2012 Gianni Bonadonna Award: Reflection of Multidisciplinary Nature of Breast Cancer Management
|Dr. Monica Morrow, is the fi rst surgeon to receive the Gianni Bonadonna Breast Cancer Award.
The recipient of the 2012 Gianni Bonadonna Breast Cancer Award and Lecture, Monica Morrow, MD, embodies this year’s Annual Meeting theme of “Collaborating to Conquer Cancer” and the true multidisciplinary nature of breast cancer care today. Chief of the Breast Surgery Service, Co-Chief of the Breast Program, and Anne Burnett Windfohr Chair of Clinical Oncology at Memorial Sloan-Kettering Cancer Center (MSKCC), Dr. Morrow is the first surgeon to receive the award.
Dr. Morrow, who is also professor of surgery at Weill Cornell Medical College, president of the Society of Surgical Oncology, and editor of ASCO Daily News, said that there are a number of outstanding medical oncologists specializing in breast cancer to whom ASCO could bestow this award.
“I am particularly fl attered that ASCO chose to give this award to me on a personal level,” she said in an interview with ASCO Daily News, “but also it is recognition of the truly multidisciplinary approach in breast cancer management and of the important role that surgeons have on that team.”
The award, first presented in 2007, recognizes an active breast cancer specialist with a distinguished record of accomplishments in advancing the field of breast cancer and with exceptional mentoring abilities.
Seeing Beyond Treatment Modality Dr. Morrow began her surgical training during a time when patients’ families often resisted communicating the diagnosis of cancer to the patients themselves.
However, also during this time, the National Surgical Adjuvant Breast and Bowel Project was in the early stages of its first breast cancer trials. As a medical student and fellow, Dr. Morrow was witnessing a shift in the overall attitude about cancer—it was transitioning from a “bad word” to an area in which “expertise in cancer as a discipline could make a difference in patient treatment.”
During the early years of her career, Dr. Morrow was infl uenced most directly by both a surgeon and a radiation oncologist. Roger Foster, MD, a surgeon at the University of Vermont when Dr. Morrow was a resident there, piqued her interest in breast cancer specifically through his evidence-based approach to cancer surgery and through his participation in clinical trials. Samuel Helman, MD, a radiation oncologist and dean at the University of Chicago when Dr. Morrow joined the faculty there, encouraged Dr. Morrow to think about breast cancer in a broader context, outside of just the surgical implications.
“Dr. Helman was really the person who inspired me to think about breast cancer as biology, rather than just considering the role of surgery in treatment,” she said. “Thinking about the disease process itself, rather than simply how I treat it, is something that has been extremely helpful to me going forward in my career.”
As the head of a breast cancer surgery fellowship for many years—starting out at Northwestern University, moving on to Fox Chase Cancer Center, and for several years at MSKCC—Dr. Morrow has been given opportunity to interact with many young surgeons specializing in breast cancer. One of the greatest rewards of her current work at MSKCC is her ability to build a program that infl uences the career paths of the next generation of oncologists.
“I find the role of mentor to be very valuable and rewarding. I am given the opportunity to share my knowledge and opinions with early-career surgeons, and they can incorporate what works best for them into the care they provide their patients. At the same time, they constantly challenge me to make sure that I am up to date and logically consistent,” she said.
The Next Shift in Care
Dr. Morrow’s vision for the future of breast cancer care is one in which multidisciplinary efforts must be made to improve patient communication and decision making through alteration of physician expectations. Dr. Morrow encourages oncologists to remain mindful that patients are forced to process increasingly complex and rapidly changing information in addition to coping with the stress of diagnosis, thereby impairing decision-making abilities.
“We have accepted this model of shared decision making as a way to deliver care,” she said, “and it’s a great model for educated people who have a lot of time to devote to thinking about their treatment options and to researching them and who are comfortable with that model. However, it doesn’t necessarily work for everyone.”
Oncologists of all disciplines also must exercise good decision making and focus on the potential burden of treatment for patients and their families, as well as the possible benefits. In the age of personalized medicine, a better understanding of the biology of cancer can lead to a greater awareness of the likelihood of benefit.
“As an overall goal of treatment, reaching that balance where we can most aggressively treat those patients who are most likely to benefit from that aggressive treatment and treat more conservatively those patients with cancers that we know have a very favorable prognosis will be a true achievement,” Dr. Morrow said.
Specific to the role of surgeons in the management of breast cancer, Dr. Morrow’s award lecture (to be delivered at the 2012 Breast Cancer Symposium in September) will focus on how improvements in nonsurgical treatment modalities offer the opportunity to revisit questions regarding the optimal use of surgery in breast cancer management.
According to Dr. Morrow, successes in targeted therapies and improvements in chemotherapy have not only improved overall survival, but have also improved local therapy outcomes and should infl uence the extent of surgery that is required to manage the disease.
The question for surgeons becomes how best to take advantage of these effects so as to decrease the morbidity of surgery without sacrificing the improvements in outcome that have been achieved.
“Although we sometimes lose sight of this fact, surgery still cures more cancer than anything else so in that sense it’s a very rewarding field to be in,” Dr. Morrow concluded.
The Gianni Bonadonna Breast Cancer Award and Lecture and the Gianni Bonadonna Breast Cancer Research Fellowship are supported by a grant from Glaxo- SmithKlineOncology.