Chapter 20: Breast Cancer Service at MD Anderson in the Late Seventies
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Description
In this chapter, Dr. Hortobagyi talks about the state of breast cancer services at MD Anderson and in the country in the late seventies. He begins explaining the position of the Breast Cancer Service within the institution, lists his colleagues, then notes that the non-surgical treatment of breast cancer was evolving in the seventies (and eighties). Dr. Aman Buzdar shared Dr. Hortobagyi’s commitment to research, and they both learned how to treat breast cancer via an “empirical” process that was common in institutions at that time, when medical oncology was not yet a specialty and institutions lacked formal training programs of the type common today. In general, health care institutions were less structured than they are today, and researchers had much more freedom.
Identifier
HortobagyiGN_03_20130123_C20
Publication Date
1-23-2013
Publisher
The Making Cancer History® Voices Oral History Collection, The University of Texas MD Anderson Cancer Center
City
Houston, Texas
Interview Session
Gabriel Hortobagyi, MD, Oral History Interview, January 23, 2013
Topics Covered
The Interview Subject's Story - The AdministratorThe Administrator MD Anderson History Building/Transforming the Institution Multi-disciplinary Approaches Growth and/or Change Understanding the Institution Understanding Cancer, the History of Science, Cancer Research The History of Health Care, Patient Care
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.
Disciplines
History of Science, Technology, and Medicine | Oncology | Oral History
Transcript
Tacey Ann Rosolowski, PhD:
Well, you are beginning to address the next real subject area that I wanted to talk about, which is your roles within—first what was the breast medical oncology as a service and then the shift when it became a department and, obviously, that involved a whole other set of skills and roles than working in the laboratory and collaborating with other experiments—also where you kind of entered into this subject in an unusual way. So I wonder how do you want to tell that story. Do you want to go back in time and kind of trace it chronologically? Or would you like to talk now about the facilitative coordinating roles specifically? How would you like to proceed?
Gabriel Hortobagyi, MD:
To go back in time briefly because I think it is important to look at that. So initially—I might have mentioned in an earlier conversation—breast cancer was seen as part of the Department of Medicine at a time when there was developmental therapeutics in medicine. There was virtually no breast cancer seen in Developmental Therapeutics. So even though I trained in Developmental Therapeutics, I had to cross over to the other side in order to have access to breast cancer patients and research.
Tacey Ann Rosolowski, PhD:
As I was just taking notes about the organization, it was Division of Medicine and then the Department of Medical Oncology and the Breast Medical Oncology Service was within that. Is that correct?
Gabriel Hortobagyi, MD:
There was no Division of Medicine.
Tacey Ann Rosolowski, PhD:
Oh. There was no Division of Medicine?
Gabriel Hortobagyi, MD:
At that time, this was called MD Anderson Hospital and Tumor Institute.
Tacey Ann Rosolowski, PhD:
Uh-hunh (affirmative).
Gabriel Hortobagyi, MD:
There were no divisions. So there was a—I guess there was a Department of Developmental Therapeutics. There was a Department of Surgery. There was a Department of Radiotherapy. There was a Department of Medicine. The relative structure of these various organizations to each other was not very clear.
Tacey Ann Rosolowski, PhD:
Uh-hunh (affirmative).
Gabriel Hortobagyi, MD:
Clearly, Developmental Therapeutics and Medicine were competing. They were artificially separated, but it was that way because it was the only politically acceptable way to bring in new people who would certainly antagonize those who had been here before; and in fact, they did. There was a lot of turmoil during that time within medicine. Within the Department of Medicine, there was this small thing—I guess we were a section. I don’t know how formal that was, but we were called Medical Breast. Nylene Eckles was the—I guess the section chief before I arrived, and George Blumenschein became the section head when Nylene stepped down, probably about six months before I arrived. So George—by the way, George Blumenschein’s son—also called George Blumenschein—is now a faculty member here in the Head and Neck and Thoracic Oncology. So his father was a hematologist by training, and he did a year or so at the NIH looking at coagulation. It is my understanding that when he finished that he was looking for a job and his father-in-law, who was the dean of medicine at the University of Chicago, knew Lee Clark. So he put in a call and said, “Lee, my son-in-law is looking for a job. Do you have any openings there?” He was recruited pretty much fresh out of his fellowship at the NIH in clotting. He was recruited as a section chief for breast cancer and as director of education for MD Anderson. I won’t even speculate about how that happened and what—but that’s the way things happened at that time.
Tacey Ann Rosolowski, PhD:
I’m remembering when we first had a conversation about the institution. When you arrived, there was a very real problem about there were no mentors in breast cancer for you, and this is another story to indicate how there was that vacuum.
Gabriel Hortobagyi, MD:
Right.
Tacey Ann Rosolowski, PhD:
So how did it all happen then? (laughing) How did treatment and diagnosis and all those things happen in this environment?
Gabriel Hortobagyi, MD:
Well we still had Nylene Eckles around, and she was helpful, if nothing else, in giving us the example. Then we had a group of very good surgeons who were focused on breast cancer—Charlie [Charles M.] McBride and Marvin Romsdahl and Ed White and a couple of others—and they knew a lot about breast cancer. There were a couple of radiation therapists who were really outstanding: Eleanor Montague, who has since retired; Gilbert Fletcher, who was the head of Radiation Oncology; and Norah Du Tapley. These three were truly outstanding radiation oncologists. They were entirely focused on breast cancer, and they knew a lot about it. Dr. [Aman U.] Buzdar and I started on the same day as fellows in the breast service. We knew dramatically little about breast cancer, so we had to sort of learn on the job because there were no classes about breast cancer. Nobody lectured us about this is Breast Cancer 101, and this is the way you diagnose it, and this is the way you treat it. You sort of picked up pearls left by the center. So we learned about our colleagues in the other disciplines. By the time we arrived, George Blumenschein had been here for about six months, so he had learned a little bit and transmitted whatever he knew. He was a very good communicator. Nylene Eckles was still around, so she served as an example. Then there was another guy called Charlie Tashima. Charlie Tashima was an older guy. I think he was from Hawaii. He’s still around. I think he works out of Park Plaza. That’s in private practice. He was a good solid medical oncologist who had experience with breast cancer. He enjoyed serving as sort of a more senior faculty member. We could ask him questions and whatnot. But it was largely an empiric process of watching and learning and reading and learning on the job.
