For gynecologic cancer surgeon Carol Brown, a commitment to equity in healthcare was forged during her time as a medical student at Columbia University in the 1980s. In addition to being President of the Black and Latino Student Association and the first recipient of the Malcolm X Scholarship, Dr. Brown spent many rotations at Harlem Hospital where she witnessed firsthand the benefit of providing cutting-edge care to those who needed it most but had the least access.
“I was part of an all-Black team of exceptional physicians in the ICU treating a man in his 50s with an experimental medicine for his rare heart arrhythmia. It felt like we spent 18 hours a day at this one patient’s bedside fighting to keep his heart beating in a normal rhythm — fighting to keep him alive,” she says. “The quality of care he received saved his life.”
Dr. Brown says that experience and many others have convinced her that long-standing disparities in healthcare access and outcomes can be overcome. “With the right science and the right social support and the right tools, she explains, “you can change people’s lives, including people who for too long have not gotten the care they deserve.”
During her more than 25 years at Memorial Sloan Kettering, Dr. Brown has become a national leader in the effort to eliminate disparities in healthcare — particularly cancer care — based on race, ethnicity, or socioeconomic status.
In 2020, MSK made a major commitment to this issue by appointing Dr. Brown as MSK’s first Chief Health Equity Officer. “MSK is the leading cancer center in the world in terms of high-quality care and lifesaving research,” she says. “Our vision for the Office of Health Equity is to make sure MSK is also a leader in helping all people with cancer achieve the best possible outcome regardless of their race, ethnicity, gender identity, sexual orientation, physical ability, the language they speak, or their socioeconomic status.”
Cancer Disparities and a ‘Game Changer’
Despite some recent gains, long-standing disparities in cancer threaten the lives of far too many people. Dr. Brown says 2020 was a “game changer” and believes this tumultuous year “raised a new consciousness around the country and at MSK.”
First, COVID-19 revealed that health disparities — especially those based on race — could determine who lives and who dies, says Dr. Brown. Then, she says, “The deaths of people of color at the hands of law enforcement rocked our institution and our staff.” The result at MSK, says Dr. Brown, was that “the institution listened. This year the commitment to diversity, inclusion, and health equity has risen to a whole new level.”
She is also encouraged by the reaction of the larger MSK community, such as the endowment in December 2020 of the Nicholls-Biondi Chair for Health Equity at MSK by Jamie Nicholls and her husband Fran Biondi. Dr. Brown says, “The generous gift by Ms. Nicholls and Mr. Biondi inspires me and so many others at MSK who have worked to reduce and eliminate cancer disparities. It shows us that the goals of health equity we’re working towards can really happen.”
For Dr. Brown, the seeds of purpose were planted in her childhood. Dr. Brown was born and raised in Los Angeles where her father, Charles E. Brown, was one of the city’s first African American surgeons. When she was a young girl, Dr. Brown recalls that “he would talk a lot about the issues of healthcare access for Black people in South Central Los Angeles, so I learned about it at the dinner table.”
Her father also set a powerful example of how to create solutions: In the late 1960s and early 70s, he helped found the Charles R. Drew Postgraduate Medical School and Martin Luther King, Jr. General Hospital in South Central Los Angeles. She came to understand that her father’s efforts “showed that you could affect positive change and work with health systems and big universities to really solve problems for people despite the effects of racism on the healthcare delivery system.”
More Access, Outreach, and Insight
In her medical career, Dr. Brown has turned those life lessons into action. She explains that cancer inequities exist for many different reasons: “It may be about access to care or it may be about access to screening.” In other cases, she says, “cancer disparities may be the result of tumor biology that affect different populations of people in different ways.”
Dr. Brown plans to attack cancer disparities on all these fronts — and more. She will expand the existing Cancer Health Equity Research Program (CHERP) to include additional hospitals that provide cancer care for underserved patients in their local communities. Dr. Brown explains that “CHERP partners with dedicated community oncologists to bring MSK clinical trials to their patients in Queens and Brooklyn who otherwise may not have access to cutting-edge therapy.”
For example, hundreds of underserved patients have benefited from MSK IMPACT™, a test that analyzes more than 500 genes to find tumor mutations that are vulnerable to particular drugs. It helps identify patients eligible for clinical trials or therapies they would not otherwise have access to.
She also wants to help people avoid cancer in the first place as well as provide MSK care to less-advantaged people when they are newly diagnosed. One of her efforts focuses on endometrial cancer. “The incidence and mortality for this kind of cancer has been rising rapidly over the last four to five years,” says Dr. Brown, “and the difference in outcome for Black women is actually getting worse compared to white women in the United States.”
To help, Dr. Brown is leading efforts to educate Black women about their risk of endometrial cancer and the importance of getting evaluated for its most common symptom: abnormal bleeding. She explains that “one hypothesis about the lower cure rates experienced by women of color is because Black women tend to get more aggressive types of endometrial cancer.” Dr. Brown says, “We want to make sure the women most at risk for this disease have knowledge about their risk and access to treatments and research at MSK that really make a difference, including immunotherapy and targeted therapy.”
The Road Ahead
After decades of working to reduce cancer disparities, Dr. Brown knows better than anyone how many challenges lie ahead. Too often, she says, “MSK has been perceived as a place that’s hard to get into — that it’s not accessible.” She wants MSK “to become known as a place that’s welcoming to people from every walk of life and that reaches out to help underserved communities that suffer disproportionately from cancer.”
To achieve that goal, she will draw on the same determination and compassion that helped save a desperately ill man so many years ago — and has helped forge a career devoted to helping everyone receive the care and respect they deserve.