The Cancer History Project

Melvin J. Silverstein, now Medical Director of Hoag Breast Center and the Gross Family Foundation Endowed Chair in Oncoplastic Breast Surgery at USC, sat down with Stacy Wentworth, radiation oncologist and medical historian, to reflect on his career.

Silverstein founded the Van Nuys Breast Center in 1979. As he saw more and more and more patients with what was only recently coming to be known as ductal carcinoma in situ (DCIS), he wrote the first major textbook on the disease and developed the Van Nuys Classification for Ductal Carcinoma in Situ of the Breast as well as the USC Van Nuys Prognostic Index.

Wentworth asked Silverstein about a time when his science was challenged by the medical establishment. 

At the time, most surgeons favored treating DCIS just like aggressive, invasive breast cancers, with mastectomy and radiation.

Silverstein wasn’t so sure about that. He felt that, in some cases, radiation wasn’t necessary.

Silverstein debated against radiation oncologists at conferences for years, and his arguments stirred up visceral responses, he recalls.

“Pro-radiation therapy were all the radiation oncologists from academic centers. That was Jay Harris, who was I guess my arch rival in this. He once, after one of these talks, came up to me, smiled at me and said, ‘You're killing patients.’ Which broke my heart,” Silverstein said. “It was a terrible thing. He said to me after not giving radiation therapy, but it turns out in the long run, everybody's come on board. And clearly now it's 25, 30 years later, some people have finally agreed that they all don't need it.”

Recent trial results have confirmed Silverstein’s analysis that not all patients with DCIS need radiation.

Today, Silverstein runs the USC breast fellowship program, which has an emphasis on oncoplastic surgery—the first of its kind.

Read more at https://cancerhistoryproject.com/article/melvin-silverstein/

This interview with Walter Lawrence Jr. was conducted in 2020, when Lawrence was 95 years old and director emeritus of VCU Massey Cancer Center. Lawrence died one year later, on Nov. 9, 2021.

Lawrence was one of the founders of the field of surgical oncology, setting up the first-ever university-based division of surgical oncology at what later became VCU Massey Comprehensive Cancer Center, in Richmond, Virginia. He served as director of VCU Massey from 1975 to 1988, during which time the cancer center earned NCI designation.

Lawrence spoke with Paul Goldberg, editor and publisher of The Cancer Letter, and Robert Winn, director of VCU. 

“The thing that was exciting about the National Cancer Act, which I think was one of the best things President Nixon did, among things that weren’t so good, was that it did bring the federal government into the funding of various kinds of research,” Lawrence said.

Lawrence saw promise in the National Cancer Act, and earning the Cancer Center designation from NCI in 1975 allowed VCU, then called the Medical College of Virginia, to become systematically involved in clinical trials.

“Randomized clinical trials were the only way we had of really improving patient cancer care—things like the one that Bernie Fisher in Pittsburgh started, the National Surgical Adjuvant Breast and Bowel Project,” Lawrence said.

Read more and explore related archives at https://cancerhistoryproject.com/article/walter-lawrence-podcast/

In this episode, Susan Ellenberg, emerita professor of biostatistics, medical ethics, and health policy at the University of Pennsylvania Perelman School of Medicine, describes her lifelong love of mathematics, how she accidentally became a biostatistician, and her well-rounded career in clinical trial design and analysis.

As a child, Ellenberg was fascinated by a mathematical puzzle.

John is twice Mary's age when John was Mary's age. When Mary will be John's age, the sum of their ages will be 63. How old are John and Mary?

Ellenberg occasionally chipped away at the question by randomly plugging in numbers, but she soon discovered another way to approach it.

“When I got to high school algebra, I learned that there was an actual way to solve this problem. I was so excited I knew how to do it,” Ellenberg said.

That enthusiasm, combined with her college entrance exam math scores—which topped her graduating class, despite not being in the math honors program—led her to become a math teacher.

But Ellenberg soon put her career on hold so she and her husband could start their young family.

However, when Ellenberg was pregnant with her first child, a friend asked if she could help with computer programming for a project under the eminent biostatistician Jerome Cornfield.

