I am not an oncologist. I have never prescribed chemotherapy. I have never delivered radiation. I have never staged a tumor.
And yet I spent almost my entire career inside Memorial Sloan Kettering Cancer Center.
For decades, I practiced gynecology in a place where cancer was not theoretical. It was present in every hallway conversation, every chart, every waiting room. My patients carried diagnoses that ranged far beyond gynecologic malignancies. They came to me after treatment for breast cancer, lymphoma, colorectal cancer, melanoma, sarcomas, and many others.
Some were in the middle of treatment. Some were years out. Some believed they were done with cancer, only to discover that survivorship brings its own challenges.
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Others had never had cancer at all, but carried a genetic mutation that placed them at high risk. For these patients, cancer risk shaped decisions about screening, family planning, and whether or when to undergo risk-reducing surgery.
I did not treat their cancers. I treated what cancer treatment did to the rest of their lives.
Women in their twenties arrived in abrupt menopause after chemotherapy, often unprepared for the symptoms or the emotional implications. Some were navigating dating. Others were trying to make sense of a suddenly uncertain future. Some had been able to pursue fertility preservation. Others had missed the opportunity.
Women in their thirties struggled with infertility after pelvic radiation or gonadotoxic chemotherapy. Women in their forties and fifties experienced sexual pain, hormonal disruption, bone loss, or bleeding changes that no longer fit neatly into what we think of as normal aging.
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Women of all ages experienced some or all of these effects.
Others came because something simply felt off, and they did not know whether to call their oncologist or their primary care physician.
Their questions often began the same way.
“Is this normal?”
Over time, I realized that I was practicing in the space between specialists.
Oncology quite appropriately focuses on eradicating disease. Primary care addresses general health. But survivorship often lives in a gray zone.
That gray zone became my territory.
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Cancer navigation, as I understand it, is not ownership of the cancer diagnosis. It is stewardship of the person who carries it.
When you care for patients over years, you begin to see patterns. You learn which symptoms are common late effects of radiation. You recognize the hormonal cascades that follow certain chemotherapies. You understand when pelvic pain is expected and when it requires further investigation. You learn when reassurance is appropriate and when escalation is urgent.
You also develop strategies for management that are honed over decades of experience.
When I first began practicing in the late 1990s, the options for managing vasomotor symptoms were limited. There were even fewer options for sexual health concerns. Often, one had to be creative when trying to help patients whose quality of life had been dramatically affected by treatment.
My mantra was simple: there is a difference between living and surviving.
I dedicated my career to helping patients truly live.
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Over the following decades, there has been an explosion of hormone and non-hormone therapies for managing menopause and survivorship symptoms. Patients spoke about what they were experiencing, and we listened.
At a time when the word estrogen was almost taboo in breast cancer clinics, I introduced low-dose vaginal estrogen at Memorial Sloan Kettering and helped support the hypothesis that it could be used safely, even in breast cancer patients, through clinical research.
Working in this gray zone has also highlighted one of the most powerful tools we have in medicine, and one that is deceptively simple: a detailed family history.
From the earliest days of medical training, we are taught to ask about family history. Yet too often this part of the record is incomplete. Charts may simply list “family history of cardiovascular disease” or “family history of cancer” without documenting who had what, and at what age.
Those details matter.
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I am certified in cancer genetics, and that training sharpened my awareness of risk that extends beyond a single tumor.
A woman may present to me after treatment for colon cancer. During conversation she mentions a sister with endometrial cancer and an uncle with pancreatic cancer. That constellation may suggest a hereditary cancer syndrome.
Another patient treated for breast cancer may have a mother with ovarian cancer and a cousin with early prostate cancer. These patterns matter.
While only about ten percent of cancers are believed to result from inherited genetic mutations, that ten percent represents an opportunity. It is a place where careful evaluation can change outcomes.
By taking the time to map a family tree carefully, physicians can identify individuals at risk who might otherwise be missed. We can refer patients for appropriate genetic counseling and testing. We can ensure that siblings, children, and other relatives receive the surveillance they need.
In some cases, we can alter the trajectory of future cancers entirely.
Even after a diagnosis, there remains an opportunity to prevent the next one.
This is another dimension of navigation. It is not only about guiding a patient through what has already happened. It is about anticipating what could happen next and intervening early.
Survivorship is not static. It unfolds over decades.
I have had patients from twenty years ago reach out with new symptoms or new diagnoses. They often tell me there is no other doctor like me.
What they are describing is continuity.
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I remember the arc of their story. I remember the treatment they received, the complications they endured, the family members who were ill, and the questions that kept them awake at night.
I do not see a single visit in isolation.
Personalized care is not a marketing phrase. It is pattern recognition over time. It is system fluency. It is knowing which colleague to call and when. It is understanding how a treatment delivered fifteen years ago may shape the symptoms a patient experiences today.
It is recognizing that someone who has survived one cancer may be at increased risk for another, and acting before that risk becomes reality.
Inside a cancer center, I learned that the end of active treatment is not the end of vulnerability. Hormonal changes, genetic predispositions, and late effects continue to unfold.
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A gynecologist practicing in that environment becomes attuned to those shifts. Over time, I became comfortable speaking both languages: the language of oncology and the language of quality of life.
Navigation requires both.
When I contributed a section on cancer navigation to a recent book authored by a cancer survivor, I drew upon these decades of experience. I thought about the questions I have answered repeatedly, the reassurance I have offered, and the referrals I have made. I thought about the moments when identifying a hereditary risk altered not just one patient’s future, but an entire family’s.
I remain clear about what I am and what I am not.
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I am not an oncologist.
I am a gynecologist who spent a career inside a comprehensive cancer center, who became certified in cancer genetics, and who learned to recognize patterns across families and across time.
Today, I continue to provide this kind of high-touch cancer navigation to men, women, and families facing the unimaginable disruption of a cancer diagnosis. I serve as a liaison, a teacher, a confidante, and a guide.
I work in the space between specialties, where patients most need continuity, perspective, and reassurance.
If navigation means helping someone understand where they are, where they have been, and where they may be headed, then that is the work I have done.
And it is work I continue to believe deeply matters.
By taking the time to map a family tree carefully, physicians can identify individuals at risk who might otherwise be missed.