Tacey Ann Rosolowski, PhD:
Uh-hunh (affirmative).
Gabriel Hortobagyi, MD:
Fortunately, both Dr. Buzdar and I had a major interest in becoming involved in research, in part because of our ignorance. So we spent a good part of our fellowship developing research projects and starting to write papers and trying to pick brains from whoever was willing to make them available to us. By process of trial and error, we sort of came up with what we are today.
Tacey Ann Rosolowski, PhD:
Uh-hunh (affirmative).
Gabriel Hortobagyi, MD:
At that time, we didn’t know any better. I think we could have shortcutted that process enormously had there been individuals who sat down with us and said, “Now let me walk you through the process.” There were several other people on the faculty who sort of semi-mentored me: Jordan Gutterman, Evan Hersh, Bob Livingston—even J Freireich. But they were not really the hands-on mentors. They would sort of say, “Why don’t you do this?” And then you were on your own. Fortunately, both Dr. Buzdar and I are pretty much self-starters. We don’t need people looking over our shoulders, so we would just say, “I have no idea how to do this, but I’ll figure it out.” We did eventually.
Tacey Ann Rosolowski, PhD:
I was curious. As you compare the section in the late ’70s and early ’80s at MD Anderson, I imagine that when you compare it to peer institutions there were other institutions that had more of a critical mass of individuals who did specialize in breast cancer. But given that difference, how would you compare the treatment that was offered to patients? Then I was also thinking—do you think that the lack of or the vacuum enabled you and Dr. Buzdar and others to be more creative perhaps here than you might have been elsewhere?
Gabriel Hortobagyi, MD:
Yes. So I think of this process in a way similar to the way I think of the development of the state of Texas in the 1800s. The early part of the 1970s was really the Wild West in oncology. There were a few centers that were starting to organize themselves and certainly Memorial in New York had been around for a number of years. They had outstanding surgery. But medical oncology was not a developed specialty. There were training programs and only a handful of organizations. We have something like 150 medical schools in this country, give or take a few. When I started looking for a fellowship in the early ’70s, there maybe four or five places that had a formal training program—Rochester, New York. There was Boston. Harvard had a very small program. Boston University had a somewhat larger program. Actually, it was Tufts. Memorial had a program. MD Anderson had a program. The NIH had a program—NCI. But these were all very small. I didn’t know of any others that actually had a structured training program. Training didn’t have the same meaning as it has today. If you compare how we train our fellows today—how much time we spend with them, how much time we spent structuring their curriculum and their rotations, and all of that—that’s a far cry from—people would come here and train, and eventually they would be told, “Today you work there.” Why? Because there’s nobody else working there, so it’s like a good idea. But it wasn’t like, “We are going to teach you about lung cancer,” and “Why don’t you sit here today and the next several days, and we’ll give you every day a lecture about a different part of lung cancer, and you’ll learn and you can ask questions.” No. And it wasn’t only here. I think it was everywhere because that was the state of the art. In fact, medicine—even in the 1970s—was largely a process of apprenticeship. It was not a systematically taught thing, expect for the basic medical school part. Beyond that, it was largely an apprenticeship. So in that setting, I took my boards of internal medicine because you had to take that in order to qualify for the boards in oncology. I took my boards in oncology in 1977, and I was the second class that took the boards. The boards in oncology did not exist before 1975. The first boards were in 1975 and the second in 1977, so it wasn’t really a modern organized discipline. It was not recognized until just a couple years before as a subspecialty of internal medicine. We had very few drugs, so there was very little to do except give morphine and symptomatic control and hope that people would die in peace and without too much suffering. In the breast cancer area when I started, we did not see patients with primary breast cancer because the surgeons cured them all according to them, of course. There was no need nor was there any reason to see that type of patient because they were cured by mastectomy or whatnot. It was only over the next several years after I started that we started to be involved in the treatment of primary breast cancer. We started to develop neoadjuvant and adjuvant chemotherapy and hormonal therapy, and eventually we got to where we are today. But that was a process and a very slow process. By the same token, in the institution—most of the healthcare institutions were much less structured at that time. You had much more freedom to do things because there were fewer regulations. There were fewer rules. There were fewer guidelines, so to some extent you could do many creative things. You didn’t have to get seventeen signatures to go to the bathroom. So that, of course, had great advantages for a budding researcher. I guess it had some disadvantages in the sense that there was not as much control over things.
Tacey Ann Rosolowski, PhD:
Uh-hunh (affirmative).
Gabriel Hortobagyi, MD:
But for the time I think it was the right approach.
Recommended Citation
Hortobagyi, Gabriel N. MD and Rosolowski, Tacey A. PhD, "Chapter 20: Breast Cancer Service at MD Anderson in the Late Seventies" (2013). Interview Chapters. 1125.
https://openworks.mdanderson.org/mchv_interviewchapters/1125
Conditions Governing Access
Open