That job led to Ellenberg earning a PhD in mathematical statistics and having a career in clinical trial design and analysis. She has held positions at the Emmes Clinical Research Organization, NIH, and FDA. She also worked with activists during the AIDS epidemic and has combatted misinformation about vaccine safety.

Eventually, though, she took a job in academia and returned to her first passion: teaching.

“I said I would teach a class on clinical trials, which I did all the years until I became emeritus,” Ellenberg said. “I really enjoyed doing that, [going] back to my original love of teaching.”

Ellenberg spoke with McKenzie Prillaman, reporter at The Cancer Letter. A transcript of this conversation appears on the Cancer History Project.

To mark Hispanic Heritage Month, in this episode, six cancer experts discuss Latino representation in clinical trials, translational research, and healthcare professions.

Hispanic and Latino people comprise nearly 20% of the U.S. population, but less than 6% of physicians nationwide identify as Hispanic.

“The pipeline issue continues to be a huge issue for us,” said Amelie Ramirez, of UT Health San Antonio and Mays Cancer Center. “As our population continues to grow, in terms of the Latino population, we definitely need more [Latino physicians].”

Since trust plays a huge role in recruiting participants, the dearth of Latinos in health care affects clinical trials and translational research, said Cruz-Correa, of the University of Puerto Rico and PanOncology Trials. “For our patients, for our communities, language is still important—that concordance between the physician that is telling you about the study and the patient’s background.”

Still, it’s important to remember that Latinos are a very diverse group, who speak languages other than Spanish, said Carvajal-Carmona, of UC Davis. Latino people of the myriad ethnicities throughout the Americas have a variety of histories, cultures, and cancer risk factors, he said.

And for Latino professionals in oncology, it’s vital to continue making their presence known, said Edith Perez, of Mayo Clinic. “We are part of the population. We are part of the intellectual minds that exist in this nation. And we're here to help lead and collaborate.”

Panelists included:

A transcript of this conversation is available on the ⁠Cancer History Project⁠.

In this episode, Lawrence Phillips, an endocrinologist at Emory Clinic, a professor at Emory University School of Medicine, and medical director of the Clinical Studies Center at the Atlanta VA Medical Center, discusses pushing through lung cancer to continue doing what he loves—seeing patients, teaching, and conducting research.

Something odd turned up in one of Phillips’s routine health screenings in 2008. A radiologist who was examining Phillips’s CT scan images to look at his coronary arteries noticed a mass in his left lung.

Phillips had previously been told not to worry about the mass because it wasn’t growing.

“Well, that’s not true,” Phillips recalled the radiologist saying. The tumor had, indeed, grown.

Three days later, Phillips had it removed via segmentectomy. He thought his lung cancer was over and done with.

But in 2014, his surgery scar had started to change. It lit up in a PET scan. So, Phillips had a lobectomy, after which he learned he had an EGFR mutation.

Eventually, Phillips began a treatment regimen gefitinib, which he still takes today. He is currently free of evidence of disease.

Phillips spoke with Deborah Doroshow, associate professor of medicine at the Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai.

A transcript of this conversation is available on the Cancer History Project.

In this episode, stay-at-home mom Christy Erickson discusses how she went from a roundabout lung cancer diagnosis to riding a motorcycle and competing in strongman competitions.

Erickson wasn’t worried about lung cancer when she was younger. Breast cancer had a stronghold on her family tree. Her mom died from it when Erickson was seven years old.

She took preventative measures for breast cancer, including a mastectomy. But a few years later, in 2006, scans for an unrelated health issue revealed spots all over Erickson’s lungs.

Her biopsy came back negative for cancer at the time. But 10 years later, she was diagnosed with stage 4 EGFR-positive lung cancer.

Receiving that news after dedicating years to prevention measures pushed Erickson down an emotional spiral.

But her condition stabilized with osimertinib. “I sort of hit this point where I thought, 'Well, I'm still here and I'm relatively healthy. If I'm not dying, I want to go live,’” she said.

Erickson spoke with Deborah Doroshow, assistant professor of medicine, hematology, and medical oncology at the Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai.

