Conversations with the Pioneers of Oncology: Dr. Samuel Hellman
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Dr. Daniel F. Hayes is the Stuart B. Padnos Professor of Breast Cancer Research at the University of Michigan Rogel Cancer Center. Dr. Hayes\\u2019 research interests are in the field of experimental therapeutics and cancer biomarkers, especially in breast cancer. He has served as chair of the SWOG Breast Cancer Translational Medicine Committee, and he was an inaugural member and chaired the American Society of Clinical Oncology (ASCO) Tumor Marker Guidelines Committee. Dr. Hayes served on the ASCO Board of Directors, and served a 3 year term as President of ASCO from 2016-2018.
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The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnoses or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.
Hello. Welcome to "Cancer Stories." I\'m Dr. Daniel Hayes, a medical oncologist, and translational researcher at the University of Michigan Rogel Cancer Center, and I\'ve also been the past president of ASCO. I\'ll be your host for a series of interviews with the founders of our field.
Over the last 40 years, I\'ve been fortunate to have been trained, mentored, and inspired by many of these pioneers. It\'s my hope that through these conversations we can all be equally inspired, by gaining an appreciation of the courage, the vision, and the scientific understanding that led these men and women to establish the field of clinical cancer care over the last 70 years.
By understanding how we got to the present and what we now consider normal in oncology, we can also imagine and work together towards a better future, where we offer patients better treatments and we\'re also able to support them and their families during and after cancer treatment.
Today, My guest on this broadcast is Dr. Samuel Hellman, who is generally considered one of the fathers of modern radiation oncology in the United States and frankly, worldwide. Dr. Hellman is currently a professor emeritus at the University of Chicago Pritzker Medical School, where he served as the dean from 1988 to 1993. And he\'s been the A.N. Pritzker Professor of the Division of Biological Sciences. He\'s also served as the vice president of the University of Chicago Medical Center.
Prior to moving to Chicago in the late 1980s, he had previously been physician in chief and the professor of radiation oncology at the Memorial Sloan Kettering Cancer Center. He served there from 1983 to 1988, and he was also chair of the Department of Radiation Therapy at the Harvard Medical School, where he served as the co-founding director of the Joint Center for Radiation Therapy.
Dr. Hellman has authored over 250 peer-reviewed papers, and he\'s been one of the co-editors of one of the leading textbooks on oncology, Cancer, Principles and Practice.
Dr. Hellman has won many awards and honors, including being named a fellow of the National Academy of Medicine, formerly the Institute of Medicine, and of the American Association for the Advancement of Science. He is frankly, one of the few individuals to serve as president of both the American Association of Cancer Research and the American Society of Clinical Oncology, for which he was actually, I believe-- correct me if I\'m wrong Dr. Hellman-- the first radiation oncologist to hold that position, which he served in 1986 to 1987. Dr. Hellman, welcome to our program.
Thank you for having me.
I hope I got all that right. Your introduction has taken longer than some of the others. You have been so prominent in the field. I have a series of questions. The whole point of this is sort of like Jerry Seinfeld\'s Riding in a Cab with Friends. I\'ve always said, if I had an opportunity to right with some of the giants in our field, what would I ask them during a cab ride? So I get to ask the questions, and you get to answer.
I know you grew up in the Bronx. Can you tell us a little bit more about your background? I\'m particularly intrigued about the fact that a boy from the Bronx ended up at Allegheny College in Pennsylvania. Why\'d you go there? What was your interest? Was it always in science and medicine, or did you have something else in mind?
OK. Well, start with the Bronx. I was born in 1934 in the Bronx in a nice part of the city, which doesn\'t often go with descriptions of the Bronx today, but it was at that time. And about well, 1950, which was when I entered my senior year in high school, I had gone to high school at DeWitt Clinton High School.
And as I say, my senior year, we moved to Long Island, and I spent my senior year at Lawrence High School. The important part of this is that Clinton had about 4,500 to 5,000 boys, and Lawrence High School was much smaller and most importantly, coeducational, and that made me very much want to go to a smaller school for college and definitely one that was coeducational.
And so my mother and I took a little tour of colleges not too far from New York, but Allegheny was the farthest, I think. It\'s in Western Pennsylvania, very close to the Ohio border. And it was a beautiful day. I had a very nice two people showing me around, and I became enamored of the place. It was a very good fit for me, but I must say, my method was not a very analytic one, but that\'s how I got to Allegheny College.
And was science and medicine in your thoughts then, or did you have other things that you thought you\'d do?
