Season 2 - Episode 4: A Global Outlook on Women, Power, and Cancer

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Episode Guest

Ophira Ginsburg, M.D., M.Sc.

Dr. Ginsburg is a medical oncologist and global women’s health researcher with nearly 20 years of experience in global cancer prevention and control. In 2022 she joined the U.S. National Institutes of  Health, as a Senior Advisor for Clinical Research at the National Cancer Institute’s Center for Global Health. Formerly based at the University of Toronto, Canada, she was a Medical Officer at the World Health Organization (WHO) Geneva, Switzerland (2015-2016) where she provided technical support on cancer control for countries in Africa, Asia, the Middle-East, and Latin America, and contributed to the development of normative guidance on cancer early detection and screening. Read more about Dr. Ophira Ginsburg. 

 

Show Notes

Ophira Ginsburg, M.D., M.Sc. 
NCI Center for Global Health 
Women, power, and cancer: Lancet Commission 

Ad: NCI Cancer Data Science Training 

World Health Organization (WHO) 
WHO Cervical Cancer Elimination Initiative 
WHO Guide to Cancer Early Diagnosis 
NYU Department of Population Health 
Royal Society of Medicine 
London Global Cancer Week 
African Organization of Research and Training in Cancer (AORTIC) 

Your Turn Recommendations: 

Ikigai 
Book: Peace is Every Step: The Path of Mindfulness in Everyday Life by Thich Nhat Hanh 
Podcast: Night Science with Dr. Itai Yanai and Dr. Martin Lercher 

Episode Transcript

Oliver Bogler
Hello and welcome to Inside Cancer Careers, a podcast from the National Cancer Institute. I'm your host, Oliver Bogler. I work at the NCI in the Center for Cancer Training. On Inside Cancer Careers, we explore all the different ways that people join the fight against disease and we hear their stories. Today, we're talking with Dr. Ophira Ginsburg, Senior Advisor for Clinical Research in NCI Center for Global Health and leader of a recent Lancet Commission on Women, Power and Cancer. Listen through to the end of the show to hear her make some interesting recommendations and where we will invite you to take your turn. 

Dr. Ginsburg, Ophira, welcome.

Ophira Ginsburg
Thank you so much.

Oliver Bogler
So you've done a lot of things in global health, but I wanna start with one particular recent initiative that you led, which is this commission for the medical journal Lancet. And the commission was called on Women, Power and Cancer. It sounds like a lot more than simply looking at the incidence of cancer in women, for example. Why “power”?

Ophira Ginsburg
Yeah, it's a great question. And thanks so much for having me on the show. I guess I'll start by setting it up with a previous series we did in the Lancet. It was a three-part article, mostly reviews, with some recommendations called Health, Equity, and Women's Cancers, which I had the good fortune to lead with a 40, a compliment, 40 authors from 18 countries. We published online in 2016, in print 2017, when I was at WHO, actually, as a medical officer. Circle back to that if it's of interest. At that time we focused just on breast and cervical cancer, and we did try to dig in a little bit into the social determinants of health that we all thought were influencing, and of course there's enough evidence, there's more than enough evidence to support that we have much more to do to close this gap and reduce cancer health disparities for women at the national level and of course at the global level. Several years later we hadn't really progressed as far as we had hoped to. And I had a conversation with Richard Horton, as you know, the editor-in-chief of The Lancet in London 2019 just before the pandemic hit, and he asked me what did I think of progress. And I could say something about the emerging efforts on breast cancer, now part of the global breast cancer initiative at WHO and cervical cancer, of course, the elimination strategy that many of your listeners, I hope, are aware of. But we really still hadn't cracked through that barrier, that global barrier that seems to affect women in every setting and not just with respect to access to care, access to prevention when it comes to cervical cancer, let's say girls getting vaccinated and women getting screened, et cetera. So we kind of stepped back and looked at what is the big picture here? 

