe and effective. Getting patients to understand that is oftentimes a challenge. Fear of cancer recurring, understandably, can drive a woman’s decision to have a double mastectomy rather than a lumpectomy and radiotherapy, which has been proven to be just as effective. We also have substantial data showing that doing less in lymph node dissection is also safe, sparing women unnecessary side effects. Despite these challenges, I have seen great advances in breast cancer over the course of my career. And the advent of targeted therapies has further reduced the risk of recurrence.”

What does one of the nation’s most prominent surgeon’s do to decompress? “I read with great regularity and tend to prefer lighter novels. I also like to go on walking vacations and recently returned from a delightful vacation in Provence, France. But my idea of a walking vacation is walking from one great hotel to another.” 

DISCLOSURE: Dr. Morrow reported no conflicts of interest.