No, no. I was a middle-class Jewish boy from the Bronx. You\'re programmed to be interested in medicine. The old comment was, you know what a smart boy who can\'t stand the sight of blood becomes? The answer is a lawyer. And I was not offended by the sight of blood.
So I actually heard about your decision to go to SUNY Upstate Syracuse and the serendipity involved. And I\'m always struck by how so many of us have what we plan and what we end up doing. Can you give us that story? I though it was really fascinating.
Well, I\'m not sure what part of it you want, but I went to Syracuse Upstate because I won a state scholarship, and I hadn\'t applied to any New York state schools. And fortunately, the medical school advisor and a former Alleghenian, who was at Upstate, arranged an expedited interview, et cetera. So anyway, that\'s why I ended there.
Why I ended up in radiation oncology--
Well, that was my next question is, how did we get lucky that you decided to go into oncology?
Well, I interned at Boston at the Beth Israel Hospital, which was essentially very oriented to cardiovascular disease. Our chairman was a renowned cardiologist. He was the first one to use radioactive tracers. He used radium, as it turned out, and there is an award given by the nuclear medicine society. Their big award, their annual award is the Hermann Blumgart Award, and Blumgart was my chairman.
And Paul Zoll, the external defibrillator inventor, was there. Louis Wolff of Wolff-Parkinson-White syndrome was there. So it was a cardiac place. And internal medicine was what I wanted to do, but my father was quite hard of hearing and had a lot of trouble making a living, because he was so impaired. And electronic devices, of course, weren\'t available at that time.
And it was widely thought that otosclerosis which is what he had, was a hereditary disease. And so I was discouraged somewhat from entering medicine, not being able to be sure I could use a stethoscope.
Parenthetically, I have never had any trouble, and the disease is no longer thought to be hereditary but rather the sequelae of infectious diseases, either diphtheria or influenza. This was the great influenza epidemic. The two, one of those two.
But anyway, that\'s what he had, so I sought to do something else. And I was a little bit put off by taking care of disease which we really could not alter the course of. We could modify it. We could palliate, but probably if I were more dexterous, I would have become a surgeon. But I wasn\'t, and so I decided I didn\'t know what to do. I\'d take a radiology residency and see where that led.
This was late in the year, and there were no radiology residences, literally, in Boston that were available. But a new chief had come to Yale, and he was starting a new program. And one of radiologists in a neighboring institute told me go there. So I did.
Well, he turned out to be a radiation oncologist, and he, Morton Kligerman and Henry Kaplan, were the two chairmen of departments of radiology who were radiation oncologists. And Henry had been at the NIH and got them to, with the National Cancer Institute, I guess, to start a fellowship program to encourage radiation oncology. And Kligerman applied for one, got one.
I was there. I was captivated by the opportunity to do some curative treatment. I was a chemistry major in college, and physics and chemistry were things I enjoyed. Sounded like a good choice, so that\'s what happened.
So there could not have been very many specific radiation oncology fellowship programs at that time in the United States. Is that true?
Yeah, very much true. The ones that stood out was, I say, Henry Kaplan\'s. There was a very good one at UCSF. And there was one in Penrose Cancer Hospital and one at the MD Anderson, and those were the ones.
So your decision to go oncology then, really your decision to go into radiology-- diagnostic radiology originally, sorry-- didn\'t sound like you were--
Not really. I took a radiology residency, because I thought it would be helpful whatever I decided to do. I really didn\'t expect to go into diagnostic radiology, but I figured that\'s something I could do. I didn\'t have much training or any training in that before. There was a great dynamic radiologist at the Beth Israel Hospital, and he captivated me. And so I figured, there\'s a lot to learn there, and I\'ll try it.
I think a lot of the younger doctors don\'t realize that the two were together for a long time. What\'s your perspective of the split between diagnostic and therapeutic radiology-- I\'ve actually heard you talk about this, so I think I know what you\'re going to say-- and bringing them back together?
Well, I was a great proponent of it. The whole fields are entirely different. But having diagnostic radiology is extremely helpful in radiation oncology, because we depend on images to determine how we treat, where we treat, and so forth, so it was there. But they were interested in entirely different things.
And just parenthetically, when I took the Harvard job, I wasn\'t going to take it unless I had a promise that we could start a Department of Radiation Oncology. Shortly after I came, and the decision was made with just a shake of the hand that, after a year or two, I\'d be able to do that, and that\'s what happened.
Actually, that segues into another question I had is I was looking over your background. I met you first when I was a first-year fellow at the medical oncology. That was 1982, by the way, a long time ago, when it was still the Sidney Farber.
