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Reflecting on Thirty Years of Progress with Dr. Larry Norton

By BCRF | September 26, 2023

BCRF co-founder Dr. Larry Norton looks back on the progress and promise of research

It all started 30 years ago at Evelyn H. Lauder’s kitchen table. Evelyn recognized that the major obstacle to achieving a cure for breast cancer was funding for research. Together with the guidance and support of her dear friend and revered medical oncologist Dr. Larry Norton, they launched BCRF in 1993.

Since then, remarkable advances in breast cancer prevention, diagnosis, treatment, survivorship, and metastasis have been made. But there is still critical work to be done. The Foundation is moving faster and closer than ever to achieving its mission to prevent and cure breast cancer by advancing the world’s most promising research. 

BCRF co-founder and Founding Scientific Director, Dr. Larry Norton, has been there since the beginning. He and the over 250 investigators BCRF supports are tirelessly working to achieving this mission. We spoke with him to discuss the progress BCRF has made and what advances are on the horizon.

Dr. Norton is Senior Vice President in the Office of the President and Medical Director of the Evelyn H. Lauder Breast Center at Memorial Sloan Kettering Cancer Center. He is also a Professor of Medicine, Weill-Cornell Medical College. Dr. Norton has dedicated his life to the eradication of cancer through his work in medical care, laboratory and clinical research, advocacy, and government. He was a U.S. Presidential appointee to the National Cancer Advisory Board. Dr. Norton is also involved in collaborations with BCRF investigators on several projects––most notably the Mathematical Oncology Initiative. Over his illustrious career, Dr. Norton has received many honors. In 2021, Dr. Norton was elected to the American Academy of Arts & Sciences.

Read more on Dr. Norton here.

Read the transcript below: 

Chris Riback: Dr. Norton, thanks for joining me. I appreciate your time.

Dr. Larry Norton: My pleasure, my pleasure. Thank you.

Chris Riback: Let’s start with the topic of time. What does “30 Years of Progress” represent?

Dr. Larry Norton: It’s almost unrecognizable. When I think about where we were with breast cancer 30 years ago and where we are now, it’s just been remarkable the advances. And it’s not just in one thing, it’s across the board, which is actually one of the key parts of the philosophy of the BCRF is to work across the board, not on any specific one topic putting all eggs in one basket; better diagnostics, better prognostication, better medical therapy, better surgical therapy, better radiation therapy, and most important, a better understanding of the disease. And not just the biological understanding of the disease, which is obviously key. What are the molecules that make cancers cancerous? What are the changes in the DNA we call the mutations and other DNA changes and RNAs and proteins and other things that we can sort of measure? But the social impact of breast cancer and what we could do to try to ameliorate some of those aspects as well. Survivorship issues. After you’ve gotten treated for breast cancer and the cancer has gone away, what are the issues that are affecting you in terms of your return to normal life, to normal activities? Across the board there have been really major, major advances. And I must say I’m very, very pleased to report that the vast majority, if not all of the significant advances that have happened have in one way or another involved one or more BCRF investigators.

Chris Riback: You and Evelyn Lauder started the Breast Cancer Research Foundation three decades ago. What motivated you to make it a reality?

Dr. Larry Norton: What really happened is that she and her husband, Leonard, were very involved with building our first breast center at Memorial Sloan Kettering Cancer Center, which was also a great innovation. It had not been done before, the idea of a freestanding breast center where the patient could be taken care of comprehensively and not have to go from doctor’s office to doctor’s office and gather opinions and go someplace for a mammogram or someplace else for something, some of the tests and go someplace else for treatment. But the idea of putting it all together for the convenience of the patient, which was really based on her experience in business and basically the department store idea, the concept of you build the store around the customer, you don’t necessarily have the customer searching to find the things that they want. And that was spectacularly successful, so much so that we later on built a much bigger center, a freestanding building. The first center was the first time Memorial Sloan Kettering actually had a center for care that was not in its main campus, was not in its main hospital. And that has been a remarkably successful innovation, copied throughout the world.