And if I might just draw on my own career point, when I was doing more hands-on global health work, I co-founded a small breast clinic, breast cancer center in rural Bangladesh, and women were coming in with these large, fungating masses, for those who are clinicians, you'll know what I mean, for those who aren't, just desperate situation of terribly advanced cancer, the likes of which you see maybe once a year or never really. This was sort of the norm. And we started asking these women, and I was working with qualitative researchers, why did you come so late? First of all, it's a really loaded question, right? It places the blame on the woman. And also without asking, we really made wrong assumptions. So understanding the power dynamics within their families and within society led them to say to us “We're making a choice. I can't make this choice. I have no choice but to have used the little bit of money I had to spend on school books and uniforms for the kids”. “I'm not the person who decides on my own healthcare”, they would say in some other way, which is typical in that particular setting in the South Asian conservative community, that it's the mothers-in-law and mostly the husbands, fear of being ostracized, fear … anyway.

I'm going on and on, but to say the element of power dynamics and patriarchal systems as they pertain to opportunities for equitable, high-quality, respectful care for people with cancer as well as other elements we can talk about really spoke to me. And when we started the commission, the concept note I wrote and shared with Richard Horton and then to the editorial board, there's a process for how these commissions come about. And then eventually started inviting people to join me - we saw that power was really central. And the name of the report eventually became not Women and Cancer, but ‘Women, Power and Cancer’. That by the way is inclusive of women as healthcare providers, as well as people with lived experience of cancer.

Oliver Bogler
So would you then say that power is a new social determinant of health? Is that a fair comment?

Ophira Ginsburg
You know, that's a terrific question. And I think you're the first person to ask me this. All the interviews we've had since the report came out. I don't know that we're inventing it. It certainly is an element that is discussed in other domains, but I haven't seen it, what's the word I'm looking for? 

Oliver Bogler
Explicitly called out or…

Ophira Ginsburg
Yeah, I haven't seen it really framed in terms of cancer with one exception. And I should mention her. When we did the series, there were a couple of commentaries. One was by our colleagues at the American Cancer Society. This was the series, Health Equity in Women's Cancers that I referred to. And the other was by then president of Chile, Dr. Michelle Bachelet, co-founder of UN Women, who went on the next year after that to become the UN High Commissioner for Human Rights. She wrote an editorial about our series and she called it  . So there you go. We can't own it. That's the great legendary former president, Dr. Bachelet.

Oliver Bogler
So what are the key findings that you published in this commission report?

Ophira Ginsburg
Right, so first what we set out to do was to look at power in three domains, in knowledge, decision making, and economics. So we had our working groups. The first working group really was the one I was attached to as a scientist working with our colleagues at IARC and others on the burden. So one of the main quantitative findings was that cancer ranks in the top three causes of premature mortality - death under 70 - for women in every country except two. That's out of 185 countries. It's rather mystifying that more people don't know this and in fact we weren't really aware the degree to which cancer ranks in that few top causes of death under the age of 70 and so what does that mean for the society, what does that mean for the children of these mothers etc. especially when they when they die, when they still have young children. So that was a key point.

And when we broke it down by country, we saw there were huge differences depending on where you lived, the degree to which cancer deaths are premature, right? Largely because population structure and other factors, but also different types of cancer that are more or less prevalent according to geography and also income level and what's called the Human Development Index. And so the other thing we broke down was of the 2.3 million women who died in 2020 prematurely of cancer, 1.3 million women's lives could have been saved if they had appropriate access to what we already know works in terms of prevention and early detection. And another 800,000 women could have been spared death prematurely under the age of 70 if every woman diagnosed with cancer of any kind, right? All taken together had access to the optimal care. These are really important data points. That's just a couple of the quantitative findings. I'll stop there for a second.

Oliver Bogler
Yeah, that's fascinating. So I mean, the problems you're describing seem, to someone like myself who's not in global health, quite overwhelming. You know, the infrastructure, the socioeconomic circumstances. So does the report also have ideas on how these challenges can be tackled?

