Cancer Luminaries Podcast: Dr. Suzanne Conzen on Approaching Problems from the Micro to the Macro Level

Thank you so much for having me on this podcast, Camilla. It’s a pleasure to be here. I am currently the Chief of Hematology and Oncology at UT Southwestern in Dallas, Texas. That is a Texas state institution with a large academic medical center. I became interested in cancer research at a very late age for most cancer researchers. I was a political science major as an undergraduate and saw myself doing something at most in public health if it involved medicine. Once I went to medical school, I was introduced to a number of really fantastic researchers. It was a small class. It was at Yale, and they encouraged seminars, and you really got to know your professors. During actually a curriculum committee meeting, I was introduced to a wonderful immunologist and teacher named Charlie Janeway. And after a few meetings of me speaking my mind and doing my own analysis of the situation at Yale, I was asked by Charlie to work in his lab. He said, “You have a really analytical mind. You should try it, science.” I said, “I think I would get nauseated if I walked into a lab. I don’t think that’s going to work for me, but I really appreciate that comment. Thank you so much.”

And he was very persistent. So rather than going to the NIH that summer, which I had planned to do a public health project, I worked in the Janeway lab, and that was so eye-opening. To me, it was like waking up every day and discovering that you could control what you wanted to explore. You could read, you could design an experiment. It was incredibly creative. After that, I decided to do a residency in internal medicine, was pulled back to clinical medicine, but also to the science of cancer. And I didn’t plan to be an oncologist early on, but as the human genome was being solved and tumor suppressors and

oncogenes were being discovered, I found that an incredibly interesting and very attractive thing to study. So I did my fellowship up at Dartmouth, where my husband was doing a surgery residency. And I worked in a lab there as a Howard Hughes physician-scientist investigator on DNA tumor viruses, which at the time were the way that one studied how cancer cells become cancer cells, how normal cells were transformed to regular cells. And I think it’s really there in that second laboratory experience that I decided that this was for me.

[00:03:22.800] – Camilla Frost-Brewer

Wow. I mean, to me, that’s not late. But that’s really cool. Cool. That’s really special that there was this professor, this mentor that said, I think this would be a really good fit for you in the lab. And it changed your trajectory.

[00:03:41.650] – Dr. Suzanne Conzen

Exactly. It’s hard to underestimate how important someone taking the time to say something like that to a young person is and asking them to try something new because they think you might be good at it. And then you, of course, have to decide whether that’s what you want to do for the rest of your life. But mentorship is the key to the future.

[00:04:06.450] – Camilla Frost-Brewer

And I’d say it’s a pretty successful life so far.

[00:04:10.790] – Dr. Suzanne Conzen

I’ve enjoyed it.

[00:04:11.960] – Camilla Frost-Brewer

Excellent. So congratulations on being an Alumni Star for the UChicago Medicine Comprehensive Cancer Center in celebrating our 50 years of NCI designation. I’m just curious, can you tell us about when you were at UChicago and in what capacity?

[00:04:29.320] – Dr. Suzanne Conzen

So I was at Dartmouth doing an extended post-doc after my hematology/oncology fellowship. And we moved to Chicago in 1996, and I was nine months pregnant. I have to thank Gini Fleming for opening her arms to me as a fellow/instructor. We planned to be here for three years. My husband was doing a fellowship in cardiothoracic surgery at Rush. And Harvey Golomb, who saw this woman walk in nine months pregnant, didn’t bat an eye and said, well, maybe you should start in three months if you come here. So very open, very welcoming. And so that was in 1996. And I was, I would say, a senior fellow, what you would probably call an instructor now, for a couple of years. I worked in Nissim Hay’s lab. Nissim eventually went to the University of Illinois at Chicago. Harvey allowed me to go there with him and continue my research. And then when I was ready to become an assistant professor, I was able to come back and was offered a position here at UChicago. All the long, Dr. Fleming was mentoring me in breast cancer in the clinic one day a week, and I just found that her mentorship was extraordinary.

And the mentorship I was receiving through Nissim and also through the Ben May Institute at the time, it’s now called the Ben May Department for Cancer Research.

[00:06:11.710] – Camilla Frost-Brewer

Yeah. I’m going off script a little. Can you talk more about Dr. Fleming and Dr. Nissim?