But when we did that, we realized that there were other changes that had to be made, and so we met in her kitchen with a beautiful view of Park Avenue over tea. I think it was Darjeeling tea. And said, “We have a little bit of money left over. We can potentially raise some more money. What else is needed?” Having started this great experiment, I said, “There’s another experiment that really should be started.” Thirty years ago was the dawn of the really molecular understanding we call molecular biology. The molecular understanding of cancer in general, in breast cancer in particular. And I was part of a community of great doctors that knew how to take care of patients really well with all the available knowledge that we had at our disposal at that time, but also clinical investigators that we were able to do studies and are a well-oiled operation funded by the federal government largely in those days to do clinical studies.

But there was a disconnect between what was happening in the laboratories and what was happening in the clinic. We were not necessarily testing the really exciting things that we were discovering in the laboratory. So we decided that what would really work well, or as an experiment to try, is to create an organization, a foundation that could bring together the very best scientists who were studying breast cancer, the very best doctors who knew how to take care of breast cancer and clinical investigators and see if they could form a community and work together to understand cancer better and improve cancer therapy.

So, it was an experiment. And she decided that she was going to have a dinner party in her home a few steps away from her kitchen and invite some of her friends. I would invite some really superb colleagues who were doing this kind of cancer research, both in the laboratory and the clinic. We’d get to know each other, we’d raise some money and we’d see what would happen next.

And what’s happened next has really been remarkable. BCRF is the largest non-governmental funder of breast cancer research in the world at the present time. And we really have a global impact all throughout the world in this regard. And it has grown into this extraordinary activity where we find the best investigators. And regardless of their age, we like to have young investigators and older investigators, accomplished investigators, often regardless of the topic they’re studying, as long as we know that it’s an important topic. Because science is always changing. You can’t say, “Well, over the next five years, I’m going to study this” because six months after that or a year after that, this might’ve changed, and you want to be able to move off in different directions.

Part of this was based on the fact that she and I were both very immersed in the arts, supporting the arts. And arts grant-making organizations were different then and still are different than many science-oriented organizations. Many science-oriented organizations have a competitive grant process by which people send in applications, and they’re carefully reviewed and decisions are made. Arts organizations often have a panel that is very knowledgeable about the field, goes to a lot of performances, go to a lot of museums, listen to a lot of music, know what’s going on, and then seek out the best opportunities for funding to be able to make advances. We put together a small, in those days as it has grown to be much larger scientific advisory board of real luminaries in the field with a very broad expertise in all of cancer biology and medicine and social aspects of medicine, diversity and equity issues in the whole spectrum. And we seek out projects, we seek out individuals.

And I would also emphasize that something that makes us different than many other organizations is that we find the best individuals and we fund them. We ask them to give us a proposal of what to do. But the grant is not necessarily for that particular project because that project may change. We fund the artists. You know, you go to Picasso and you say, “You’re a great artist. Do some great art.” We go to great scientists, clinical scientists, laboratory scientists, and we say, “Do great work.”

They report to us. We have a very, very strenuous process of review of the work. Along with freedom comes accountability in that regard. And it’s really worked remarkably well, as I said. So many major advances. So much of what we are now accomplishing in breast cancer can be traced to our investigators but also our style of giving grants and of finding the best science and of moving it forward.

Chris Riback: I have the great honor of having these conversations with BCRF scientists, researchers every month, and the major themes that you just touched on come across in every one of those conversations. The translational aspect of medicine, the connection between the clinic and the labs, so many of your researchers with whom I talk about that, the global nature of what occurs, the collaborative approach. Everyone talks about the collaborative approach. And then I didn’t know that part. And I’ve had the privilege of talking with you before. I didn’t know that part about you and Evelyn Lauder and the arts connection. And it makes total sense because the creativity that scientists with whom you are connected—the creativity that they apply, it’s exactly as you described. They feel like it’s them that BCRF is investing in. And yes, with responsibility comes accountability, with freedom, you had said, comes accountability. They feel it. But the major themes that you just talked about, which I guess were created figuratively on the back of a napkin drinking Darjeeling tea 30 years ago, they are solid today.