Ophira Ginsburg
Absolutely. So the point of these reports is not just to highlight a problem, which would be horribly depressing for all of us. And I mean, there's enough other ways to express and analyze and publish on such a paper. You know, many papers could have come out of this work. But to do this as a commission meant that what we were tasked with was coming up with a set of evidence-informed, evidence-based recommendations, and specific enough that they could then be advanced, which is what we're working on now.

We started actually about a year ago to look at what we call in public health policy, monitoring and evaluation. How are we going to see that these recommendations can be actioned? And who are we aiming this for? How can we help them develop a set of, let's say, metrics? Are there baseline data, baseline statistics? Doesn't have to be that we as a commission come up with these. I'll give you an example. We know that breastfeeding is an important contributor to reducing the risk of breast cancer. It's underutilized as a prevention strategy. Of course, there's other really good reasons for people to breastfeed if they're able. But what are the upstream factors that determine whether a woman or whoever is available to be able to breastfeed their child can do that? Also has to do with policy around, right, a private space, etc. The rights and enablers enabling factors to be able to breastfeed.

So do we have to make up that data? No, there's a whole global breast cancer observatory. There's a lot of global health data out there of great quality from World Health Organization and other partners. And so tapping into those was key. Another one would be looking at the existing laws like the Framework Convention on Tobacco Control, which is one of the few legally binding health-related treaties globally. There are gender responsive policies around tobacco, such as the targeted marketing, what's called pink washing, that was very effective in the 1950s and onwards, you know, tripled the number of women who were taking up tobacco smoking because of that very cynical marketing, which by the way, you know, abused concepts of feminism and empowerment to encourage women to smoke as a sign that they've made it, that they're successful. We're seeing the same thing with alcohol. So,there's a set of 10 recommendations we encourage people to look at. And there's a table at the back of the report that gives just one example for each of those where we say, who is this aimed at? Is it multilateral, like UN organizations? Is it for countries to do, subnational governments, civil society, the private sector? And guess what? Research funders like us at the NIH and the National Cancer Institute. Some of these recommendations are aimed at several of these. And then we just took one example for each of the recommendations to give people a chance to sort of hang their hat on that, think about it, and then help move the needle forward individually and on behalf of their organization.

Oliver Bogler
So you've already mentioned one dimension, if you will, of power, the example you gave of a woman in Bangladesh not being able to maybe determine her own health care future or pathway. Another element that you, I think, point to in the report is that of leadership and representation, and also, of course, in cancer health care and also in cancer research. So I'm curious, why is that important? And how can we do better?

Ophira Ginsburg
Yeah, that's particularly important for us to think about here at the NCI. And I would say that we are on the leading edge, I think, of improving that situation for women as leaders. As we can see now, we have a woman as a leader of the National Institutes of Health and the National Cancer Institute. But by and large, historically women have been underrepresented in pretty much everywhere in terms of research funding organizations. We took a look at a couple of parts of this. We looked at the editors in chief in the top 100 cancer journals by sex. And we found that only 16% of editors-in-chief in those top 100 journals were actually female, which is kind of shocking. We thought it would be maybe a third. So that's a low-hanging fruit, by the way, that we're gonna push the editors-in-chief, we've had discussions with Elsevier or with The Lancet, and they are discussing with their publishers. The Lancet actually does well, but many journals do not.

So that's one aspect. Another is looking at the principle investigators on research grants by sex and ideally by gender as well as other domains such as race. We haven't really done enough, I think, in this regard globally or even nationally in the US to help ensure that equity is achieved if it hasn't already occurred in every domain of health, including cancer. So there's a lot we can do. I mean, you obviously lead all these training initiatives, the whole division at the NCI. There are ways to help give a leg up in terms of unique opportunities for women, mentorship and other scholarships. On the global scale, a number of our partners like ASCO, AACR and others have been offering specific scholarships for additional training for women in low and middle income countries. As a scientist, I know AACR also has that. So these are really doable things and we need to act and we need to measure and hold ourselves accountable for how we're doing in a short period of time. There's a lot that could be achieved in that regard. 

