NCI Director Monica Bertagnolli has breast cancer

Monica Bertagnolli, the 16th director of the National Cancer Institute, announced that she will be undergoing treatment for early-stage breast cancer.

Bertagnolli is the first woman and the first clinical trials cooperative group chair to be named to the NCI directorship. With this disclosure, Bertagnolli also becomes the first NCI director publicly known to have been diagnosed with cancer and undergoing treatment while running the institute.

Bertagnolli told her personal news to NCI staff at the town hall meeting, her first, on Dec. 14.

“If anything, I have more motivation to get up every morning to keep doing what I do. I may need some time off to rest here and there, and I am grateful for wonderful colleagues on the NCI leadership team who have already expressed their support,” Bertagnolli said to The Cancer Letter.

“From a more philosophical standpoint—I imagine my treatment will deepen my empathy for what people with cancer go through. It will be a personal experience, but also somewhat of a shared one, because I’m choosing to be public about it.”

Bertagnolli said the cancer was found during routine screening after Thanksgiving and her treatment planning is ongoing. She is, quite literally, going on a clinical trial while also revamping the clinical trials enterprise.

“Yes, I have enrolled in a clinical trial—a diagnostic trial,” Bertagnolli said. “One of the things I’m particularly grateful for is that the evidence from my experience, that will be contributed to advance research in diagnostics, is supported by NCI trials. One of the things I asked my care team is whether there are any trials I’m eligible for, and I will happily participate.”

Bertagnolli was tapped for the NCI job in July and reported to work on Oct. 3 (The Cancer Letter, July 21; Aug. 10; Oct. 7, 2022).

At the time of her appointment, Bertagnolli was the group chair of Alliance for Clinical Trials in Oncology, Richard E. Wilson professor of surgery at Harvard Medical School, and chief of the Division of Surgical Oncology at Brigham and Women’s Hospital.

Bertagnolli came to NCI at an unprecedented moment in oncopolitics. FDA, NCI, academic oncologists, advocates, and the industry are in agreement on the need to streamline the process of development, testing and approval of cancer therapies.

Bertagnolli’s arrival at NCI has increased the urgency of change. Her impact at the institute and beyond was felt immediately, and recent weeks have brought fundamental changes in the way some oncology drugs are being developed.

The 2024 NCI Bypass Budget, published Sept. 15, is asking for additional $1.166 billion for new initiatives and $1.272 billion for “revolutionizing cancer clinical research” (The Cancer Letter, Sept. 16, 2022).

At this time, attention is focused on Pragmatica-Lung, a trial that is about to be launched by SWOG Cancer Research Network (The Cancer Letter, Dec. 2; Dec. 9, 2022). Pragmatica-Lung is intended to serve as proof of concept as well as provide a template for commercial drug sponsors to launch their own pragmatic trials. Whether conducted by NCI or the industry, these trials can span a broad range of indications.

“Having been an oncologist my entire career, it was always—and still is—all about the patients and survivors for me,” Bertagnolli said to The Cancer Letter. “It’s one thing to know about cancer as a physician, but it is another to experience it first-hand as a patient as well.”

Bertagnolli responded to questions submitted by Paul Goldberg, editor and publisher of The Cancer Letter.

Paul Goldberg: Monica, I am sorry to hear about your diagnosis. I have seen [FDA’s] Rick Pazdur become an advocate after Mary became ill (The Cancer Letter, Dec. 4, 2015). Do you think this experience will affect your stance toward this job? Is being both a physician and a patient different?

Monica Bertagnolli: Toward the beginning of my career, after I finished medical school and training and was a brand-new doctor, I had the chance to work with and learn from the great Marshall Wolf, at Brigham and Women’s Hospital.

I remember when I would ask him how’s he doing, he always used to say, “Every day I walk into this hospital and I’m the doctor—instead of the patient—is a really good day.”

So, I have been hearing that since I became a brand-new doctor—that we are also human, and we are not fundamentally different from the people that we care for just because we are on the provider side of things.

