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The Washington Post – For new NCI director, work turns personal: She is diagnosed with cancer

The Washington Post – For new NCI director, work turns personal: She is diagnosed with cancer

Last summer, when Boston cancer surgeon Monica M. Bertagnolli heard she might be selected to lead the National Cancer Institute, she asked a friend whether she would be able to do the job.

It was a disarming display of humility from an accomplished professional who has removed gastrointestinal tumors as big as pumpkins and herded not only Black Angus cattle on a Wyoming ranch but also thousands of strong-minded oncologists conducting clinical trials. Bertagnolli said her friend gave her a vote of confidence, adding, “You are kind of annoying — you never take no for an answer.”

In October, Bertagnolli became the 16th director of the cancer institute and the first woman to have the job. And then, just before Thanksgiving, her life took an unexpected turn: The 63-year-old Bertagnolli was diagnosed with early-stage breast cancer after a routine mammogram in Boston.

On Wednesday, Bertagnolli held her first town hall with thousands of employees, outlining her vision for the cancer institute and explaining her medical situation — topics she also discussed recently with The Washington Post. She made clear that while she will have to slow down from her ferociously rapid pace for a while, she expects the change to be temporary.

Bertagnolli has the most common type of breast cancer for someone her age — hormone receptor-positive, HER2-negative, she said. The cancer is considered treatable and has a very favorable prognosis, with a high survival rate.

She is still awaiting additional tests to determine her treatment plan, which will probably include surgery and some kind of drug therapy. She is being treated by doctors at Dana-Farber Brigham Cancer Center in Boston, where she was chief of surgical oncology for a decade.

Medications to block estrogen — a hormone that can accelerate tumor growth — often are prescribed for early-stage breast cancer, and chemotherapy is sometimes used as well. Treatment decisions are often based on a patient’s risk of recurrence.

Bertagnolli alludes to, but does not dwell on, the poignancy of being diagnosed with the disease just as she takes the helm of the nation’s biggest cancer-fighting enterprise, a $7 billion-a-year research operation. “I can’t imagine having this challenge, on top of a very important job, without the kind of support I have from an incredibly talented team” at NCI and from her physicians and family in Boston, she said.

“I really am just fine in getting everything accomplished,” she said. “We will take it as it comes.”

At the same time, she said, she is a realist.

An older doctor, she recalled, would greet physician colleagues each morning, saying, “Every day when I walk in here as a doctor and not as a patient is a great day.” From the very beginning, Bertagnolli said, “I always had it in my mind, yeah, one of these days I’m going to be a patient. We all are.”

Monica Bertagnolli is introduced during remarks by President Biden in August at the signing of a law that expanded health care for veterans exposed to burn pits and other toxic substances. (Sarah Silbiger for The Washington Post)
Herding cattle

Bertagnolli grew up on her parents’ cattle ranch in southwestern Wyoming, learning to ride and mend fences, 90 miles from the nearest town. She said her upbringing made her self-reliant but also sympathetic to the problems of rural health care, where someone who might have had a broken arm faced a long drive to get an X-ray.

She studied chemical engineering at Princeton University and graduated from the University of Utah School of Medicine, falling in love with surgery when she first walked into an operating room. She eventually focused on a rare inherited syndrome that leads to colon cancer and also concentrated on sarcomas, which are soft-tissue cancers that often wrap themselves around blood vessels or vital organs. She did in-depth training in tumor immunology — the relationship between the immune system and tumor cells — and became an expert on clinical trials.

At Dana-Farber, Bertagnolli was known as “a happy surgeon and a big-case surgeon,” willing to perform technically difficult, high-risk operations that other doctors turned down, said Atul Gawande, a surgeon and writer who trained under Bertagnolli.

Unlike in some operating rooms, where the mood was grim and tense, the atmosphere “in Monica’s was happy and weirdly comfortable and easygoing,” said Gawande, assistant administrator for global health at the U.S. Agency for International Development.

Bertagnolli said it was critical for her team — which sometimes numbered nine or 10, including surgeons, anesthesiologists and nurses — to be at ease during long, complicated operations: “You want everyone to feel comfortable and secure so that they perform really well.”

Bertagnolli became a surgeon when women were just starting to enter the field in substantial numbers, said George D. Demetri, a medical oncologist and director of the Sarcoma Center at Dana-Farber.