Now why is it important? I think our listeners probably know this, but women are more likely to come for care, to stay throughout their health care course, especially for women with breast or gynecologic cancer, if they have gender concordant care. We've seen this in many different countries. It's not just in South Asia, for example, or in African countries. There's a certain degree of stigma, taboo, and disrespect, really disrespectful care, including for women of color in this country, in the US. So there's, you know, representation matters. And I think enough said on that topic.

Oliver Bogler
No, that's really important. You've mentioned this really important aspect. Are there other things that we could do maybe that are also in your report in order to create a more gender-equitable cancer care system here and across the world?

Ophira Ginsburg
Absolutely. In our healthcare workforce group, we had actually the workforce group and also the team of scientists on the commission who looked at with a deep dive into the literature, the health systems across countries, across cancer types, especially looking at non-sex specific cancers like lung cancer and colorectal cancer. We really wanted to take a deeper dive into those two as an example of where things might be problematic. We didn't know what we'd find. We found a lot of problems. Women were more likely to present with an emergency presentation of colorectal cancer in a number of countries. So together with the workforce group, we present in the report a template for what we call a gender competency framework that could be adapted, evolved in different settings to make it culturally appropriate, etc. that is not only about gender, but again, intersectionality, inclusive of people of diverse gender orientation, gender expression, sexual orientation, et cetera. And we'd like to see that taken forward by the big cancer societies, as well as health systems throughout the US and elsewhere.

Oliver Bogler
So I think you're coming up on your second anniversary of having joined the NCI. Why did you come to the NCI? What are you hoping to achieve in your current role?

Ophira Ginsburg
Well, I'm thrilled to be at the NCI. I still am pinching myself. First, for people who don't know, I'm a Canadian national, hoping to become a US citizen very soon. And the idea of working with such incredible people, really dedicated to the best science and to be of service nationally and globally. And particularly working at the Center for Global Health, I was very fortunate to have, well, leadership, as you know, Dr. Satish Gopal, to give me the time I needed to complete this big report of the Lancet Commission and start to take the recommendations forward as part of my work. One of the other priorities that I have is to help advance a new programmatic area to advance capacity building for cancer therapeutic clinical trials in low and middle income countries, which is very exciting and timely. Also goes along with the equity principles that are so close to our hearts.

Oliver Bogler
Fantastic. We're going to take a short break now. And when we come back, we'll hear all about Dr. Ginsburg's career path and what advice she has for our listeners. 

[music]

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[music]

Oliver Bogler
And we're back. I'd like to turn to your career path now. Let's start at the beginning. What got you interested in science?

Ophira Ginsburg
Oh wow, I can't remember a time when I wasn't interested in science. And apparently, supposedly, when I was six, the first time somebody remembers anyway, asking, what do you want to be when you grow up? And I said, a zoologist. I wanted to be Jane Goodall or, you know, Diane Fossey. I was absolutely mad about animals. And funnily enough, now if I could retrain, I would be a marine biologist. But… yeah, so I've always been fascinated by genetics. I think when I was 13, I was in grade nine, I skipped a grade and ended up, and then took a course above my year. So I was really young for the course and presented something about, now it sounds silly, but gene splicing based on what little we understood of that back then. This is a long time ago.

Oliver Bogler
Yeah, no, those were exciting times when so much was being discovered. But you then … you did a bachelor's of science and I think you did a master's in human genetics, right?

Ophira Ginsburg
I did, I was actually a genetic counselor. I was the first cancer genetic counselor in like full time, just doing cancer genetic counseling in Canada in the early nineties and before I went to medical school.

Oliver Bogler
I mean, that's a field that's exploded, genetic counseling, as we've discovered more. Interesting. So what prompted you then to go to medical school?