[00:06:21.690] – Dr. Suzanne Conzen

Nissim Hay.

[00:06:22.730] – Camilla Frost-Brewer

Yes. Dr. Hay, and about their mentorship and what made you want to stay here, continue your research, and become an assistant professor here?

[00:06:31.250] – Dr. Suzanne Conzen

Yes. Well, I have to say that I saw the incredible, I would say, uniqueness, overused word probably, but uniqueness of the University of Chicago in that the quality of the clinical care and the research in both the clinical sphere and in the basic science was incredibly high. And what I really loved about the mentorship in the clinic, for example, was that Dr. Fleming was doing very important clinical research, but was also very interested in the type of research that I was doing in the laboratory. She has both an encyclopedic and creative mind in terms of clinical research, but she completely understands anything that’s done in the laboratory, no question. So that was unique, and I really appreciated that. And then I also met Geoff Greene, who was and is a very important figure in what we call nuclear receptor biology. At the time, I knew him as a luminary and estrogen receptor-positive breast cancer. But as luck would have it, as I started my assistant professorship, I discovered the importance of another nuclear receptor, which is your body’s stress hormone receptor. It’s called the glucocorticoid receptor. We call it GR for short. And it hadn’t actually been identified in what we call solid or epithelial tumors as an important mechanism of promoting cancer.

[00:08:10.310] – Dr. Suzanne Conzen

It was known to be important in lymphoma. In any case, not expecting to discover this particular receptor had a role, I did. And immediately, I cemented my connection with the Ben May Department for Cancer Research because they were studying nuclear receptors as well.

[00:08:27.470] – Camilla Frost-Brewer

Wow. It almost seems like right place, right time, but also really smart people understanding one another’s research and clinical care to make discoveries.

[00:08:39.490] – Dr. Suzanne Conzen

I think that’s exactly right. I think it has to be somewhat serendipity. Right place, right time. I think you’ll talk to a lot of scientists who’ve had wonderful mentors, and the way they found that mentor was not by incredible research on the mentor and a lot of, I would say, intentional decision-making, but sometimes things just work out. And then the other aspect of the serendipity is that when I did an unbiased screen to figure out what was important in what we now call triple-negative breast cancer, which, of course, I was seeing a lot of on the South Side of Chicago and had not before and was incredibly shocked, actually. I think that would be the best word at how young my patients were compared to what I had been seeing in New England, that I decided this is something I want to study. This is not okay, and we need more research on this. At the time, estrogen-receptor negative breast cancer was not really called triple- negative breast cancer. We’re talking now about 1999. And so I set up a screen to look at what helped those cells be resistant to chemo and be so aggressive.

[00:09:52.640] – Dr. Suzanne Conzen

And it turned out that this stress hormone receptor was involved. So luck, I think an important problem and good people around was essential. And then, of course, I met Funmi Olopade, and the rest is history because I had a champion on either side of me with the clinic, with the basic science, and with the translational science.

[00:10:16.300] – Camilla Frost-Brewer

Wow. So switching gears just a little bit, you’ve shared with us where you are, UT Southwestern. Can you just walk us through what you do in your job as chief, as professor, in clinic? What does look like for you now that you are way beyond assistant professor?

[00:10:35.930] – Dr. Suzanne Conzen

Yes. So I guess I could start by saying that UT Southwestern is a very large, freestanding medical university, so it doesn’t have an undergraduate. The undergraduate programs there are at UT Dallas, UT Arlington. Many UT institutions provide undergraduates. So it’s a very different feeling. And so what I do is much more focused on developing a hematology and oncology division in an institution that was mostly known in the past for its basic science. It turns out that UT Southwestern is a huge institution. So it has three major hospitals. It has Parkland, which is what is known as a safety net hospital and is a Dallas County hospital. It’s a really important caregiver and I think delivers outstanding care to the citizens of Dallas County. Then there’s a university hospital, which is called Clements University Hospital, and there’s a VA. And each of these hospitals has 750 beds. So the first thing I had to do was to wrap my mind around actually staffing these hospitals with our faculty because we were woefully understaffed and our fellowship too small as well. So clinically, what I do on a day-to-day basis is I have tried to organize this division into a functional unit that can cover these three hospitals and into a great fellowship.