Dr. Larry Norton: What you’re saying, Chris, is so important because first of all, number one, that they’’e feeling it. And often when we bring in new grantees, they’re not used to that. It takes them a while to get used to that because they’ve had specific aims. And they have to accomplish their specific aims and whatever too, so they’re not used to that. The other part of it is that when they are grantees for a while and doing this good work, they relax in terms of their collaborations with their colleagues. And this is something very important. Other granting mechanisms create a competition as a gladiatorial combat where if you have a great idea and you share a great idea your colleague may apply for grant and you may be denied that because somebody else already has a grant in that idea.

And it all goes back to something that at that meeting with Evelyn in her kitchen with Leonard walking by and saying, “Gee, it sounds great. I’m in,” with that meeting, she said, “Larry, I’ve worked around creative people all my life. That’s what we do. We create things. And they need two things. They need freedom and they need security.” The freedom to actually follow their most intriguing ideas and the most inventive ideas and the security knowing that if they do good work and it doesn’t work out that they’ree not going to lose their job. And very often, people don’t feel that freedom. They have a job to do and they do it. And very often they feel insecure, is that, “My goodness, I want to study molecule X. And if molecule X doesn’t work out, I’m not going to be able to get my grant renewed.”

And we’re not like that. If they do high quality work and they come up with a different answer, including a negative answer that they weren’t expecting, that we weren’t expecting, it does not mean that they’re not a good investigator. You have to take chances. You have to swing the bat a lot of times to hit a home run. That is really very much an intrinsic part of our community, that feeling. And the very fact that our investigators feel that and they acknowledge it and they speak to you about it is really heartwarming because that’s really what we’re all about.

Chris Riback: They do. And it comes across in every conversation. I’m curious just in listening to you, and we’re thinking about the last 30 years, I want to get into it in a moment a little bit about today and tomorrow. Listening to you describe the impact on the community over the last 30 years, the growth of BCRF over the last 30 years, the way that it’s affected scientists, and then of course the way it’’ affected patients and families and people who think and have to worry about this. You may not appreciate the question, but I feel I must ask it. What about you? What has the journey meant for you?

Dr. Larry Norton: It’s been exhilarating and it’s been wonderful in every aspect of it. I’ve always said that the favorite part of my job is training the next generation. I have an army of fellows and other people that I’ve been in contact with over the years who’ve gone on to do really marvelous, wonderful work—that’s the thing that really is the most exciting thing to me. But that also extends to colleagues, frankly, is that you can be a mentor to your trainees, but also you have relationship with your colleagues and that you can actually help them and influence them in a positive way to do the kinds of things that are important for them to do because their life mission is also to make advances against cancer. That’s been really very profoundly exciting. And colleagues come up to me all the time and speak to me all the time and say, “Listen, I’ve got a major paper that we’re publishing in a major journal, and it’s going to really change the way we practice medicine, and we owe it all to BCRF funding. If you didn’t fund me with this idea, I never could have gotten this funded in any other way. It was just too new an idea. And that led to this advance or to another advance, another advance, and it went on to do wonderful things.” There’s nothing really more heartwarming than that.

Another aspect of it is actually personal. I’ve learned so much from my contact with my colleagues and learned so much in terms of science that’s influenced my own science, my own way of moving forward. I’m going to give you a very concrete example of that is that I’m involved in a lot of areas of science, but one of them is mathematics. My original background was mathematics. Music and math were the things that I thought I was going to do with my life, and then I ended up doing what I’m doing now by the way life works with its long winding road.

And I realized from looking at our program that there were mathematical insights that could be applied to the problem in addition to biochemical insights and other areas of science that we know are very, very relevant. With the support of the Simons Foundation through BCRF, we’ve established something called a Mathematical Oncology Initiative. And that’s been extraordinarily productive in general, but also for myself, for my own personal growth because it’s put me in contact with extraordinary mathematicians who are basic mathematicians often who don’t do applied work, they just do work on theoretical mathematics. But they’re very excited by the opportunities. And we’ve made very significant advances in that regard in terms of understanding biology, picking who’s going to respond to immunotherapy, being able to tell prognosis of a breast cancer patient just from looking at a microscope slide and just analyzing that using machine learning and artificial intelligence and other tools that have been developed to augment mathematics.