And I\'d heard about your legendary efforts starting the Joint Center and also your teaching methods with your own residencies. But you were rubbing shoulders with Sidney Farber and Francis "Franny" Moore and Tom Frei. That must have been pretty intimidating for a relatively young guy trying to start a whole new department. What was the impetus behind that?
It was an interesting experience. Dr. Farber was, of course, the dominant figure in cancer at Harvard, and nationally, he was one of, if not the great leader. I mean, but he was a difficult man, and I don\'t like to speak disparaging, but we had a rocky relationship.
When the Joint Center-- I\'m getting ahead of my story, but it\'s appropriate to this question. When the Joint Center was started, it was started by Harvard Medical School, and the dean for hospital affairs was a man named Sidney Lee.
Dr. Lee had formerly been the head of the Beth Israel Hospital, the director, not the chairman of medicine but the director. And he got the idea that all the hospitals in the Harvard area were relatively small, the Mass General was across town and quite large, but that was not true for the Brigham or the BI or the Deaconess or what at that time was the Boston Hospital for Women.
And so he got them all together. So there were those, and I think I left out the Children\'s, but Children\'s was amongst them, as well as the Sidney Farber, as you say. Or at that time, it wasn\'t called that. It was called the Jimmy Fund, but that\'s another story, and one you know better than I, I suspect.
But anyway, those six were to get together when I started the Joint Center. Because Dr. Farber and I had so much difficulty with each other-- he wanted really for me to be reporting to him and being part of the Jimmy Fund but that wouldn\'t have worked with the other hospitals. He was not liked by any of the places, including Children\'s, which is where he was the pathologist.
So those six initial institutions, when we finally came to sign, turned out to be only four because the Children\'s wouldn\'t come in, and the Jimmy Fund wouldn\'t come in. For a number of reasons, two years later, they acquiesced, mostly because we were successful, and they were without supervoltage treatment, and it was just not sensible for them not to join. But that\'s my relationship with Sidney.
Franny Moore is a different story. Franny Moore was an internationally-known surgeon and expected to have his way, but he was very graceful, very nice. I had very few disagreements with him. He expected, and I think, deserved certain deferences. Sydney did, too, but it just made it too difficult to do that but Franny was not that way.
Franny and I came to the treatment, conservative treatment of breast cancer from different points of view. He didn\'t agree with it, but he was entitled to his opinion, and he was fine.
Tom is a different story. I got there ahead of Tom, and he came, and if anything, I helped out Tom, although he was much senior. Harvard has its own culture, as you know, and he needed at least an introduction. I mean, he sailed along fine after that.
And in fact, at one time, he and I wanted to start a joint residency program. It was to be a four-year program, which would have people take two years together and two years in their respective specialty. But the boards were not in agreement, so it was dropped. But Tom and I always got along fine.
Actually, that raises one of my other questions. I spent a lot of time in Europe, and the field of so-called clinical oncology still remains, combining radiation and medical oncology. In fact, they style it as a particular specialty in Great Britain. How did it evolve not that way in the United States?
Radiation oncology went off on its own. And I think you had a lot to do with really professionalizing radiation oncology as a specialty in this country. Is that not true? I\'d be interested in your perspectives on this, too.
Well, I should parenthetically say that I spent a year in the National Health Service in 1965, while I was a fellow at Yale, in clinical oncology at the Royal Marsden Hospital, their major teaching hospital for cancer. And I always believed in the joint efforts of a non-surgical oncology program.
You can include the surgeons, mostly because their lives are so different and their technical training is much more extensive, but you can work closely with them, and I\'ve been fortunate to be able to do that. But medical oncology and radiation, in my judgment, would be better off close together.
And your comment about me and ASCO, being the first president as a radiation oncologist, and I never call myself a radiation oncologist, at least not initially. I always call myself an oncologist. But I do, I agree and then describe what I do as radiation. But I agree with you, they have the best title-- clinical oncologists.
And why it occurred the way it occurred, I\'m not sure. I know we started in radiology and medical oncology started in hematology. I mean, the real revolution, and leaving aside Dave Karnofsky and his work, the real changes occurred in acute leukemia. And the real founders of the specialty, Dave was surely one of them, but a great many of them were all hematologists, leukemia doctors, and it grew from there. It grew out of hematology. And a lot of major oncology papers were in Blood, the journal Blood before they were in JCO.
