In her latest column, Daphne Koller discusses the forefront of breast cancer research and treatment with Dr. Anees Chagpar, Director of The Breast Center at Yale's Smilow Cancer Hospital. Through Yale University, Chagpar teaches an Introduction to Breast Cancer course offered on Coursera.
Dr. Anees Chagpar holds more job titles currently than most people do in a lifetime--among them are professor, surgeon, radio show host, researcher, writer and medical director. A world-renowned breast cancer expert whose experience spans all of these fields, Dr. Chagpar has applied the knowledge gained from her multifaceted experience to drive innovation and change within the healthcare space.
In addition to her bachelor's and MD, Dr. Chagpar went on to receive degrees in surgery, public health, bioethics and, most recently, an MBA, to fight breast cancer from a variety of angles. Now, as one of the world's preeminent breast cancer scholars and educators, she's sharing her insight in hopes of promoting a greater understanding about the nation's most common female malignancy--and maybe even coming one step closer to finding a cure in the process.
I recently sat down with Dr. Chagpar to discuss cutting-edge research taking place today, emerging healthcare technology and the innovators who will build on these advances.
Breast cancer has picked up a lot of awareness over the years. What advancements have been made since you first started studying breast cancer nearly two decades ago?
If you actually plot out all the innovations that have been made since the 1800s (back when breast cancer was treated with a radical mastectomy), the rapidity with which we're having these breakthroughs is unprecedented. And it's happening across all medical disciplines. The emergence of mammography allowed us to find breast cancers you couldn't feel, which led to earlier diagnosis and treatment, and has really improved survival rates. With surgery, we've been able to master techniques that are much less invasive while still having the same, or even better, outcomes. And from an oncology perspective, we've seen a dramatic improvement in the ability to tailor therapy to the individual.
What about some of the newer innovations? Are there any emerging technologies you're particularly excited about?
Genomics is one thing that comes to mind. It's been critical in helping us improve personalized medicine. Now, when we do a biopsy, we can figure out which genes are contributing to it and then decide what kind of treatment people will respond to best, whether that's chemotherapy, radiation, surgery, etc. 3D mammography is also taking off. It allows us to see cancers better, more accurately and reduce costs. I think immunotherapy--harnessing your immune system to fight cancer--shows a lot of promise too.
What do you think has contributed most to these recent advancements?
Clinical trials have made an enormous difference across every aspect of breast cancer management, but there's still fear associated with them that we need to alleviate. In the past, nightmares like the Tuskegee Syphilis Study have scared people away, especially minority patients. There's a fear among patients that they'll be treated like guinea pigs, placed on placebos or actively have their health threatened, but intense regulation has resolved those issues. Now, people who participate in clinical trials tend to do better than those who don't, and they've also helped us discover the newest and best treatments, so I'm a strong advocate for that.
Beyond the new technologies available, how have approaches to treatment evolved?
I think there's much more of an emphasis on driving down costs. It's not just about how we can do better anymore--it's about how we can do better for less, and derive the most value from our efforts. I think affordability is going to be the next big wave of innovation in healthcare. As time goes on, technological gains become more and more incremental unless they can be efficiently scaled. Fortunately, there are plenty of existing business principles we can use to create a leaner process. That's a crucial component when it comes to addressing breast cancer on a global level.
Interesting--what does breast cancer treatment currently look like from a global perspective? What are some of the uniques challenges it presents?
Traditionally, a lot of global health organizations have focused on communicable diseases like AIDS, malaria and tuberculosis. We've come a long way in treating those--now, more lives are lost due to cancer than all three of those diseases combined. So I think it's time to refocus our international healthcare efforts on cancer. We can have a tremendous impact, especially in low- to middle-income countries. In India, for example, about 87 percent of patients present with either stage III or IV breast cancer. In the US, however, the vast majority of patients present with stage I disease, which has over a 95 percent five year survival rate. It's clear there's a large opportunity for improved early diagnosis--even a small dent in that 87 percent will translate to a tremendous amount of lives saved. But there are significant challenges that come along with that. You can't just put a mammogram machine in the middle of rural India. You need to think about healthcare infrastructure, cultural values, transportation... everything that might prevent access to treatment.
How do you think we can start to solve some of those bigger structural problems moving forward?
The most important thing we can do is promote a holistic understanding of breast cancer. Entrepreneurial spirit is key, but it needs to be balanced with a well-rounded understanding of the disease. I once had some MBA students come to me with an idea that was really great on the surface: utilizing blind people, who may have better tactile sensation, to perform breast exams in India. This was a fantastic idea from an economic and cultural standpoint, but it overlooked the fact that the most aggressive form of breast cancer often presents as a redness of breast skin with no mass at all, so visual cues are critical. To come up with an effective new approach in the fight against breast cancer, you really need to have thought about every piece of the puzzle. That's a big task.
What's your advice to innovators who want to be at the forefront of advancements in the healthcare field?
Don't let anybody tell you that you can only do one thing at a time. You can do anything and everything you want to, because you're the master of your own destiny, and the CEO of your own life. You get to decide what your mission is and how you're going to achieve your objectives, then go for it.
On my end, I've taken every opportunity possible to explore the different facets of breast cancer, from research and surgery to bioethics and finance. I like to say I'm addicted to education--in addition to my degrees, I've also taken a handful of Coursera courses on negotiation, improving healthcare systems and strategic planning to learn as much as possible about my field. Now, I'm not smart enough to figure out all of the solutions on my own, but I'm willing to bet there are a lot of people in the world--and hopefully, even in my online course--who are. And I hope those folks will join the cause.