[00:12:13.420] – Dr. Suzanne Conzen

And I was lucky enough to be able to both recruit and uplift people who were in a rather… It hadn’t really had a lot of attention for a few years because the fact of the matter is it had a wonderful clinician leading it who was interim, and that’s always a difficult position. So when I got there, I tried to do what I do best, I think in my lab, is to organize people into areas of their own interest and just really get to know them and figure out what people wanted to do. And I’ve been there now for almost five years, for four and a half years. And I think that now we have… people will now identify themselves as I’m a prostate cancer person and I have a prostate cancer team or I’m a classical hematologist. And then what I did was I tried to arrange these three-hospital faculty members into their own groups, no matter where they were treating patients, whether it was a veteran, whether it was an underserved population, whether it was a hospital, university system so that we all are aligned and we all have exactly the same approach to specific cancers.

So that’s been my goal. And that included integrating a lot of population science, especially at Parkland, hiring a lot of people interested in social determinants of health so that we could shine in these really important aspects of the three different hospitals. That’s my day to day for division chief is to organize, inspire, recruit, retain, and just articulate a vision of a quality of care in Dallas. That’s my day job. Now, I also run a lab because I was lucky enough to get a Cancer Prevention Research Institute of Texas scholarship when I arrived, and that enabled me to have freedom to build a lab. And that’s been incredibly important to me. So my lab still works on the glucocorticoid receptor. There are, I would say, two types of

scientists, one that is no better than the other. Some people are just dogged about what they’re studying and they can’t get over it, and they always get back to it. And for me, it’s the GR. I’ve also been able to see patients. I see patients one day a week. In my clinic, I’ve tried to fashion, as Dr. Fleming fashioned hers, who had been my mentor here.

[00:14:46.520] – Camilla Frost-Brewer

Wow. You do a lot.

[00:14:49.080] – Dr. Suzanne Conzen

Yes. It’s three jobs.

[00:14:50.830] – Camilla Frost-Brewer

Three jobs. Okay. I think it was so interesting what you were saying about UT Southwestern, having these three separate hospitals and serving three unique populations, and how you’ve been able to rally the faculty and staff around a centralized care ethic, if you will.

[00:15:14.890] – Dr. Suzanne Conzen

Yes. And the way that evolves is very similar–for those scientists who are listening–to a lab meeting. You bring together leaders who have things in common, and these can be young leaders or mid-level leaders or senior leaders, and they talk about the challenges they’re having, not with specific cases, but just with how patients are treated or with administrative challenges or with educational challenges. And somebody will speak up from Parkland and say, well, you know the way we do it here is those patients are actually transitioned to a clinic that is run by APPs, and that’s freed up our new patients to see the faculty. And that interaction where Parkland is so efficient because they’re resource limited and have to be has been incredibly valuable for the leaders at the other two hospitals. So we’ve learned so much from the way things are done there. And vice versa, the way we teach potentially our fellows in certain clinics over in the other two hospitals has been picked up by the university clinic. So while it sounds rather siloed at first glance, and I would say it was when I started, we no longer hire people to one hospital.

[00:16:34.880] – Dr. Suzanne Conzen

We hire people….they have to be at least two places. And lest I forget, we also have a large community practice. So we’ve opened up a community practice on the south side, on the west side, and on the north side. And it’s really important to integrate those faculty members into the main campus and understand the challenges that they face when they’re doing clinical research and seeing patients in the community.

[00:17:01.500] – Camilla Frost-Brewer

Wow. I also heard a little bit of your political science, interest in public policy come through and how you have organized hematology oncology at UT Southwestern. So that’s really cool.

[00:17:15.990] – Dr. Suzanne Conzen

I think you’re absolutely right. I think whether it’s so intentional, I think I would be fibbing if I said I had really set out to do that. But it was really clear when I got there that we needed to do. And as people started to talk to me and I listened to them, I saw the challenges. I was seeing all these parallels across the institutions. And then I decided, and I will tell the audience, because I think this is a really important thing to know, is I had a terrific coach. I have a professional coach. And he, who was a pediatric oncologist, helped me to see some of these parallels as well. And what he’s really helpful for is to organize the meetings so that they’re productive. So that has to do with having an administrator there who’s taking notes and I’m focused on people and really what they’re saying so that they can see the parallels and the problems that they’re seeing and facing.