So that\'s the best I can do with it. Our big thing was to separate from diagnostic. Getting closer to medical oncology is much easier, because we have the same book. You said I wrote the textbook with Vince and Steve, and so I did. And that was very easy. We spoke the same languages. We saw the same things, not completely. I saw more head and neck. Vince saw more of the hematologic malignancies, but the rules were similar. It was no-- it was easy.
And I\'ve heard Dr. Frei-- I trained with him when he was alive and obviously, Dr. DeVita talked about what it was like to give chemotherapy when they started. And how we really professionalized, in many ways, and split up giving chemotherapy, the different responsibilities.
What was it like with radiation oncology back 40 years ago? I mean, how did you-- the safety issues, were you all cognizant of the safety issues related to radiation at the time? How did you do your planning? What was that like?
Well, safety was-- Hiroshima made everybody know a lot. In fact, if anything, we were more conservative than we probably needed to be because of radioactivity being an evil and all the things that happened after \'45 and at Hiroshima and Nagasaki experience. And so safety wasn\'t a problem that way.
But there were a lot of people in the field who were using the field, who are not radiation oncologists. Some of them were radiologists, diagnostic radiologists and did it part time. They had a cobalt unit, before that, just an orthovoltage, conventional energy, much less effective and more damaging.
And also gynecologists, and when I visited Memorial Hospital early on in my training, and the surgeons would send a prescription blank, a regular prescription dying down to the radiation therapist. And that\'s what they were, technicians, or often were.
And they may have differed with the prescription but only by being careful and discussing it with the surgeons and convincing them that some change should be. That\'s very different.
How was the planning done? How was the planning done?
The planning was fairly primitive. Well, most places had a physicist, usually a physicist, who did both diagnostic machines and conventional radiation oncology, and they were important in that department and those people subspecialized, too.
And in fact, when I came to Boston in 1968, Herb Abrams, who was the new chairman of radiology-- he\'s the one who chaired the committee that selected me-- but he and I jointly started a physics department. So it was still in diagnosis as well as therapy, but we realized that wasn\'t a good idea and separated.
So physics was evolving, but treatment planning before supervoltage, and even with supervoltage before multileaf collimators and a lot of the newer, what then were newer techniques, was reasonably rudimentary. When I did my residency, we did our own planning, and usually, it got checked by the physicist but not all the time.
It\'s a lot different now.
Yes, it is.
I want to turn this to an area that\'s more personal to me and that is your role, out of all the many contributions you\'ve made to the field, your role in the field of breast-preserving therapy. I came in just as you and Jay Harris were really making that institutionalized.
Just for our listeners, what were the hurdles there? They must have been both personal and professional and technical. And did you ever doubt that this be successful in the long run? You must have had some second thoughts about getting into this.
Well, I have to back up. It was well before Jay, but it was at Yale. And apropos of how many-- going back to our previous question-- how few radiation oncologists there were. There was a club. Before there was a specialty, before there was a society, there was the American Club of Radiation Therapy. And all you had to do to belong to it was do radiation therapy without doing diagnostic radiology.
And I was in the low 200ths of the consecutive order of people who belonged to the specialty from its very inception at the turn of the century. So there were very few of us, and we knew each other extremely well and had these little conversing meetings.
And a number of people would talk about patients who had medical diseases which wouldn\'t allow them to have their breasts removed. They still had localized, apparently localized breast cancer, and the radiation therapist took care of them, and I did, too. I had these people.
And we also had the Europeans, especially the French, who were treating breast cancer with radiation. In fact, they were doing it with a fundamental difference with what we did from the beginning and they do now. And that is, they did it without removing the breast cancer, because they were doing it primarily for cosmetic reasons. And they felt that taking out the breast cancer might damage the cosmetic effect.
So we weren\'t alone. We weren\'t first. So I knew that other people had done it. Some people who did, Simon Kramer in Pennsylvania at Jefferson, Thomas Jefferson, did a great deal of it. And we did it, because we had a surgeon at Yale who was interested in sending patients.
You mentioned Jay, but really, before Jay, there was Lenny Prosnitz, who you may or may not know of, who was a long-time chairman at Duke. But Len was a medical oncologist at Yale, who was about, I don\'t know, three or four years behind me in training, and I was either a young assistant professor there at the time or a fellow, I can\'t remember which.
And he came over to me and said, you\'ve got a nice life. You do interesting things. I\'m not so crazy with this. Can I get into it? And Lenny, obviously, being trained in medical oncology, being a boarded internist was also interested in breast cancer. Because that\'s the one disease, even in the beginning that medicine, or one of the few diseases that medicine was interested in for the hormonal aspects of the disease.
