Interview with Dr. Maggie Dinome: A Duke Breast Cancer Surgeon
Written by Lina Shoman
Introduction
Dr. Maggie Dinome is a renowned breast cancer surgeon at Duke University, and she is celebrated for her expertise in treating breast cancer and leading innovative surgical techniques. With a career devoted to patient care and research, Dr. Dinome has played a pivotal role in advancing our understanding of cancer and improving patient outcomes. “As a surgeon, it’s always about finding ways to improve the care we give to our patients and understanding cancer better,” she shared during a recent interview. This conversation offered a glimpse into her insights on the evolving landscape of breast cancer treatment, including the promise of epigenetics, precision medicine, and emerging technologies in oncology.
The Science of Epigenetic Signatures in Breast Cancer
Revolutionizing Cancer Surgery with Epigenetics
Dr. DiNome highlighted an exciting breakthrough: using epigenetic signatures to predict cancer behavior. Historically, breast cancer surgeries were extensive, often involving invasive procedures like lymph node removal. “When we first started doing surgeries for breast cancer, they were really big surgeries. We always thought that the bigger the surgery, the better,” she explained. Now, her team is working to decode the molecular instructions within cancer cells to determine whether the disease is likely to spread.
Understanding Cancer Without Invasive Procedures
Epigenetics, the study of changes in gene activity that do not alter the DNA sequence, offers new ways to predict cancer progression. Dr. DiNome explained, “It’s not because genes are broken that people get breast cancers, but because bad genes are turned on and good genes are turned off.” These insights allow researchers to predict cancer behavior without surgery, paving the way for more personalized and less invasive treatments.
Reducing Unnecessary Surgeries
One of the most promising aspects of this research is its potential to eliminate unnecessary surgeries. Dr. DiNome’s team is developing a DNA methylation signature that could reveal whether cancer has spread to the lymph nodes without surgical intervention. “We’re trying to determine whether a patient has lymph node disease without actually having to do a surgery under the arm,” she said. This innovation could revolutionize breast cancer care, making treatments more precise and less physically taxing.
Precision Medicine and Metastatic Cancer
The Future of Tailored Treatments
Dr. DiNome emphasized the transformative potential of precision medicine, which customizes treatments based on the unique characteristics of each patient’s cancer. This approach is particularly crucial for metastatic breast cancer, which remains a formidable challenge. “We’re constantly looking for targets on tumors that drive cancers to grow, and then we target those specific mutations,” she explained. By identifying these tumor-specific drivers, doctors can develop therapies that are both more effective and less harmful.
Minimizing Side Effects
Targeted treatments offer a significant advantage over traditional chemotherapy, which can cause widespread damage to healthy cells. “The more targeted you can be, the less broad the insult of the treatment,” Dr. DiNome noted. Precision medicine not only improves outcomes but also enhances patients’ quality of life by reducing side effects.
Personal Motivation Behind Focusing on Breast Cancer Research
A Profound Personal Connection
Dr. DiNome’s journey into medicine was profoundly shaped by her father’s battle with colon cancer. “My father had passed away from colon cancer when he was 39,” she shared. This early loss ignited her passion for making a difference in the lives of cancer patients. “I wanted to help my father... I wanted to help my family.”
Finding a Calling in Breast Cancer Research
Although her initial motivation stemmed from family, Dr. DiNome discovered her calling in breast cancer research. “It just became a natural kind of focus and progression toward that. There are so many women, and I felt like there’s so much promise in this field,” she explained. Her work reflects her commitment to addressing one of the most common cancers affecting women.
Emerging Technologies and the Future of Oncology
Advances in Epigenetics
Dr. DiNome sees epigenetics as a bridge between genetics and environmental factors. “It’s the link between the environment and our genome,” she explained, using the example of identical twins to illustrate its impact. While twins share identical DNA, their epigenetic profiles can diverge over time due to differences in environment and lifestyle, leading to distinct health outcomes.
Tackling Metastatic Cancer
Metastatic cancer remains a significant hurdle in oncology. Dr. DiNome emphasized the importance of early detection, highlighting technologies like blood biopsies that could identify microscopic cancer cells before they spread. “If there were a way to know if a patient has microscopic cancer cells in the blood that will lead to distant disease, it could change the way we approach metastatic cancer,” Dr. DiNome elaborated. She highlighted the current limitations of blood biopsy technology, noting that while promising, it is not yet refined enough for routine clinical use. “We are beginning to detect circulating tumor cells and DNA fragments in the blood, but the challenge lies in interpreting what these findings mean for individual patients. The potential is there—early detection could guide treatment decisions before the disease spreads—but we still need more precise tools and validation.” she mused, envisioning a future where early intervention could drastically improve outcomes.
The Challenge of Cure
Despite advancements, metastatic cancer remains difficult to cure due to its ability to adapt and resist treatments. “We can prolong life, we can treat the disease...but ultimately the cancer becomes mutated...and then we’re stuck,” Dr. DiNome admitted. However, she remains optimistic that ongoing research will bring new solutions.
The Role of Duke University in Cancer Research
Collaboration and Cutting-Edge Research
Dr. DiNome praised Duke University for its collaborative environment and robust research infrastructure. “Duke has the infrastructure and support to do research at the highest level,” she said, emphasizing the institution’s ability to integrate clinical expertise with innovative research. Clinical trials are essential to advancing cancer care, and Duke offers patients access to cutting-edge therapies. “All the clinical trials that we can offer to our patients...that really sets Duke apart,” Dr. DiNome noted, underscoring the university’s role in shaping the future of oncology.
Advice for Aspiring Cancer Researchers and Caregivers
Start Early and Stay Curious
Dr. DiNome encouraged students to explore cancer research early in their academic journey. “Get involved early...jump in and see if you love it,” she advised. Hands-on experience, she believes, is invaluable in discovering one’s passion and making meaningful contributions.
The Rewards of Medicine
Reflecting on her career, Dr. DiNome highlighted the profound satisfaction of helping patients. “Patients need people who are dedicated, committed, and who help them,” she said, inspiring future medical professionals to embrace both the challenges and rewards of the field. With ongoing advancements, she believes that with patients, there is reason for optimism, even in the face of difficult diagnoses.
“ “Just continue to have hope...things are constantly changing. ...new medications are helping patients...we’ve come a long way, we’ve got a long way to go, but we’re getting there.””
