Breast Cancer AllianceDr. Lucy De La Cruz, Chief of Breast Surgery
“If you look at the statistics, I wasn't supposed to be where I am today."
That’s Dr. Lucy De La Cruz talking, the Chief of Breast Surgery at Georgetown Lombardi Comprehensive Cancer Center. Despite the odds, she has shattered one proverbial glass ceiling after another and become the youngest Latina to take on a leadership position at a major academic medical center in the U.S.
Today, the Cuban native—who grew up in Africa and Spain—is an advocate for the underserved, shining a light on the disparities in breast cancer health. Black and Hispanic women, for instance, are more likely to develop more aggressive, more advanced-stage breast cancer at a younger age; the former also has a higher incidence of triple-negative breast cancer, which has fewer treatment options.
In addition to Lombardi, De La Cruz works with a number of institutions to impact change, including the nonprofit Unite for Her and the Basser Center for BRCA at Penn Medicine, which hosts an initiative focused on BRCA-related cancers in the Latino community. She's gunning for more systemic change at a nationwide level, too. "I'm here and there's a purpose to me being here," she acknowledges. "I need to do something with this opportunity, position and voice I've been given."
My parents were HIV researchers—I grew up as a lab brat—so I always knew I wanted to become a doctor. Then during my first year as a resident at the University of Miami, I met a patient who was going through breast cancer treatment. She was Cuban, 35 years old, a single mom with a 15-year-old daughter. She was alone in this country and faced this horrible cancer and massive surgery. She didn't speak English; her surgeon didn't speak Spanish. I ended up translating. I identified with her and felt close to her. I realized that, in this field, I could take care of women through surgery and have a bond with my patients.
While breast cancer is more prevalent in Caucasian women, it is more common for Black or Hispanic women under 40 or in premenopausal settings. Because they're young, most of these women have not had children. They end up getting chemotherapy, which leads to iatrogenic infertility. And here's the thing: Only 11 out of 50 states have insurance that covers fertility treatment. And if you're on Medicaid, then you're definitely not covered. As I mother of two, I can't even imagine that feeling of helplessness. One of the things I'm working on with Lombardi at Georgetown is creating a fundraising initiative for fertility treatment, so we can provide financial support to the low-income. But we also have to advocate for a change in laws so Medicaid and insurance in all states cover infertility for women undergoing any cancer. We also have to raise awareness for research trials that will benefit minority women. We're underrepresented in clinical studies because there's skepticism about being included. Women need to know these trials are safe.
“I'm here and there's a purpose to me being here. I need to do something with this opportunity, position and voice I've been given.”
Education. I feel really strongly about this. At the Basser Center for BRCA at Penn, we're starting to record education videos in Spanish and Portuguese, so patients have access to online resources. If they don't speak the language, they may not understand what's happening or get the full picture. I've met patients for treatment who have no idea what surgery they did, how they did it, what's the benefit of one surgery over the other…
There's the patient challenge, the institution challenge and the biologic challenge—and each is multilayered. For patients, it's access to healthcare, education, fear, cultural and language barriers. Institution obstacles—if patients aren't living in large metropolitan areas, they're getting sent to places that are potentially not the best for breast cancer treatment, where there aren't specialists in the field. And then biologically—all cancers are not the same. In minority populations, patients tend to have more aggressive cancers and it's not necessarily because they're identified at a later stage; it has to do with our evolution. There's data suggesting that certain genes that prevailed for other circumstances, like immune resistance, may be used by tumors against the patients themselves. This is just the tip of the iceberg. I foresee that, in the future, we're going to have treatment not just based on surgery or radiation but targeting the genes.