So Lenny took over when I left with the surgeon Ira Goldenberg, and he kept it up. And when I went to Harvard, I had all those different hospitals, and I had a very good colleague there, who was the only radiation oncologist in those hospital complex, and he also treated some. So we continued to do it.
One of the nice things about Harvard at that time was, at least for this purpose, was we had this women\'s hospital, Boston Hospital for Women. And gynecologists in those days did everything for women and that included breast surgery. And those guys delivered their babies and when they got breast cancer, took care of them.
They weren\'t interventional. They were their private primary care docs, and they were much more sensitive to the cosmetic aspects and the self-image aspects of breast cancer surgery. And so they knew we did it, and they became a big source of suggesting patients and sending them to us.
Anyway, Marty, Marty Levine, the fellow I was talking about, and I developed a reasonable number of them. One of my residents, Eric Weber said, why don\'t you write a paper about this? I said, it\'s all done. The French have it. The Brits have it. Even the Canadians have it. He said, we don\'t. So I said all right.
We sent out the paper, and the first paper is with Eric and Marty and me, and it was a JAMA paper and that gets to another point.
What year was that?
I had to bully pulpit.
What year was that, the JAMA paper?
The JAMA paper? About \'75-- \'74, \'75. And it made a big splash. And then Lenny and Simon Kramer and Luther Brady, two Philadelphia people who had big experience, and us put all of our stuff together. And Lenny brought it all together, and so there was another big paper. I think that one was in JCO, but maybe not. I can\'t remember.
And I think that\'s how it got started. And my issue with it and my involvement in it is, yes, pioneering the treatment in America. I don\'t claim to have pioneered it anywhere else. It wouldn\'t be true.
But what I did do is use the bully pulpit of being the Harvard professor, and I went everywhere and talked about it. And I took on the surgeons in a number of places and talked about it. And if I made a contribution to it, it was that.
I can remember being in an audience and hearing you talk about the Halstead theory and then the Fisher theory and what became known, in my opinion, as the Hellman theory, which is a combination of the two. That both local and systemic therapies make a difference, and the mortality rate of breast cancer has dropped by almost one-half over the last 30 years, and you should be proud of that.
Oh, I\'m proud of it. I\'m proud of it. But people don\'t do things in a vacuum. You build on people and on their doings.
Well, I want to be respectful of your time, if I can finish up here. I really just touched the surface of many of the contributions you\'ve made. I wanted to talk a little bit about your role in getting radiation oncologists to think about what we now call translational science. But at the end here, what do you think are your greatest accomplishments? What do you think your legacy has been to the field? Do you think it\'s the science or your administration or your teaching and mentoring or all of those together? I think all of us would like to think about what our legacies would be.
Oh, I would say, it\'s an interesting and not an easy question, because I\'m interested in all of those things. But I like to remind people that, and it\'s been commented on by others, I am one of the few people who maintained a practice of medicine, a real practice, all through being a dean. I always think of myself first as a doctor. And I am an investigator, and I am interested in research, both basic and clinical, and did both of them, but I\'m a doctor first, that\'s number one.
Second to that, I was very involved in teaching and believe-- and that\'s why I became a dean and before that, started a department in Harvard and gave courses in oncology, and my residents are my greatest legacy, if you really want to know.
Nobody lives forever, and what you did in the lab and your patients, that passes, but your residents are your history. They continue it, and their residents continue it and so forth.
And just to end on a high note that you mention, is that the Karnofsky lecturer this year was one of my residents.
Yes, he was.
Of course, that\'s Ralph Weichselbaum.
He was. I actually chaired the selection committee, and I can\'t tell you how proud I was to stand up and introduce him. He did a wonderful job.
In addition to your own residents, I\'m going to tell you, you\'re also passing this on to the medical oncology fellows who were hanging around the Farber in those days. And to this day, I tell patients I wear two hats. My first hat is to take care of them as I can with the knowledge I have today, and my second hat is to do research to make it better. But my first hat always wins, because Dr. Hellman said you\'re a doctor first. So there you go.
Well, I haven\'t changed on it. That\'s very nice to hear though.
OK. I think on that note, we\'ll end up. I had planned over about half an hour. We\'re just over that. So thank you very much, both from me, personally, and from those of us in the field and from our patients who have benefited. Dr. Hellman, you are truly a pioneer and a giant in our field. So thank you so much.
Well, you\'re very kind to say so.
For more original research, editorials, and review articles, please visit us online at jco.org. This production is copyrighted to the American Society of Clinical Oncology. Thank you for listening.
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