Breast surgical oncologist Laura S. Dominici, MD, was born and reared in Litchfield, a small town in the southern portion of New Hampshire. “Our house was on a long dirt road, in a very rural area,” she shared. “There were only about 5,000 residents in the town. My mother was a teacher, and my dad was an accountant; there were no early influences on my decision to become a doctor, other than my own interest in the field, which began at an early age.”
Laura S. Dominici, MD
Dr. Dominici was an enthusiastic athlete, playing soccer on the town’s co-ed team, which often left her on the bench, watching the boys play. However, her father suggested she and the other girls should have their own team. “My father got together with some of the other dads and helped us form a girls’ soccer team, which we called the Care Bears. We played against the all-boys soccer team, and did terribly, but my dad’s you-can-do-anything philosophy was truly formative in my life and has carried me through to today.”
Early Experience in Caring for Patients With HIV/AIDS
After graduating high school, Dr. Dominici attended Bowdoin College, a small liberal arts institution. “By that time, I sort of had in my mind that I was going to go to medical school, so I took all of the premed required courses,” she recalled. “I was a biochemistry major and double-majored in anthropology, too.”
A senior-year project shaped Dr. Dominici’s decision to go into medicine. “For my senior year project, I received a grant to study medical anthropology in patients in a residential home who were living with HIV/AIDS,” she explained. “It was an amazing experience. I was a volunteer but also wrote observations about my experience into my thesis. All of the material they had for the volunteers was essentially about comfort care for the residents who had AIDS, but this was in the late 1990s. By then, there were effective medications for HIV, so I helped change the volunteer program focus from how to comfort dying people with AIDS to how to educate them about medications and promote life skills. The experience of interacting with and making an impact on the lives of vulnerable people was the final component in my decision to go into medicine,” Dr. Dominici commented.
At First, a Reluctant Surgeon
After graduating from Bowdoin College, Dr. Dominici entered Tufts University School of Medicine. However, her first thoughts about a career in medicine did not include surgery. “I never thought I’d be a surgeon,” she admitted. “For one, I had very skewed ideas about who surgeons were and what made them tick. However, in medical school, I did surgical rotations at Brigham and Women’s Faulkner Hospital and found the surgical residents to be bright and enthusiastic educators. Soon afterward, I realized I was gravitating toward surgery. I loved that in surgery, you deal with immediate problems and have immediate results,” said Dr. Dominici.
Asked if she experienced any bias as a female in a discipline that is still largely male, Dr. Dominici replied: “I know the challenges women who were surgical pioneers faced in the days when surgery was thought of as a male dominion. However, I trained in the early 2000s; and although some bias still exists, I had wonderful female surgical mentors, like Elizabeth Pomfret and Patricia Roberts, who helped me negotiate my way through, and my training was a very rewarding experience.”
“I loved that in surgery, you deal with immediate problems and have immediate results.”— Laura S. Dominici, MD
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Deciding on Oncology
After receiving her medical degree, Dr. Dominici completed a general surgical residency at Lahey Clinic. “I chose Lahey because of its strong clinical surgical program,” she explained. “I worked with Drs. Larry Munson and Roger Jenkins, both of whom were top-notch cancer surgeons and terrific mentors. That’s when I decided to go into oncologic surgery. It was an exciting period because the multidisciplinary care model was just emerging, and breast cancer was at the forefront. I had a month-long rotation with a breast cancer surgeon, and that experience truly cemented my career path,” shared Dr. Dominici.
Following her surgical residency, Dr. Dominici was drawn toward an academic career. Feeling the need to bolster her research experience with clinical training, she went to Texas for a breast surgical oncology fellowship at the MD Anderson Cancer Center. “At MD Anderson, I spent a year focusing on breast cancer surgery and breast surgery research,” Dr. Dominici revealed. “I had some excellent mentors in Kelly Hunt, Henry Kuerer, and Isabelle Bedrosian. I had the best of both worlds in clinical care and research opportunities. I became interested in issues such as patient-reported outcomes in clinical care and left MD Anderson with the tools to further my research interests when I arrived at Brigham and Women’s Hospital/Dana-Farber Cancer Institute in 2009.”
Busy Surgical Schedule Plus COVID-19
At Dana-Farber, Dr. Dominici works in a large group of multidisciplinary breast clinicians. “We have 11 surgeons in our group, and I’m one of the clinically busiest of the group. I operate 2 to 3 days a week and see patients in our multidisciplinary clinic 2 days a week as well. I also spend part of my time working on incorporating patient reported outcomes into routine clinical care, to help us inform patients with breast cancer not only about what to expect in treatment, but also in survivorship, and to improve quality of care. Along with those duties, I’m Cancer Committee Chair for the Dana-Farber/Brigham and Women’s Cancer Center and work with the Commission on Cancer on a national level,” said Dr. Dominici.
When asked about the COVID-19 pandemic, Dr. Dominici noted how it has affected every aspect of her daily routine. “Since mid-March, we needed to begin limiting even many cancer surgeries to preserve our resources.
Dr. Dominici continued: “We have been able to resume our clinical efforts, but started doing screening imaging just this month. I have been impressed by how members of our group have been instrumental in formulating national guidelines to help physicians figure out how to safely temporize patient management and then work their way back into a semblance of normal medical practice. Moreover, as a group, we’ve done a lot of work looking at how best to care for our patients with cancer during the quarantine, such as via virtual visits, which work well for medical oncologists and are more challenging for surgeons related to physical exams. However, we’ve sucessfully transitioned some of our visits to virtual, such as postoperative visits,” said Dr. Dominici.
Less Is More in Surgery
Dr. Dominici said that over the arc of her career, one of the advances she’s been part of is to be able to offer patients less-invasive surgery. “It’s great to refine treatments and have targeted therapies at your disposal, but I think dialing back on surgery has been a terrific change in practice. For instance, we see far fewer women undergoing extensive lymph node dissections. We’re trying to hone surgery to the biologic risks of individual patients. Even though we’re doing less-invasive surgery, we need to get feedback from our patients, so we can continue to advance the field and focus on the outcomes that are important to patients.”
What does a busy surgical oncologist do to prevent burnout? “I have an amazing husband who is now homeschooling our kids during the pandemic. Personally, my biggest de-stressor is running. We live outside of Boston on the south shore, so it is very relaxing to run by the ocean. But family is always the best way to get away from the rigors of work.”
DISCLOSURE: Dr. Dominici reported no conflicts of interest.