The impetus came from my contacts with my colleagues through the BCRF as well as my wonderful colleagues at Memorial Sloan Kettering Cancer Center. We started a program in understanding the molecular biology of breast cancer, called the Founder’s Fund after Evelyn. When we tragically lost her, Leonard stepped up to the plate and auctioned off her high-level jewelry and made other contributions. Many of her friends came in and we established this Founder’s Fund.

The etiology of that is very interesting is that BCRF for many years has been supporting an annual meeting between breast cancer clinical investigators in the United States, North America, and the breast cancer clinical investigators originally in Europe and now internationally, something called the Breast International Group. And we formed together. We used to meet annually one year in Brussels, one year in Chicago at the American Society of Clinical Oncology meeting. And now we’ve been meeting largely in Chicago.

But at one of those meetings, in particular in Brussels, we had presentations of people who were studying the molecular biology of breast cancer. What are the changes in DNA, RNA proteins? What are the molecular changes that are in breast cancer? And Martine Piccart, great European investigator now on our scientific advisory board, and I were in the back of the room. We noticed that all of the studies were breast cancer coming from the breast, tumors coming from the breast. But that’s not the dangerous part of breast cancer. The dangerous part of breast cancer is metastasis, the spread of the breast cancer cells to other parts of the body. And we weren’t studying that. The analogy that popped into my mind at the time is trying to figure out why the cows have left the barn by only studying the cows who are still in the barn. You’ll get the exact wrong answer. The cows who are still in the barn are there for a very good reason. The ones that are left are the ones that you want to know about, the cells that have spread to other parts of the body.

And so the Founder’s Fund was focused on something called the AURORA projects. There’s one AURORA project in Europe and one AURORA project in the United States, both of which have produced extraordinary discoveries about the molecular characteristics of breast cancer, including the discovery, independent discoveries, but coordinated independent discoveries on both sides of the Atlantic that the immune system has a profound effect on cancer metastasis, which has given impetus to studying immunotherapies for breast cancer and a better understanding of that. And in the analysis of all that data, I realized that mathematicians could also get into this in a novel way that had not been done before. And so, we not only have this mathematical oncology initiative and not only have the AURORA projects, but we can marry them together in a productive way.

I can’t think of any other organizational system that could actually do this, that could fund international trials involving most of the stellar leaders in molecular biology of breast cancer together; mathematicians who’ve never had a practical application in all their years of work starting to work on the cancer problem. And then being able to bring them together to be able to work together on this kind of problem. This can only come from a cohesive community. And it really illustrates the wisdom and the insight and the foresight of Evelyn in our kitchen conversation in terms of how to actually make this happen. You find the best people, you give them freedom, you give them security, and magic happens. And that’s what’s happening in BCRF.

Chris Riback: Well, it’s not surprising to me that you raised the mathematical oncology group, the initiative. As I was researching for this conversation and was reading more about that, it absolutely felt to me like the proof was in the pudding…that you were executing in your own activities exactly the vision that you describe.

Additionally, listening to you right now, the importance of the Founder’s Fund and the importance and “challenge “is too light of a word of metastasis. It is written on your page that no topic in cancer medicine is more pressing and no opportunity more significant than understanding and stopping metastasis. Is that at the center of it?

Dr. Larry Norton: No. The dangerous part of cancer is metastasis. It’s not the lump in the breast. Lump in the breast is a big pimple. You could remove it. That’s not the problem. The problem is that cancer cells can spread to other parts of your body. It can go to your bones and your liver and your lungs and your brain. That’s the lethal part of cancer, so that’s actually the essence of it all.

