Melanoma is a complex disease. Through her nearly 30-year tenure, surgeon Mary Sue Brady — one of the first female surgeons on Memorial Sloan Kettering’s staff — has seen major changes in the treatment of this illness. Here, she tells us what’s different now, both in caring for patients and in her own life as a surgeon.
How has caring for people with melanoma changed since the beginning of your career?
Overall, deaths from melanoma are going down. That’s attributable to early diagnosis and awareness, both by doctors and patients. People are more aware of the risk factors now. If you have red hair, blue eyes, or fair skin; if you sunburn easily; if you have a family history of melanoma; if you’ve had skin cancer — those are the things that should get you to a dermatologist for a checkup.
Immunotherapy is also very exciting. When I started in melanoma, there was surgery. That was all we could do. We tried all these other things in the past that didn’t work: vaccines, interferon, autologous vaccines made from the person’s tumors. For decades, nothing worked. And we didn’t have adjuvant therapy, which is treatment after surgery. So it was this horrible wait for a semi-inevitable recurrence in many cases.
Now, people can get adjuvant therapy with an effective immunotherapy that has a pretty low risk of side effects. Psychologically, that’s huge. And we’re not going back. We’re going to get better and better drugs, better combinations, and hopefully someday we’ll be able to skip surgery altogether. That’s the way it’s going. Surgeons have to try to put themselves out of business. If you’re not trying to put yourself out of this business on some level, you’re in the wrong profession.
What drew you to becoming a melanoma surgeon?
It’s hard to articulate why you choose a certain specialty. But my daughter phrased it best recently. She’s in medical school now, and she rotated through the neurosurgery department and loved it. She said to me, “Mom, I think I’ve found my people.” And that’s very much what it was for me — I found my people. Surgeons share the same kind of mind-set, the same mentality, are passionate about the same things and interested in the same things. We speak the same language. In surgery, I never look at the clock. The hours fly by.
I graduated from medical school in 1983 and did my fellowship training at MSK in 1988. I did some research on melanoma in the Sloan Kettering Institute during my fellowship, so specializing in it as a surgeon was sort of a natural segue. Melanoma is a fascinating disease. As a surgeon, you treat all kinds of people — young people, old people, both genders, all parts of the body — so I like that. I like the aesthetic part of it, too, where you really try to minimize the physical impact of what you’re doing for patients.
I also just have a surgical personality. I like to get things done. I don’t like using extra words in sentences. I like to communicate with people effectively and have them communicate with me effectively. I love to work with my hands. I love the operating room. It’s a sacred place for me.
What’s kept you at MSK for so long?
The people are what’s kept me here — staff, colleagues, patients — and the ability to do research. Anything you want to study, you can do it. That was really key. I’ve always been fascinated by the idea of lymph node metastasis in melanoma, when cancer spreads to the lymph nodes. I’ve been able to do so many studies with fellows and residents, trying to sort out what lymphatic metastasis really means. It has been extremely rewarding and great fun. I love watching a fellow’s expression as I propose a question to study. They might look puzzled or skeptical, but then we look at the data and often find that the question was indeed valid and helped bring us closer to understanding the role of lymphatic spread in melanoma.
The other thing that has kept me here is the expertise of people across specialties. Particularly as a melanoma surgeon, you need a really good dermatopathologist to accurately diagnose the disease. Sometimes patients will say to me, “Should we get another opinion about our slides or our pathology biopsy?” And I’ll say, “No one is as specialized as MSK.” How cool is that? We have a lot of resources that not everyone enjoys, particularly human resources. Patients pick up on that.
Also, the culture is wonderful. I would have trouble working at a hospital with a different culture. At other places, people do the nine-to-five thing. Nobody at MSK has that attitude. It’s like, how can I help you? It makes a huge difference.
What’s changed at MSK during your time?
Taking care of patients has become easier. I used to spend a lot of time trying to find information that now I can just see when I sit down at my computer.
The other thing that I love is having female colleagues. I didn’t have any female colleagues for years. I never made a big deal out of that. When I said I found my people, that’s really true. But when I became a young attending surgeon and I started to experience a lot of the pressures of work and family, I didn’t really have anyone to share that with. It was very lonely.
I didn’t realize I was lonely until I went to a professional meeting for women in academic surgery. All of a sudden I was surrounded by all these women, and I had the best time. It was just so fun. I didn’t realize what I was missing. But now we have so many wonderful women on staff that I don’t feel that way anymore.
Do you think women in medicine still face those same pressures?
When it comes to being a medical professional and being a mother, it’s very hard to do both well. Young surgeons face a lot of that pressure. How do you have a life and a family and become really successful in academic medicine? You need a lot of help at home, but even with that, you can’t hire somebody to emotionally support your kids. It’s a complex undertaking in today’s world to raise children. They face a lot of pressures that I never faced.
I’m married to a very busy surgeon, and of course he would step in to take care of the kids if he needed to. But when it comes to being there for my kids — say, if they’re struggling at college and I need to pay a visit — no one else can do that. You can’t sign out the mother thing. Jackie Kennedy said it best when she said that if you don’t raise a child successfully, nothing else matters.
Some things are definitely changing, though. Before, there was this idea that if you’re a woman, you’re distracted by family. That has to get fixed. The young women around me now are doing that. A lot of institutions have made real progress in terms of delaying the promotion of women until after their childbearing is complete, or considering other factors besides how many papers they’ve published or how many grants they have. But there’s still progress to be made.