Ophira Ginsburg
Well, I was really enjoying what I was doing, but I was all of whatever 23 years old and I didn't see a big opportunity to expand and grow as a scientist. I was working, I was fortunate to work with Dr. Steven Narod, who's one of the co-discoverers of the BRCA2 gene. And we were recruiting families for the linkage analysis. That's how long ago that was. But I was getting frustrated already and I thought I need to learn more and do more. I thought about going to medical school or doing a PhD, and in retrospect, I wish I had done both. But I chose medicine because I loved patient care as well, and then ended up sort of developing cancer genetics as a specialty within the specialty of medical oncology.

Oliver Bogler
And so then what sparked your interest in global health? What was your first experience in that space?

Ophira Ginsburg
Well, when I think about why I got involved in global health, it really comes from my passion for social justice, which again, I sound like a super geek here, wanting to be a zoologist at six. And my first radio interview was when I was 12 years old about children's rights. 

Oliver Bogler
Wow, okay.

Ophira Ginsburg
Yeah, so I was really involved in social justice and I was an activist since, again, almost since I can remember.
But I really truly did not know anything about global health until I was already well into my medical training. And some of my friends were involved in infectious disease and maternal health. And that was sort of the obvious route. But I was so passionate about becoming an oncologist. I couldn't really see those two things lining up. So I chose to sort of evolve them in parallel. And I took time out. People who are listening might find this a bit strange, but in my fellowship in medical oncology, I asked for time and I took two and a half months with a backpack and really like roughing it in rural Southeast Asia and asking people what they thought about cancer and going into clinics with permission obviously. Also doing a lot of meditation and sort of soul searching to find my path and somewhere in rural Cambodia I found it.

Oliver Bogler
Remarkable, remarkable. And you also, I think you mentioned this a little bit earlier, you worked at the World Health Organization. So how did your path take you there?

Ophira Ginsburg
So in 2014 or so, I was already working on that Lancet series, Health Equity in Women's Cancers, and I was the director of a cancer genetics program in a part of Ontario where I was living, working at the University of Toronto on faculty. And I got a call from someone who some of the listeners should know, I hope, Dr. Ben Anderson, who was then a surgical oncologist at Fred Hutchison. And he was asked “do you know anybody who might be interested in helping us out with women's cancers at WHO in Geneva”? And he thought of me. So I literally got a call out of the blue, which was completely unexpected, obviously, and I had never really considered what the World Health Organization was doing in the domain of cancer. And boy, am I glad that he called, because that turned out to be an incredible opportunity. I mean, of course it was a competitive process, et cetera. but I was selected for the position, and then I went and spent a year there, where they were in some ways building up this cancer program. I was working with just one other person, if you can believe it, all of the World Health Organization at the headquarters level in Geneva was just myself and another who many people know now, he's such a star, Dr. André Ilbawi, who was junior to me, which seems funny now, because he could be, he could be the director general one day of the World Health Organization. So a lot has happened since then. I'm happy to share that with people if they're interested.

Oliver Bogler
Yeah, tell me before we do, can you tell us what is the World Health Organization? Maybe not all of our listeners think about the WHO a lot.

Ophira Ginsburg
Mm-hmm. So the WHO is the only truly multilateral global health organization we have. It is made up of member states. It's part of the United Nations. It's made up of 194 member states, of which the U.S. is one, and has three sort of parts to it. I mentioned headquarters. People think of the WHO in Geneva, which is correct, but it also, in fact, even more importantly, is comprised of its regional offices. There are six world regions, each with an office, with staff and country level offices, which is really where the rubber hits the road. So, you know, some people are a little bit cynical nowadays and they can say, well, “what is the WHO doing?” and “how come they're not doing more?”. And we had a lot of critique around the COVID pandemic, having worked inside the organization, even though it was just one year. I've worked alongside and helping support WHO. And by the way, the Center for Global Health at the National Cancer Institute is a WHO collaborating center in cancer control. So in all these efforts, I've come to understand the tremendous importance, especially in low income and middle income countries, when it comes to their opportunities to get buy-in and financial support locally or otherwise through grants and other mechanisms.