[00:18:16.530] – Camilla Frost-Brewer

Yeah. Thank you. So you’ve talked a little bit about it, specifically in terms of mentorship and modeling maybe your lab after what Dr. Fleming did. But how do you feel UChicago influenced your career trajectory?

[00:18:32.740] – Dr. Suzanne Conzen

I think it really was everything, honestly, in terms of career trajectory for the last 20 years. I was here from 1996 all the way to til the end of 2019. So that’s a long time. That’s 23 years. And that’s a long time in a very, I would say, best word probably is formulative time to interact with people. And it’s really the relationships with the scientists on how they think about things. It’s also meeting people in other divisions. So in the social science division I am a collaborator with Martha McClintock. And in other sections, I’m a collaborator with Matthew Brady, who’s an endocrinology PhD. That interactive science was really important to my career. I feel very strongly that if you want to study something that’s molecular, even nanosubparticle molecular, you really have to constantly think about its role in the larger organism if you’re doing cancer biology, because afterwards, after all, we are actually treating mostly patients who are human, who interact with the social environment and have a very complex physiology. So I always like to take it back to understanding these different levels of the micro to the macro.

[00:20:07.470] – Camilla Frost-Brewer

Are there any key moments or things that you learned at UChicago that you’ve carried with you beyond working here? And again, I know you’ve mentioned a little bit how it shows up in your current position, but you had mentioned Dr. Olopade and her being a real champion for you. Was there anything specific, a little anecdote you’d like to share?

[00:20:32.720] – Dr. Suzanne Conzen

I think there really are a couple. One is when we discovered that your body stress hormone receptor actually prevented triple-negative breast cancer cells, at least a subset of them, from undergoing cell death. In other words, it was bad for the patient, good for the tumor cell. All sorts of things ran through my mind. But I think the first thing, since it was so new, is I rather tentatively went to Geoff Greene’s office and showed him the difference between the cells that were alive and the cells that were undergoing organized cell death without glucocorticoid. And he said, when you see a difference like that, you just need to go after it. Don’t worry that no one else has ever seen this. People have never looked. And you just need to study it because it’s these large differences that really lead to a successful later series of experiments because you have such a large signal-to-noise ratio. So that was super important to me. And the other thing is that Dr. Olopade was so good at being enthusiastic and absolutely indefatigable, right? If that’s the proper pronunciation of that word. She would not give up at collecting human specimens and involving patients and community members in the research.

And those two things go together. You have to ask the community what matters to them before you can ask anybody for any sample. And she taught me that lesson way before its time, way before. And then in the irony of ironies, I would go to clinic on Thursday or Friday afternoon, and I would listen to my patients, and my patients would say, Do you think that the stress that I’ve had throughout my life, and they were young, has anything to do with my cancer? And of course, in the beginning of my time here, I said, Oh, of course not. Don’t blame yourself. The whole aspect of that. But honestly, they weren’t blaming themselves. And we are just the recipient of our environment. And how we react to it is in large part completely out of our control because it has to do with our genes and how we were environmentally exposed as young people. And so then I realized that social stress might be a real problem, not for the initiation of the cancer. And I was always very careful to I don’t say that, but it may actually, our environment may affect how aggressive the tumor is in some settings.

[00:23:37.570] – Dr. Suzanne Conzen

And it’s not all because cancer is very heterogeneous, but it is something to consider and how we respond to things and how we incorporate what we can control versus what we can’t control in our own

wellness. So I stopped saying, of course not, and started saying, maybe there’s some things we should work on as you recover that might make things go better.

[00:24:07.780] – Camilla Frost-Brewer

Yeah. Number one, thank you, Drs. Greene and Olopade. And I think that’s so critical to involve patients in the understanding of their cancers, in the healing, in the treatment, in new discoveries. And like you said, that was before that existed in name. So that’s really fascinating to me, at least. Hopefully, our listeners as well.