I’ve come to realize that we all become a patient—someday, sooner or later. It doesn’t matter if you are a doctor, a nurse, a student, caregiver, professor. The patient experience is something that I think everyone goes through in life—although each individual’s experience is unique, especially when it comes to cancer.

From a practical standpoint, I don’t anticipate that my stance toward my job as NCI director will change much. I am going to keep doing what I have been doing to lead the agency in carrying out the National Cancer Program and bringing along partners in our collective action against cancer. Nothing different there.

If anything, I have more motivation to get up every morning to keep doing what I do. I may need some time off to rest here and there, and I am grateful for wonderful colleagues on the NCI leadership team who have already expressed their support.

Might this also be a teachable moment? Imagine if I had delayed my routine screening appointment, or not gone at all? The situation may have been worse. I am grateful that I had access to effective screening and caught this early. I think it’s an important message that we clinicians practice what we preach.

From a more philosophical standpoint—I imagine my treatment will deepen my empathy for what people with cancer go through. It will be a personal experience, but also somewhat of a shared one, because I’m choosing to be public about it.

Having been an oncologist my entire career, it was always—and still is—all about the patients and survivors for me. It’s one thing to know about cancer as a physician, but it is another to experience it first-hand as a patient as well.

I tend to find bright spots in every situation, and it has served me well in my career so far. A bright spot in this is that I am sharing this experience of a cancer diagnosis and treatment with people in a way that I wasn’t able to before. I want to say to anyone with cancer today: you are not alone, and I am truly in this together with you, even more than before, if that is possible. It further confirms why I wake up every day passionate about what I do.

Might this also be a teachable moment? Imagine if I had delayed my routine screening appointment, or not gone at all? The situation may have been worse. I am grateful that I had access to effective screening and caught this early. I think it’s an important message that we clinicians practice what we preach. 

This reminds me of a talk I gave—the presidential address at ASCO in 2019. There was an interactive moment where I asked the audience to use a web-based word-cloud generator by submitting a few words or phrases that describe who they are, where they are from, what they do, etc.

Do you know what the biggest word was?

“Survivor.”

It was an auditorium full of oncologists, researchers, providers—colleagues that we work with every day, and so many identified themselves as survivors. It shouldn’t have surprised me, but it did.

Some people choose to be open about their stories, and some are so private that you might never know they ever had a diagnosis.

The point is, there are so many survivors and patients around us—they are our neighbors, our colleagues, our family, our community members, etc.

I want them to know that they are not alone, and that NCI is doing everything we can to work together—with all of society—to help more people with cancer live the full and active lives they deserve.

There is no requirement for you to discuss this at all, but you are the NCI director—so it could be another opportunity to lead. What is the diagnosis: stage, pathology, etc.?

MB: I have the most common type of breast cancer for someone my age—hormone receptor-positive, HER2-negative. The cancer is considered treatable and has a very favorable prognosis, with a high survival rate.

I expect to continue in my role. I’ll be on leave as needed, with some extra support from the overall leadership team. I’m grateful for the support I’ve already received from the leadership team at NCI. And I’m really grateful for all of the bright minds and big hearts that I get to work with every day.

When did you get the diagnosis? If it’s none of my business, it’s none of my business. Will you be going on a clinical trial? Which one? If you are going on a clinical trial, why did you choose the trial you chose? Is it an Alliance trial?

MB: I went in for my routine screening just after Thanksgiving.

Yes, I have enrolled in a clinical trial—a diagnostic trial.

One of the things I’m particularly grateful for is that the evidence from my experience, that will be contributed to advance research in diagnostics, is supported by NCI trials. One of the things I asked my care team is whether there are any trials I’m eligible for, and I will happily participate.

As you know, I am and have been a big proponent of data sharing—and so I am especially grateful to be able to do that as someone providing data from my experience to contribute to research on better ways to diagnose cases in the future. Early diagnosis is so important.

I can say that from personal experience now.

What will the treatment be? How will it affect travel? Is travel even needed? If you don’t yet know the answer, I understand.

MB: I’m still waiting for additional tests to determine my treatment plan which will likely include surgery and some systemic therapy.

Thank you so much for talking to us about this.

MB: Thank you.