On the Front Lines of Breast Cancer: Dr. Lisa McGrail
Dr. Lisa McGrail has spent her career on the front lines of cancer—both literally and figuratively.
After going through medical school at Georgetown University thanks to a military scholarship, she spent 11 years serving as a general oncologist for the U.S. Army, where she discovered her second professional love: research around how vaccines can be used in breast cancer treatment and recovery.
Her first love? The patients. Now that McGrail has finished her duty, she splits her time between giving her patients at The George Washington University’s Breast Care Center the best in holistic care and working on clinical trials to make the experience of fighting breast cancer a better one. In other words, not only is she on the forefront of the coolest new technologies in breast cancer care and recovery, she’s also not afraid to tout the importance of basic things like diet and exercise to improve patient outcomes.
This Breast Cancer Awareness Month , we sat down with McGrail to chat about her career path, her fascinating research, and what it’s like to work with cancer patients day in and day out.
What did you want to be growing up, and what ultimately led to you to want to go into medicine?
I started out as a little kid wanting to be a doctor, mainly because that’s what I saw on TV, but nobody in my family was in the medical field, and I didn’t really have any role models. When I went to college, I was an English major and liked writing, and I loved things like Sherlock Holmes and mysteries, so I wanted to be an investigative reporter for a little while. I went from that to wanting to be a lawyer—a criminal type lawyer. And from there I circled back around again.
I kept coming back to the whole investigative thing, and that’s how I got hooked on science—because science is about discovery and figuring things out. By the time I graduated college, I knew that I wanted to go into medicine and science.
What drove you to specialize in oncology—the treatment of cancer?
I think it was the patients. When you finish medical school , and you do an internship and residency, you start to understand the patients a little better—why people are coming in and what you’re good at. I really liked the continuity of oncology care. I liked the fact that you get to know not only the patients, but also their families and friends: You really became part of their community. And I like to think of my patients as people and not just as patients, and I like to see them over the years and feel part of helping them at a time when they really needed it.
The research you’re doing with vaccines seems fascinating—can you tell me more about that?
The interest began with a gentleman named Dr. George Peoples who, during my time working for the military, had this idea that he could create a vaccine that would help women who’ve already had breast cancer continue to remain disease-free. For women who’ve been treated, they carry a certain degree of risk of a recurrence, so the idea behind the vaccine is that it’s a peptide—which is part of a protein that’s on breast cancer cells—and when you give that to a woman, you stimulate the immune system to create antibodies against it. And the hope is that that immune system will have memory so that, if in the future any of those cells were to come back, the immune system would remember that cell and attack it.
It’s really a new way of approaching the disease. I like the idea of a woman’s own body being able to fight off the cancer, because I like a really holistic approach to treating cancer. I hope that in years to come we’ll find that chemotherapy is barbaric and we’ll find that there are more targeted agents, holistic approaches, vaccines, and different immunotherapies that are going to be able to cure this type of cancer versus the toxic chemotherapy that we use today.
That’s the association that I made when I was in the military. I was not in the lab, but I respected what was happening in the lab and wanted to bring that into the clinic. So my role was to recruit patients to the studies, to get the word out, and to be able to offer that therapy to my patients. And I still do that now. The study we’re currently doing has matured from that and is still with the same group.
You mentioned this holistic approach to cancer treatment. What does that mean on the ground when you’re treating your patients?
I like to be able to use integrative medicine. I don’t like the term “alternative medicine” because that implies that you’re not going to use treatments that we know will work—the standard treatment. I think of it more as “complementary medicine” or “integrative medicine.” It’s a practice we employ at GW, and it is a philosophy that I have developed over the years from learning through patients.
The idea is that what we do in our everyday lives is really important. So I certainly don’t recommend that anybody forgoes the standard treatment—whether that be chemotherapy, radiation therapy, or hormonal manipulation—but I think that in addition to that, there’s a lot that we can do to help prevent breast cancer recurrence.
For example, I recommend that my patients exercise; there are studies that show that active survivors have a 50% decreased chance of recurrence than sedentary survivors. So I stress that to patients and help them on the road to figuring out ways they can fit exercise into their lifestyle. We also talk a lot about diet. And then other lifestyle things like limiting alcohol and stress. Things that I think keep people calmer, stress-free, and exercising. Making lifestyle changes after the diagnosis of breast cancer is really important.
What does your day-to-day look like?
My day-to-day is pretty busy. It mostly involves patient care—that’s really what I focus on. I probably spend about 30% of my time on research, which mostly involves reviewing protocols, going to the Institutional Review Board, getting consent forms together, and enrolling patients. Occasionally I’ll also give talks to patient groups or to medical students—we try and keep folks educated.
Part of my time is spent going to what we call a tumor board. I work very closely with the surgeons—we meet once a week and we review every new case. We’ll sit down around a big conference table and the radiologist will put up the films of the mammograms and the ultrasounds for all of us to take a look. The surgeons will review them and talk about the operation they performed on that patient. Next, the pathologists will show the slides, and we’ll actually see what was on the mammograms. And then the medical oncologists, myself, and a few others discuss what we think should be done at this point. We also have dieticians, patient navigators, sometimes some of our integrative medicine practitioners, and social workers present. We come up with a plan for every patient that everyone agrees upon. So it’s a very collaborative effort, which is really what you need when taking care of breast cancer patients. Each woman really needs to have a team of physicians and support staff around her.
What would you say is the hardest part about your job?
I think the hardest part is when a patient is not doing well or when something happens. It’s difficult to have to confront our limitations. I’ve had patients who did wonderfully in treatment, who have been doing well for years, and then all of a sudden develop metastatic disease.
The hardest part is having to tell your patient that and then tell your patient’s family. That’s the worst part, and that’s the part you take home with you. You don’t just forget about that—it weighs on you. And that’s the type of scenario the vaccine is aimed at preventing.
How do you push through that and keep going every day?
It’s hard! My motto, and the way that I like to carry myself and present myself to patients, is first and foremost to be honest. You can’t try to sugarcoat it; you just have to be honest about it. And then I think after honesty comes humor. You have to be able to find something to laugh at—something, somewhere. And then after that its hope, and I always try to give my patients hope, no matter what.
What advice would you have for someone wanting to devote his or her career to cancer?
I would say just to stay with it, to not get discouraged, to remain hopeful, and to remember what you’re doing it for. The patients are people just like everybody else—they could be the people in your life. Most of the time there’s no reason that one person has cancer and somebody else doesn’t.
And, finally, that we will be able to figure this out. So just stick with it, remain hopeful, and work hard.
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