Monday, December 1, 2008
Carol L. Brown is the director of Memorial Sloan Kettering’s Office of Diversity Programs in Clinical Care, Research, and Training.
Gynecologic oncologist Carol L. Brown is a surgeon with a lifelong interest in the reduction of healthcare disparities among underserved populations. As director of Memorial Sloan Kettering Cancer Center’s Office of Diversity Programs in Clinical Care, Research, and Training, she oversees initiatives to make the Center a leader in decreasing and eliminating these disparities as they relate to cancer.
Growing up in Los Angeles, I became interested in medicine because my father was a physician. He also was influential in my decision to devote my career to addressing healthcare disparities. He was one of the first black surgeons to open a practice in the city in the 1950s, and he later helped establish the first hospital in an underserved area in Watts in 1972. I remember being at the ribbon-cutting ceremony as a girl, and it made a big impression on me. Throughout my career, my father and I remained close, and he continued to provide important guidance about my work in medicine until he passed away a few years ago.
By the time I entered medical school at Columbia University, I’d decided I wanted to be a surgeon but hadn’t settled on a specialty. A mentor noticed that I liked taking care of people over a long period of time, and thought I wouldn’t be happy performing surgery on someone and then not seeing that patient again after the first postoperative visit. He suggested I consider gynecologic oncology, a subspecialty of obstetrics and gynecology (OB/GYN), where you do surgery and chemotherapy and care for patients throughout their lives. I chose my residency in OB/GYN at the Hospital of the University of Pennsylvania knowing that I wanted to be a gynecologic oncologist.
I came to Memorial Sloan Kettering in 1990 for a four-year fellowship and joined the faculty in 1994. During the next 11 years, while practicing as a gynecologic oncologist, I conducted laboratory and clinical research and worked with local and national organizations on health-policy issues.
In 2005, I was appointed director of Memorial Sloan Kettering’s new Office of Diversity Programs in Clinical Care, Research, and Training. [Memorial Sloan Kettering President] Harold Varmus recognized the importance of addressing disparities in cancer outcomes based on race, ethnicity, cultural differences, and socioeconomic status and the need to do so through an institutional program.
Cancer disparities exist in many forms. The disease affects various populations differently in terms of how commonly it occurs, survival rates, and the type of treatments that people receive. Among all major cancers — breast, lung, colon, prostate — people of lower socioeconomic status have worse outcomes. Part of this is lack of access to care and health insurance, but the disparities go beyond that. For example, black women have a much higher chance of dying from uterine cancer than white women and a much lower five-year survival rate, even when they receive the same care. So part of it has to do with tumor biology, molecular differences that vary with race and ethnicity. Scientists have found that different racial and ethnic groups may have gene variants that affect how they respond to treatments.
The Office of Diversity Programs has three major areas of focus: clinical care, research, and training. In the area of clinical care, we’re working to improve the Center’s screening, diagnosis, and treatment programs to ensure they reach medically underserved populations. A large part of this effort comes through outreach programs such as the Ralph Lauren Center for Cancer Care and Prevention, the Memorial Sloan Kettering Breast Examination Center of Harlem, and a partnership with the Queens Cancer Center.
The research component of the Office of Diversity Programs has two main objectives. The first is to ensure that medically underserved and minority populations participate in clinical trials. The other objective is to foster collaboration and communication among researchers at Memorial Sloan Kettering and other institutions investigating cancer health disparities.
The third focus, training, seeks to increase representation of minority faculty at Memorial Sloan Kettering, including both research scientists and clinicians. Right now, underrepresented minorities account for about six percent of all physicians in the United States but only two percent of oncologists. We’re encouraging young people from minority groups to go into research and medicine, and to choose careers in oncology. Memorial Sloan Kettering currently offers several programs through which medical students, undergraduates, and high school students work at the Center doing clinical and laboratory research. Through these programs, we hope to increase the pipeline of minority scientists and physicians who will work in oncology.
In addition to my role as director of this office, I continue to care for patients, participate in clinical research, and keep up my national activities to increase awareness and research funding for gynecologic and other cancers. Healthcare reform has become a national priority, and we need to make sure that providing access to high-quality cancer care for all is part of that reform. I see our efforts at the Center to reduce and eliminate cancer disparities as an important step toward this goal. I am proud that my career at Memorial has enabled me to follow in my father’s footsteps, both as a surgeon and as someone working to improve care for underserved populations.