But it starts with the lump in the breast. So yes, we have to study metastasis, which we’re doing, which a large bulk of our research is studying the biology metastasis and ways of interfering with it. And essentially everything we do therapeutically is one way or the other either treating metastasis or preventing metastasis. But there’s a flip side of this as well, which is that if the lump in the breast didn’t happen in the first place, then you wouldn’t have the opportunity for metastasis, so we have to study cancer prevention as well.

We have a cancer prevention initiative that’s going on right now that is also extraordinary with extraordinary individuals because the best way to stop the metastasis is stop the lump in the first place. And so that’s part of it as well.

You see, the whole concept is you got to study the whole thing. Very often when I give lectures, people say, “Well, what’s the most important thing that we should be studying?” And I say, “I will answer your question, but you’ve got to answer your question first. Tell me what’s the most important part of the airplane? Is it the left wing? Is it the right wing? Is it the engine that makes it go forward? Is it the pilot? Is it the navigation system?” The fact is that you need all of those pieces and you need them all to work together. The most important part of cancer research is not let’s put all our eggs in the basket of immunotherapy or all our eggs in the basket of better surgery or better radiation or understanding biology. The important thing is to build the whole airplane and to make all the pieces work together.

So it doesn’t bother me at all that I study metastasis and try to cure cancer once it’s there and once it’s developed into metastasis. It doesn’t bother me at all that I can do that at the same time as I give drugs at the time of the diagnosis of the breast cancer to prevent metastasis, which is what adjuvant therapy is all about. And also that we’re studying how to stop the cancer in the first place. You got to study the whole spectrum.

The other thing that any scientist will tell you, things you learn in one area help you in another area. We use breast cancers that are estrogen receptor-positive or hormone-responsive that have spread to all the parts of the body, we use a whole variety of hormone-based therapies to actually treat such patients to extend their life. And we’re getting better at better at that because we’ve discovered mechanisms of resistance to hormone therapy, and we can give drugs to overcome that resistance. And so we’ve made huge advances in that area. And BCRF investigators have been all over that topic.

But those same drugs could be used early on to prevent the cancer from metastasizing in the first place in the adjuvant setting after the lump is discovered. And those same class of drugs could be used to prevent breast cancer in the first place, which is something we discovered. Studying one category of the disease helps you understand and helps you manage other categories of the disease. And so that is why it’s so very important to really have a comprehensive package of grantees and programs so that we can learn from each other.

Chris Riback: One hundred percent. And that also comes across. I can’t tell you the number of conversations I’ve had with BCRF investigators who have identified lessons or hints or glimmers from colon cancer or some other type of cancer that then get applied. That comes across as well. What a beautiful, powerful metaphor, the airplane. That also comes across not only in the scientific, medical, biological component, but also the emotional, psychological patient care component. And the way that those intertwine also becomes a very, very powerful lesson.

I’m interested in your views on items today. The global data hub, for example that BCRF created. First of its kind to transform how breast cancer researchers access and share data. Talk to me about the global data hub. And maybe if you could talk to me as well, is there anything today current in terms of technologies or evolutions? Of course, something like for lay people like me, we hear a lot about AI. And I had a recent conversation about AI and breast cancer, a BCRF conversation. Tell me, if you would, about some of the things that capture your attention today and the global data hub.

Dr. Larry Norton: It’s the evolution of the BCRF concept. The evolution of the BCRF concept is getting people to work together. But one of the most important things that we’ve learned over the last several decades while we’ve been doing this is the power of big data, the power of having very large data sets that can be scrutinized by a variety of tools, including the emergent modern tools of mathematics, artificial intelligence, machine learning, neural networks, and so on to be able to actually have insights. On the AI area, this is as dramatic a change in the human brain, the ability of human intelligence to interrogate the world and learn from the world as anything that’s happened previous to this. And let me explain what I mean by that.

Chris Riback: Yeah, it’s a powerful statement.