It matters that the WHO has developed or endorsed a policy or program such as, a good example would be the Cervical Cancer Program that is now several years old.

Oliver Bogler
So tell us more then about the beginnings of the cancer work at WHO that you were part of.

Ophira Ginsburg
Yeah, so I worked on a couple of major products, products as we call them, deliverables. One which is the WHO Guide to Cancer Early Diagnosis, which has proven to be a really important guidance document for countries that are looking at the burden of cancer that's growing in their countries. There's many things that they lack as we all know, including things like pathology services. 

But even if you could help downstage cancers which are detectable at an early stage and if detected and if treated properly, even with basic, you know, basic services. WHO has an essential medicines list that includes cancer chemotherapeutics, et cetera, surgery, even in the absence of radiotherapy, but ideally with radiotherapy. Those cancers, which when detected early and treated promptly, have a huge survival advantage. You know, that is important for countries to know. But how do they do that?

So the principles of early detection and distinguishing between early diagnosis versus screening was a really important piece of work I'm very privileged to have contributed to. The other main thing that I worked on was providing direct technical support to countries at the member state’s request. For example, I went to Myanmar at one point in my brief time at WHO, on behalf of the World Health Organization, was invited by that government at the time. They were in transition to, unfortunately, it hasn't played out the way we'd hoped, but they were transitioning to a democracy at that point and very eager to engage with multilateral and other UN organizations to improve the health and wellbeing of their population. So I had an opportunity to take a look at their national cancer plan and its implementation, et cetera, et cetera. And.

Oliver Bogler
Interesting. So then you returned back, you went back to Toronto, I think, and then soon after that moved on to NYU, to New York University, where you ran a high-risk cancer genetics program. Sounds almost like back to your earlier role as a genetic counselor. Is that a fair connection or?

Ophira Ginsburg
Oh, sure. So I'd actually been, all told I was the director of a cancer genetics program, two in Canada and then one in the US for about 15 years. So most of my clinical career has been in cancer genetics. And from that, by the way, if you look at what we're doing in cancer genetics on the prevention side, it fits nicely into risk reduction prevention overall, not just for women and men with genetic conditions that predispose them to cancer.
 
So that was my segue into public health, by the way, in Canada. I was also medical director for cancer prevention and screening for a part of the province. So that gave me a real education into public health. I didn't just go to WHO without having had that experience. But yeah, NYU was great. I was the director of the high risk cancer genetics program there. We quadrupled the size of the program in the four years, four and a half years I was there. And the other half of me was in global health. So I was on faculty in the Department of Population Health in our section for global health and writing grants like other extramural scientists. It's fortunate to have a couple of NIH grants that were wrapping up as I joined NCI.

Oliver Bogler
So it seems to me like you've really consistently in your career combined these multiple interests, right? Cancer genetics, medicine, global health, and really woven them into something amazing. And I've read that you described yourself as a “Jill of all trades”. I find that hard to believe. It seems to me like you're mastering these different domains.

Ophira Ginsburg
No, definitely not. I feel I had adequate expertise to be able to do the work I've done, but for folks who focus on one key area and do that for their whole career, for example, the brilliant cancer genetics researchers out there who've dedicated all of their work clinically and whether it's bench work or implementation research, et cetera, all on that one broad topic have far more expertise than I would say I have.

But, you know, like some people pointed out, well, why did you then go back to academia? For people trying to navigate careers in oncology and particularly in global health, it is virtually impossible to have a career in solely in global oncology without also having a clinical practice, if you're a clinician or having a, you know adequate salary support from NIH or other grants which are incredibly competitive and there's not many really that exclusively allow you to focus in global oncology. So I was lucky to be able to balance about 50-50 over many years until I finally found the right place where I could, you know, work exclusively in global oncology and that's here at the NCI Center for Global Health.

Oliver Bogler
So I'm interested in, you know, creativity in science and medicine. And I wonder if your connections to multiple different disciplines was an asset to you in that regard.

