Research Is the Reason I Can Give My Patients the Best Care

Dr. Lawrence Shulman has seen firsthand how research has transformed outcomes in the U.S. and abroad

BCRF investigator Dr. Lawrence Shulman has had a front row seat for every major advancement in breast cancer research since he started his career.

Just months after Dr. Shulman entered Harvard Medical School in 1971, President Nixon declared the “war on cancer” and signed the National Cancer Act to accelerate research into the disease. It was the early days of oncology, long before there were major cancer centers, standards of care, and now-ubiquitous treatments.

“It was a very exciting time,” Dr. Shulman remembered. “It was the early days of us learning how to use chemotherapy and curing people who previously had no options. We were using drugs that were quite new—and we were seeing survival rates go up substantially.”

In the 1970s and early 1980s as Dr. Shulman finished medical school and became an oncologist, everything was so new that clinicians were learning what worked and what didn’t in real time.

“Everything we were doing at that time was research,” he said. “We were asking questions about every patient we were treating and trying to get smarter. We learned things in a scientific way. That’s sort of how I was raised—and I’ve always kept that approach with me.”

As the country’s oncology infrastructure expanded throughout the 1980s, 1990s, and even into the 2000s, Dr. Shulman turned his work and research to determining how best to deliver cancer care most effectively, safely, and humanely.

Dr. Shulman oversaw the development of multidisciplinary breast programs at major cancer centers including Dana-Farber in Boston, and he spearheaded the creation of some of the earliest electronic health records.

Working with other researchers through national cooperative groups, he led major trials and initiatives to develop and test new drugs for patients and optimize how existing treatments were given. One major trial he led showed that patients who got four months of chemotherapy had the same outcomes as women who had six months of the therapy, which was then the standard of care—thus reducing the ill-effects patients experience while maximizing their cure rates.

Dr. Shulman’s work took on a more global focus thanks to a call from two former interns: the late Paul Farmer and Jim Yong Kim, who co-founded the nonprofit Partners In Health to provide medical care in the world’s poorest countries. By the late 2000s, as the Partners In Health team and others had made progress against infectious diseases like HIV and tuberculosis, doctors were seeing more cancer cases in developing countries. When Farmer and Kim asked if Dr. Shulman would help them develop cancer programs in Rwanda and Haiti, he jumped at the chance.

For about four years, Dr. Shulman worked to get funding, assemble a team, open pathology labs, and train doctors, nurses, and pathologists in both countries. In 2012, they launched the cancer programs in Haiti and Rwanda. Today Dr. Shulman works primarily with the team in Rwanda at Butaro Hospital, where the cancer center is located.

“Since then, we’ve treated around 17,000 patients, and breast cancer is by far the most common diagnosis we see,” Dr. Shulman said. “When I first went there in 2011, there was not a single oncologist in the country. There was no radiation in the country. There was essentially no cancer treatment in the country unless you had the financial wherewithal to get on a plane and go somewhere and most people didn’t. Patients would tell you if you got cancer, you died.”

Dr. Shulman became a BCRF investigator in 2013 and with the Foundation’s funding, he and his Rwanda-based team, including co-investigator Dr. Cyprien Shyirambere, have been able conduct studies, train community health care workers, and run educational programs focused on breast cancer.

“We’ve seen a major shift in breast cancer with more women diagnosed at earlier stages of the disease, which has a much better prognosis,” he said. “We developed the cancer center to deliver safe and effective care for these patients, giving them access to lifesaving treatment that they previously did not have. Even over a short period of time, we’ve made dramatic differences and literally thousands of patients have benefitted and are alive and well. BCRF support has made this possible.”

Many of these programs and their findings have influenced how care is delivered in other countries and even in Philadelphia, where Dr. Shulman is based at the University of Pennsylvania’s Abramson Cancer Center and Perelman School of Medicine.

For Dr. Shulman, his life’s work and BCRF’s mission also became very personal when his mother, the late New York City politician and civic leader Claire Shulman, was diagnosed with the disease.

Her story is one that shows just how much progress we’ve made since 1971.While serving as Queens’ first female borough president, Claire was successfully treated for early-stage breast cancer twice and lived to be 94.

“She barely missed a beat, which was important to her,” Dr. Shulman said. “She was able to be treated in ways that didn’t derail her life or career at all because of screening and advances we made in treatment.”

Whether he is working in Rwanda or in Philadelphia, Dr. Shulman said that the throughline of his five decades in medicine has been his deep appreciation for patients. Research, he noted, has shepherded in new treatments that not only dramatically improve patients’ chances of survival, but also have far fewer side effects—improving quality of life after treatment.

“I’ve contributed to clinical trials, safe care, and electronic health records, but what has grounded me is my work with each and every patient,” he said. “That’s the most important thing to me. A cancer diagnosis is a life-changing event, and to be with people and help them through these periods is a privilege.”

Read more stories from BCRF’s Research Is the Reason storytelling initiative here.