[00:24:33.500] – Dr. Suzanne Conzen

Yes, I think it’s become a much more popular thought that there are, quote-unquote, social determinants of health. But at the time, it was not so. And so I’m very excited with the way the field has developed.

[00:24:50.270] – Camilla Frost-Brewer

Well, thank you for that perfect lead-in, because I would like to know where you see or hope to see cancer research, care, discoveries, and/or advancements go in the next 50 years?

[00:25:03.420] – Dr. Suzanne Conzen

Wow, that’s a very-

[00:25:05.890] – Camilla Frost-Brewer

I know. It’s a long time.

[00:25:07.120] – Dr. Suzanne Conzen

It’s a very good question, since we’re at our 50-year mark for your cancer center. I would say what I envision or hope to see is further integration of the micro to the macro. So understanding the structure of the things that we see and the chemistry of the biology that we have been observing is absolutely crucial, the basic science, to understand how the different aspects of our body interact, because it’s such an incredibly complex issue in terms of the different tissue types we have in the body and how we treat cancer. And we’re seeing that now, for example, with immunotherapy, where we’re seeing great hope, but also great complications that can be life-threatening, and we need to understand all aspects of that. So my hope is that there’s better integration of the elements of the different types of tissues and how different approaches to cancer research may change those different types of tissues. In terms of care, I think I touched on it before, integrative care. I think that from the moment that we are either parents or grow up as children into young adults, we need to understand that the risk factors for cancer start in very, very young ages, probably pre-puberty, I would guess.

And they have to do with preventing overweight, preventing type 2 diabetes, inflammation, all the things you hear about. But we need to integrate, as cancer researchers, that knowledge into understanding this so that parents can do their best with their children as best as they can, and so that we have a public health understanding in this country that a lot of cancer could probably be prevented by, for example, lowering our rates of type 2 diabetes, which are directly related to food, most likely. The discoveries, I would like to see a combination of very deep digging into, as I said, the structure and the nanostructure of things, and then a very deep emphasis on the opposite it, which is the public health part. So I think unless we have leaders who understand the importance of both and perhaps even can engage one group with the other, it’ll be very hard to see the advancements that we make really be applied to populations as a whole. I don’t think it’s okay to only focus on precision medicine, for example, and how it applies to, let’s say, type 2 diabetes or obesity without seeing the bigger picture, which is that part of the problem has arisen over the past 20 years, and it must have something to do with our lifestyle, meaning not necessarily what we choose, but our food intake.

And so I think just providing clarity to that for the American public is really important while providing clarity on what this precision medicine can do, which is at the opposite end of the spectrum, is that we’re all different.

[00:28:58.110] – Camilla Frost-Brewer

Okay, so the key takeaway here I’m hearing is integration of research, care, and communication.

[00:29:07.640] – Dr. Suzanne Conzen

You said the word that was in my mind as you were saying that. It is clear communication and making sure that when we are scientists, we communicate with the public. And when we are the public, we are given the opportunity to communicate with the scientists.

[00:29:26.980] – Camilla Frost-Brewer

Excellent. Well, the last question I have for you, You have been highly successful in your professional career. Is there anything in your personal life that you would like to share or any advice for young investigators on ways to balance your personal and professional life?

[00:29:45.750] – Dr. Suzanne Conzen

Well, I think this is a super important question because for our young investigators, one can’t be successful without understanding what one’s own needs are in terms of interaction with others, in terms of family, in terms of community. And so I think you have to examine that for yourself, and you have to decide how you’re going to approach that, because there are only 24 hours in a day. And I think you’ll find that the most successful cancer researchers and clinicians actually do make a very substantial effort to make time for their own interests, whether it’s exercise or reading or art or music. I think that it doesn’t have to take a long time in a day, but you need to make time for that so that your brain has a chance to do the things that it finds fulfilling that are outside of the lab. And there is no question that I think all of us have something that we need to do to stay balanced. And so you have to make the time for it.

[00:30:58.900] – Camilla Frost-Brewer

I would agree. Well, thank you, Dr. Conzen, so much for spending time with me and with our listeners. It’s been a great honor. And I hope you have a great rest of your day.

[00:31:09.380] – Dr. Suzanne Conzen

Thank you so much. It’s been such a pleasure.