Dr. Larry Norton: The scientific method was a great intellectual breakthrough. The scientific method is largely you formulate a hypothesis, you design an experiment, you do the experiment, you see the results of the experiment. It modifies, confirms, or denies or modifies your hypothesis. You go onto the next experiment. It’s all about testing. I’m frequently asked, “Larry, do you believe in X, Y, Z?” And I say, “I believe in certain things. I believe Mozart is a great composer. I believe in God. I believe in certain things. When it comes to science, I have no belief. It’s all about the data. It’s all about the evidence.” It’s not a belief system. And that’s a dramatically different way of looking at the world when you really think about it is that it’s got to be based on evidence. And the evidence is based on prospective experiments.

We’ve built this incredible world where science has changed our world in so many wonderful ways because of the scientific method. Now we have a different way of actually approaching questions. What I said before is you make observations of nature and you generate a hypothesis and then you generate experiments to test or refute your hypothesis. Now we could actually look at the world, observations, data in a different way, and the data can generate the hypothesis in ways that we could not creatively come up with. It can look at the data and it could say, “It looks that to us like” the machine talking to me. The machine is saying to me that there are certain changes that we see here that are connected to other changes, certain ways that the cells look under the microscope that can tell you whether this patient’s going to be cured or not,” for example. And then we can start to then develop hypotheses that are derived from the actual analysis of the data rather than using our imaginations only to come up with those hypotheses.

This is really a revolution of thought. And where this is going to lead in the big picture, none of us really know. And it’s a very powerful tool, and therefore it has to be applied very, very carefully moving forward. But that means that we have to have the data to interrogate. And now we have these astonishing investigators from all over the world.

And by the way, a lot of people who are not BCRF investigators are interested in getting in on this data hub where all this data can be put in a way that can be interrogated, that could be looked at by qualified individuals. We can be very careful about who can actually look at the data and who can analyze the data. We’re going to have careful controls on that so it can be released to qualified people from all over the world to actually look at the data and, using modern tools of big data science actually derive hypotheses, things that we couldn’t have thought of before.

A lay example of this is look how long it took us to figure out that cigarette smoking caused lung cancer. Decades, centuries where we didn’t have a hypothesis. Cigarette smoking, tobacco smoking was ubiquitous. Everybody did it. It was all over the place. There was no hypothesis. It would take machine learning seconds to figure that out and come up with a hypothesis, “We’ve observed that there’s more lung cancer in people who smoke by looking at big data. Maybe you should look at the impact of cigarette smoke on the lungs,” the machine would say to us. And then we would do a hypothesis and then we would design experiments, and then the usual methods of science would get us to that answer.

There may be a lot of other things that are out there that we just haven’t thought of yet but that the data could speak to us and tell us this about the molecules we’re studying, about social factors, the impact of stress, chronic stress in our environment, the impact of social inequities, which is something else that we’re studying on bodies’ physiology and how that physiology could actually impact the generation of cancer or prognosis once you have cancer. Those are the kinds of things that we can actually study now by actually interrogating the data once we accumulate that data. And so that’s the underlying philosophy of what we’re trying to do with the data hub. And I think it’s going to be a transformative step in understanding not just breast cancer but all cancers, and maybe other diseases.

We’re finding connections now between heart disease, cardiovascular heart disease, clogged coronary arteries and cancer through mutations that occur not in cancer cells but in white blood cells, that normal white blood cells that look normal under the microscope may have mutations in them that predispose us not only to cancer but predispose us to heart disease. And that’s the kind of thing that can come out of these kinds of research. Yes, we’re studying breast cancer, yes, we’re studying all cancer, but yes, we’re studying all diseases.

Chris Riback: What a fascinating way to frame it because it reminded us all earlier that if you want to understand why cows are leaving the barn, you need to look at the cows who have left the barn, not the cows who remained in there. The importance of looking at, quote, “the right thing” or asking the right question. What you’re describing now is the first-ever, perhaps, opportunity to, in milliseconds, not just ask the right question but ask the new question. All of a sudden the ability to think of the new thing. What a fascinating framing.

Secondly, you understand, doctor, that I am not here to argue with you. You’re the last person I want to pick a fight with. However, in terms of Mozart’s excellence being connected to a belief, I think, my hypothesis is we could find empirical evidence of his greatness.

