Fighting the Odds to Help Others Fight Cancer
MPH, ’97, Epidemiology, MD, ’89 Director of the Division of Cancer Prevention and Control, Centers for Disease Control and Prevention
July 3, 2018, Alumni, Epidemiology, Cancer, Chronic disease, Epidemic, Health Disparities, Innovation
My whole life I've wanted to be a doctor. Growing up in rural North Carolina, I was without African American role models who were physicians. In truth, I had low odds of leaving that community for any type of profession.
In elementary school, I loved reading biographies and read one about Elizabeth Blackwell, the first woman to receive a medical degree in the US and the first woman on the UK Medical Register. The way Blackwell beat the odds in order to help people was inspiring to me. I told my family I wanted to go into medicine, and they supported me.
I experienced that same feeling of community when I got to Michigan—that I had arrived in the right place and that I belonged here.
I did my undergraduate work at UNC Chapel Hill and I did well enough to get into UNC's medical school. In medical school my passion really came out, and it inspired my own academic performance. I finally found my community and knew I was in the right place. And I used that to propel myself.
As part of my post-fellowship training, I participated in the Robert Wood Johnson Clinical Scholars program at the University of Michigan. The Clinical Scholars program trains physicians in academic and public health leadership roles. This is where my deep interest in epidemiology started, and it led to me pursuing a master's degree in Epidemiology at the University of Michigan. I experienced that same feeling of community when I got to Michigan—that I had arrived in the right place and that I belonged here.
The program challenged us to think critically about problems and to ask questions beyond the person in front of us, questions we might not think to ask—about geography, socioeconomic status, mental health, access to medical care, and so on.
I began asking myself why black women died more frequently from breast cancer than white women and why black women lived shorter lives after a breast cancer diagnosis than the general population. As a clinician, it's possible I would have asked these questions myself, but with public health training, I knew they were questions that had to be answered and I knew how to make them into research questions. And the questions helped me begin connecting the dots between cancer and race. I knew the impact of my work would be wider in public health.
As director of the Centers for Disease Control and Prevention's Division of Cancer Prevention and Control (DCPC), I provide leadership for all scientific, policy, and programmatic issues related to four national programs: the Colorectal Cancer Control Program, the National Breast and Cervical Cancer Early Detection Program, the National Comprehensive Cancer Control Program, and the National Program of Cancer Registries.
The National Breast and Cervical Cancer Early Detection Program began in 1992, and I was its first medical director. We offer screening services to low-income, uninsured, and underserved women, giving them access to timely breast and cervical cancer screening and diagnostic services and treatment through Medicaid.
I've been at the CDC for 18 years and in the Division of Cancer Prevention and Control for 14 of those years. As director, I oversee everything in the division. It is a lot of administrative work, so I stay current by connecting with staff who engage directly with state health departments. And I encourage all of our staff to get out of Atlanta to see how work is done on the ground. I continue to see patients at the Veterans Affairs Hospital in Atlanta, which helps me remember why I'm here and whom I'm serving.
I oversee our research program as well, and this research is very important. But we have to ensure that we are not just talking to ourselves in public health. It is counterproductive when we get caught up in our own lingo. What does "evidence-based" mean, and what does it have to do with medicine and policy? What does all of that have to do with politics? We have to use the best information—research-based but also just basic, everyday language—to promote the best outcomes as we see them. If people don't understand what we're doing, they might not support our work nor take action to improve their health. They might not engage with what we produce—information and ideas that could make them and their families healthier.
The odds might have been against me, but I am now helping to lead public health in cancer control research and prevention forward into innovative, new frontiers.
The most important work in cancer research today is in communications, and I think we're about to take a huge step toward better translating our work into plain language—with accessible resources—for the public to use. I am leading the development of a very exciting and innovative project: an avatar named Linda. Linda is a 5-year cancer survivor who has been treated for triple negative breast cancer. She can explain her experiences with chemotherapy and answer women's questions in a non-threatening way. Linda is not a replacement for the medical team, but she is able to answer questions at the patients' pace in a low-pressure setting. She is always available when patients have time—so she provides expanded accessibility for those who work long or unusual hours.
Avatars are now being developed for government agencies, provider organizations, and research organizations like the Robert Wood Johnson Foundation. Avatars are an important development in precision health, at least in oncology. They are a precision communication technology that helps us identify the individual needs of cancer patients. Applied in treatment settings, avatars can help us improve outcomes. In prevention settings, avatars help us share messages about public health and behavior change that resonate and empower people to manage their health. In both settings, we get a little closer to conquering cancer.
The odds might have been against me, but with family support, great educational opportunities, and my own talent and singularly focused drive, I am now helping to lead public health in cancer control research and prevention forward into innovative, new frontiers.