A transcript of this conversation is available on the Cancer History Project.

In this episode, 2024 David Karnofsky Memorial Award winner Lillian L. Siu reviews her career developing novel therapies in the phase I setting, the evolution of her field, and her mentor’s dreaded “evil red pencil.”

Siu was among the first scientists to read out the signals of safety, pharmacology, and preliminary efficacy of therapeutic agents that ushered in a new era of cancer therapy. She has been involved in the early development of over 50 drugs and has focused on ways to improve efficiency and scientific relevance of clinical trials.

Over the course of her career as a phase I clinical trialist, Siu watched as the field moved away from using “maximum tolerated dose,” the growing need for early-phase efficacy data, and the emergence of intermediate biomarkers.

After a nearly 30-year-long career, Siu’s advice for young oncologists is simple: Don’t give up.

“Learn from every mistake or every challenge and rise above it and be tenacious,” Siu said. “Be persistent, because there’s never an end that is a bad ending. It is always a good ending if you put enough effort in it. Maybe not entirely the way you want it, but at least if you put in the effort, something will return to you that is worth your effort. I truly believe in that, and certainly I see that in my career.

“I don’t only have positive results, I have very often negative results, but it’s fun. Learning from your mistakes is half of the fun, and cherish that kind of moment to learn from it.”

Siu spoke with Jacquelyn Cobb, reporter with The Cancer Letter. A transcript of the conversation appears on The Cancer History Project.

Something felt wrong during one of Morhaf Al Achkar’s regular runs on the treadmill in late 2016. He started gasping for breath.

“It became really hard to run,” he said. “That sudden development of shortness of breath alarmed me.”

Being a family physician in Indiana at the time, he asked a resident at the clinic where he worked to listen to his lungs. “There’s no air moving on the left side of your chest—that doesn’t seem right,” Al Achkar recalled hearing from the resident.

A few weeks later, Al Achkar received devastating news: he had stage 4 ALK-positive lung cancer. He estimated that he would live for just another six to 10 months.

But today—nearly eight years after his devastating diagnosis—Al Achkar is still working, now primarily as a researcher and educator.

Al Achkar spoke with Deborah Doroshow, assistant professor of medicine, hematology, and medical oncology at the Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai.

A transcript of this conversation is available on the Cancer History Project.

When Stephanie Graff was a breast oncology fellow in 2010, one of her patients brought a marked up copy of “Dr. Susan Love’s Breast Book” to an appointment.

“One of my patients had brought it in and was using it almost as her cancer notebook, and had pages flagged and said, ’Well, what about this? What about this? It says here…,’” Graff, director of Breast Oncology at Lifespan Cancer Institute and medical advisor for the Dr. Susan Love Foundation for Breast Cancer Research, said to The Cancer Letter.

It was the first time that the book, written by Susan Love, a breast cancer surgeon, activist, and founder of the Dr. Susan Love Foundation for Breast Cancer Research, had shown up on Graff’s radar.

“Dr. Susan Love’s Breast Book” was first published in 1990. Now, Graff is a contributing author of the seventh edition, the most recent version of the book published in 2023.

Graff spoke with Alexandria Carolan, associate editor of the Cancer History Project. A full transcript of this conversation, including how Graff came to know and work with Susan Love, appears on the Cancer History Project.

Soon after he was diagnosed with a dedifferentiated liposarcoma, C. Norman Coleman reached out to The Cancer Letter and the Cancer History Project to initiate a series of interviews about his life and career.

The plan was to keep going for as long as possible. Alas, only one interview–about an hour’s worth–got done. Coleman spoke with Otis Brawley and Paul Goldberg, co-editors of the Cancer History Project.

Coleman died March 1 at 79.

At NCI, Coleman was the associate director of the Radiation Research Program, senior investigator in the Radiation Oncology Branch in the Center for Cancer Research, and leader of a research laboratory at NIH. He was also the founder of the International Cancer Expert Corps, a non-profit he created to provide mentorship to cancer professionals in low- and middle-income countries and in regions with indigenous populations in upper-income countries.

This interview is available as a transcript on the Cancer History Project.