Dr. Larry Norton: Yeah. Well, we could talk about that. That’s a whole other topic. The thing is we can find evidence that he’s popular, we can find evidence that he’s played often, we can find evidence that people appreciate him, but greatness is a term that’s really a little bit harder to define in that regard, too. And so that gets into a little bit of a belief system, and so that’s what I mean. And I think that a lot of wonderful things in life belong to belief; there’s no question about it. When it comes to science, I don’t have any confidence in belief, I’ve got confidence in data.

Chris Riback: I appreciate the distinction. And yes, I look forward to our next podcast series on Mozart and greatness. But what you’re describing right there also aligns with a question that I found myself thinking about vis-à-vis you and your role as I was thinking about what you do in 30 years of BCRF and the things that you have faced, surely, and that you think about. I find myself thinking how you likely sit at the intersection of eternal optimism and frequent frustration. What I mean is, on the one hand, you have this front-row seat that you’ve described in this conversation to some of the most extraordinary, hopeful, and optimistic scientific advancements in the world. It’s nothing short of incredible what breast cancer researchers do and the possibilities that exist; you’ve described it. And at the same time, you know from the translational aspect of what you and others do and that what happens in the lab and what happens in the clinic and the realities of what happens in the clinic, everyday new people are diagnosed with breast cancer. How do you balance that daily hope?

Dr. Larry Norton: And some are dying of breast cancer, too.

Chris Riback: And some are dying. How do you balance the hope and frustration?

Dr. Larry Norton: I was interviewed by a great interviewer many years ago for the New York Times, and she asked me that same question. And I hadn’t really thought of it before then, but I answered her thinking about it. And it’s the same answer. It’s really what motivates me and really what drives me and why I’ve given up other parts of my life like music, for example, to focus in on this particular topic is that as a cancer doctor, I take care of people and I provide the very best care that can be provided for them with my colleagues, my wonderful colleagues at Memorial Sloan Kettering and colleagues throughout the world and collaborators. And sometimes it doesn’t turn out good. And I carry those memories with me through every minute of my life. And I owe it to them that their child will not die of cancer.

That’s really what motivates me every day. Yes, I didn’t save their life, but what I can do is I can work harder, make more discoveries, apply the very best of my abilities and motivate and organize and support, financially support the great investigators in the world so that the people that they love and their offspring never have to worry about this disease. That’s my obligation to those individuals. And I can’t help them anymore, but I can help others that they care about, that I care about.

And that’s really what drives me. If you want to put your finger on exactly the thing that drives me, that’s really what drives me. The successes drive me also, the great glory of those successes that drive me. Many years ago when there was an experimental therapy that’s now a standard therapy that dramatically saved somebody’s life, a new drug where she was really sick and she was clearly not going to make it. And it was an experimental drug. And we gave her experimental drug that’s now a standard drug, and she had a fantastic, remarkable response. And I knew her as a patient.

I was taking my little daughter to a play date. It was my job to take my daughter to a play date. And I knew the name of the child; I didn’t even know anything further. And I took my daughter by the hand and knocked on the door there too. And the door opened and the other child ran out, and they hugged and they went to play. And I looked up and it was that woman, it was her child, the woman whose life I’ve saved. And now my daughter’s playing with her daughter. And we looked at each other, we both broke down in tears, big wet, sloppy tears and both hugged each other at that moment. Because she had that same reaction to me. Here’s a dad bringing a kid from the school play.

The successes really are there as well. I am driven to make it universal and my colleagues are driven to make it universal. And for the ones that we didn’t save the life or we didn’t prevent the cancer, whatever too, is I owe it to them to do better. And that’s really what drives me personally. It’s a very good question.

Chris Riback: Thank you for that. It’s a very, very, very powerful answer. And I can only imagine. I’m playing the film in my mind of your patient who is now in that instant not just a patient, she’s a friend that’s a mother, a human being, a person in your life and in your child’s life. And the eyes locking. There must have been a lot of tears.