Ophira Ginsburg  
I think so. One of the sort of ways I phrased it is that I like to look at problems from the bottom up and the top down. And so the bottom up part, the literally being in clinic, seeing patients, talking to it and listening to the lives and experiences of the women who were coming for care, rural Bangladesh and Vietnam, I worked for many, many years, over a period of years. Having that experience made me reflect on what was the reason they weren't coming or what were the elements that could improve care even by simple structural things within the health system as well as of course seeing what the problems were in terms of patriarchal systems that would keep holding women back from career development in their own countries and having those decision-making authority within their families. 

Then going to WHO gave me sort of the 30,000 foot view. I sometimes said, I kept taking a step further back. What am I missing? What's really the problem here? But what else is the problem? And moving further back, I went all the way up to Geneva into the mountains, which was a little bit too high up because I lost sight of the ground. So I wanted to have that kind of balance. But yeah, I think it does matter having the opportunity to draw from different disciplines, different domains. And look, with the Lancet Commission, I didn't do a commission. It was a collective effort of 21 commissioners, 10 mentees, an advisory board, a six-person patient advisory committee from many different countries. And in the commission itself, the disciplines ranged from anthropology, social sciences, health systems, health services research, gender scholarship. It wasn't just oncologists with clinical or epidemiological expertise.

Oliver Bogler
Very interesting work that you're doing. And so I'd like to sort of turn to what advice you might give to our listeners, particularly people who are like, Oh, that sounds interesting. How do I get to do the kind of work that Dr. Ginsburg does? What's your advice?

Ophira Ginsburg
Well, there's a couple of places that I always turn to when I'm asked this or when I ask myself, have I, you know, did I fall off the rails at different points in my career? Did I lose sight of what my goals were or where my passion is? And one of those things is the concept, the Japanese concept, ikigai, has been sort of modernized and is now promoted by the Japanese government as loosely translated to ‘finding meaning in everyday life’. And so looking at that sort of, it's an intersection, it's a Venn diagram that has what you are good at, what you can be paid for, what the world needs, and what you love. So roughly it's passion, mission, vocation, and profession. Not in the order I just said, by the way. That wouldn't make sense.

But having an opportunity to really reflect on that, which I do often, I find it really important. And I have been told by students and also by peers, as well as people senior to me over the years who said, gee, I'm really, I'm fascinated by what you do. And I'm thinking of taking a sabbatical or I'd like to rework my career now to find a way to do that. It's rare that you can find that all in a job, right? It may be that you're also an artist as well as a clinical researcher or a musician, and you do that knowing you're not gonna make a living at it, but you carve out time to make it happen for you if you're able to. And that's really important, is finding that meaning as well as a vocation, something you can make a living.

That would be my main piece of advice. And the other is when people say something seems too hard or you can't do it, right? I always question who is saying that to me and what possibly are their motivations for saying that? And often in my own lifetime, it's not always been the case, but it sometimes comes from a position where the person asking that question is feeling a lack in their own life, about what they're doing. And so it's a way of sort of even inadvertently trying to spin something in a negative light because they don't feel they can do that. Like, how come she gets to, I've been asked that. It may sound a bit negative to say that here on the podcast, but I'm being realistic here. There's been people who frankly tried to undermine what I was doing and just keep your head down, keep doing the good work, you know, you'll find your way and seek out mentors, including peer mentors, people who are doing things you find interesting and learn how they got to do it.