“It was really challenging for them, it was much more of an old boys’ club,” Demetri said.

While Bertagnolli often wears cowboy boots, she does not fit the stereotype of the brusque, swaggering surgeon, say people who know her.

“She is a surgeon without the personality of a surgeon,” said Ellen V. Sigal, founder and chair of Friends of Cancer Research, an advocacy group.

Gawande said he believes Bertagnolli’s 26-year-old son, Ben, who is autistic, is one reason she is unflappable.

“Ben teaches her every day,” Gawande said. “I think a huge amount of her centeredness and calmness comes from raising a child who is a joy and a challenge every day.” Bertagnolli and her husband have a second son, David, 23, who is in college.

Bertagnolli lives in Newton, Mass., with Ben and her husband, Alex Dannenberg, who is retired. She spends three days a week at NCI’s headquarters in Bethesda, Md., and the rest of the time works remotely. Ben “has a wonderful environment, and it was not possible for us to move,” she said. Besides, she said, she is used to taking the shuttle between Boston and Washington and does some of her best thinking “when I am commuting back and forth.”

On Tuesday, she got up at 3 a.m. in Boston so that she could be in Bethesda by the start of the workday. In the little free time she has, she enjoys whipping up traditional meals — she is part Italian, part French Basque — and tooling around in what she calls her “hot rod,” a 2007 Ford Mustang Shelby.

First lady Jill Biden and Monica Bertagnolli visit the Helen Diller Family Comprehensive Cancer Center at the University of California at San Francisco in October to highlight the administration’s cancer moonshot and advances in breast cancer treatment. (John G. Mabanglo/EPA Pool)
Lean and mean?

It was late July when Bertagnolli answered the phone to hear: “Would you please hold for the first lady?” Jill Biden, who like President Biden is heavily involved in promoting cancer research, came on the line and offered Bertagnolli the NCI job. In 2015, the Bidens’ son Beau died of brain cancer.

Like her predecessors, Bertagnolli faces big challenges, including prodding the sprawling cancer institute to move faster and more efficiently. As NCI director, she is a pivotal player in the White House cancer moonshot efforts to reduce the death rate by half in 25 years and accelerate treatments for a disease that kills 600,000 Americans a year.

“The big question for her is, what is the role of the NCI?” said a federal health official who spoke on the condition of anonymity because he did not have authorization to discuss the issue. “How do you make the NCI a more lean, mean machine?”

As Bertagnolli takes over the reins, she is making the streamlining of clinical trials a priority. The cancer field is awash in promising leads, she said, but cannot test enough of them because many studies are too complicated and costly.

“We have a fire hose that goes down to a garden hose,” she said. “There are so many trials that need to be done that many are waiting for their turn.”

Bertagnolli said she hopes to encourage more cancer patients, especially those in underrepresented groups, to take part in trials; participation is in single digits. Now that she is a cancer patient, she has signed up for a trial evaluating whether a new diagnostic test is helpful in selecting the appropriate breast-cancer treatment.

Paul Goldberg, editor and publisher of the Cancer Letter, a weekly publication on cancer research and policy, said a consensus has emerged at the cancer institute, the Food and Drug Administration, and in academia and industry that trials need to be overhauled.

“This is a movement, and she is one of the key leaders,” along with FDA’s cancer chief, Richard Pazdur, Goldberg said.

One of her major challenges will be trying to secure enough financial support to increase the number of research grants NCI can fund. Only about 12 percent of applications for grants are funded, and Bertagnolli wants to increase that to 15 percent by 2025, something that would require a major funding increase.

She will also be working closely with other health officials, including those in the White House office that coordinates the moonshot and in a new agency called Advanced Research Projects Agency for Health, or ARPA-H, which plans to do ambitious projects on cancer, Alzheimer’s, diabetes and other diseases. Congress created the agency this year to conduct high-impact research that cannot be easily done through traditional approaches or in the private sector.

Since starting at NCI, Bertagnolli has appeared on several public panels to discuss her new role. When her driver said she would be 15 minutes late getting to a recent conference sponsored by the Milken Institute this month, she said, “No worries. No one’s bleeding.”

As she awaits more test results, Bertagnolli is focusing on being a good patient — “Most doctors are terrible patients,” she said, laughing — and on relying on her upbeat nature. “I am very much a glass half-full person, a natural optimist at heart in all things,” she said. “And I hit things head on. I don’t try to run away.”