So I was fortunate to be invited to the Royal Society of Medicine in London during what we call London Global Cancer Week, which sounds kind of funny. It's based on London Fashion Week, but it consists of many different webinars and in -person events. And we did an event around our Lancet Commission on Women, Power, and Cancer. And on the Friday, there's always a day dedicated to global oncology. A lot of people come who are interested in careers in global oncology from very different parts of their career. Some are medical students, some are very experienced or already retired oncologists throughout the UK and elsewhere. And I was asked to talk on careers. And in it, I had the pleasure of having just been in Senegal for the AORTIC meeting. I know Oliver, you know this meeting, the African Organization of Research and Training in Cancer. I was blown away by a panel discussion by three eminent scientists, from different African countries, including an anthropologist, someone who's sort of a cultural anthropologist. And there was this phrase that he was quoting as a proverb, no one should enter their home through another person's gate. No one should enter their home through another person's gate. And it really got me thinking. So I included it in my discussion. I test drove it at the career talk at the Royal Society of Medicine. And it apparently had an impact. People really were inspired by that, it's not my words, but to look at that from the career perspective, don't do what I did. I mean, I followed my nose. I also recognized my privilege in being able to make some of the choices I made along the way in my career, but find your own unique path because you have something to offer that no one else does.

Oliver Bogler
That's fantastic advice. Thank you so much. I really appreciate it.

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Oliver Bogler
All right. Now it's time for us to turn to a segment we call Your Turn, because it's a chance for our listeners to send in a recommendation that they would like to share. If you're listening, then you're invited to take your turn. Send us a tip for a book, a video, a podcast, or a talk that you found inspirational or amusing or interesting. You can send these to us at NCIICC@nih.gov. If you record a voice memo and send it along, we may just play it on an upcoming episode. But I'd like to invite our guest to have her turn, Ophira.

Ophira Ginsburg
Wow, okay. Well, I think I just gave one. So if you look up Ikigai, I think, you know, and there's books being written on this. It's so important. And it's just a simple image. I keep, it was my pin to tweet for a while when I was more active on, I'm still gonna call it Twitter. And for me also to find something that's really inspirational for myself, it's really, it's been Zen Buddhism. So a book that a young Vietnamese Canadian medical student gave me some 30 years ago called Peace is Every Step, really was transformative for me. And it seems almost too simple, but it's very deep. And I've shared copies of that book so many times over the years, and I welcome other people's ideas also that are inspirational. And just being open to different cultures and different ways of living is very important.

Oliver Bogler
Well, thank you for sharing that. I'd like to make a recommendation as well. It's a podcast I've started listening to recently called Night Science. It's by Dr. Itai Yanai of New York University and Dr. Martin Lercher of Heinrich Heine University in Düsseldorf, Germany. In the podcast, they interview scientists about their creative process and how they come up with new ideas for their research. And the guiding principle of this is so-called Night Science.

So, Day Science is what we commonly think of as science, right? That's when you test a hypothesis, you do an experiment, you analyze some data. But Night Science is ideation and thinking across areas and connecting disparate concepts and creating ideas, it is much more intuitive and artistic in a way. And these two modes work together. Night Science can suggest things that you can then test in your Day Science and then the information from the day science can flow back into the night science. The concept of this Day and Night science comes from the autobiography of Francois Jacob, a Nobel laureate early on in the days of the molecular revolution. And Drs. Yanai and Lercher have a great website with lots more info and resources that you can find, including their pod. So we'll post that in the show notes. Thank you very much, Ophira, for sharing your time with us and your insights.

Ophira Ginsburg 
Thanks so much, Oliver. It's been a pleasure.

Oliver Bogler
That’s all we have time for on today’s episode of Inside Cancer Careers! Thank you for joining us and thank you to our guests.

We want to hear from you – your stories, your ideas and your feedback are always welcome. And you are invited to take your turn and make a recommendation to share with our listeners. You can reach us at NCIICC@nih.gov.

Inside Cancer Careers is a collaboration between NCI’s Office of Communications and Public Liaison and the Center for Cancer Training.

It is produced by Angela Jones and Astrid Masfar.

Join us every first and third Thursday of the month when new episodes can be found wherever you listen – subscribe so you won’t miss an episode. I'm your host Oliver Bogler from the National Cancer Institute and I look forward to sharing your stories here on Inside Cancer Careers.

If you have questions about cancer or comments about this podcast, email us at NCIinfo@nih.gov or call us at 800-422-6237. And please be sure to mention Inside Cancer Careers in your query.

We are a production of the U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute. Thanks for listening.