It does lead to a wonderful way to close because you’ve taken a conversation that is thinking about 30 years of history and how meaningful it is that what motivates you isn’t the 30 years of history, but it’s tomorrow. And so within the incredible pride and gratitude that so many people have for everything that’s been accomplished, the lives that have been saved and the therapies that have been discovered and the care that has been personalized… We didn’t even really get to talk about the way that the personalization of care, how meaningful that has become. And yet at the same time, everyone shares your well-meaning impatience and want to know what’s next in your mind for BCRF? What’s next for breast cancer?

Dr. Larry Norton: Well, look, we have a lot more work to do, as you said. And that’s what really motivates us and really to move forward. Right now, as I say, we have a very broad, very broad category of research, and we want to provide that. We’d like to give more grants. We’d like to give more individual grants. We’d like to get involved in more projects moving forward. We have an extraordinary collaborative project with the pharmaceutical industry where, with the support of the industry financially and with their medicines, that we could have our investigators design clinical studies to move forward. I’d love to see that expand.

You mentioned the data hub. We’d like that to be bigger. We’d like that to be broader. More connections with other activities that are going on in the cancer space, things that are happening in the U.S. The Moonshot in the U.S. is equivalent activity in Europe, more connections in that regard basically to carry the philosophy forward. To keep our eyes open for the next big things that are happening.

There’s a particularly fascinating evolving view of cancer as not just being a disease of the cancer cell but a disease of the cancer cell and its relationship to what we call its microenvironment. You can have the worst bank robber in the world, but if the bank robber doesn’t have a getaway car and doesn’t have an accomplice in the bank and doesn’t have all these things, they’re not going to be able to do any kind of damage. The cancer cell by itself is an abnormal cell, but there are normal, or so-called normal, cells in the vicinity. We think they’re normal. They’re also helpers and are very important. And that’s why cancer may spread, let’s say, to the liver and not to the brain in individuals because there’s something about the liver that’s supporting the growth of that cancer cell. And so studying the microenvironment is an extremely important topic, and we have every intention of expanding our activities in that regard as well.

And to keep our eyes open and to move forward. The plan is to react to the best science of the moment, of the week, of the month, of the year and move things forward. There’s much more to be discovered. I personally think that, and many my colleagues do also, that manipulating the immune system in a productive way is we’re just beginning. We’re just touching the surface of our ability to use the white blood cells in our own bodies to stop the growth of cancer, prevent cancer from occurring, and help us treat cancer, so the work in that regard is moving forward. We can take white cells out of the body and manipulate them, put them back into the body. That’s another area with cancer-killing capacity. That’s something else that we’re extremely interested in. I can go on and on. I can name many other areas, but that’s really what it’s about. It’’ the philosophy that’s central, and then it branches out into specifics. And that’s what I’d like to see BCRF do.

We could be bigger. I would like to see us have the opportunity to support more investigators. We have many more investigators we want to support than we can support. And that’s also really one of our initiatives moving forward. But the future is bright. That’s the important thing to emphasize. There will be a day that we’ll look back and say that there was such a disease once as cancer. And it was a terrible disease and it caused a lot of devastation and a lot of premature deaths and hurt a lot of people. And now that’s part of history because of what we can accomplish. And that’s what we have to keep our eyes on and keep our minds on.

This can happen, really, in your own life. I gave you the story of that individual patient. Why you’re undergoing therapy or why you’re worried about breast cancer, things are happening right now that could influence you and that could be advantageous to you. It’s not just about the far future, it’s about the immediate future, results of studies coming through.

I didn’t even mention the Translational Breast Cancer Research Consortium, which is a large cooperative group of investigators in the country supported by BCRF and by Susan G. Komen jointly in terms of, again, collaboration. Collaboration is key to that and moving things forward in that regard to be able to do our studies. I said on the steering committee that, and I’m seeing new studies come out all the time with major advances, things that could help individuals. We have to work hard. We have to remember the past, never forget it, but we also have to work hard with an optimistic view of the future because we are going to accomplish breast cancer in all cancers. Our job is to make that happen as fast as possible.

Chris Riback: It is clear from your conversation, it’s clear from the conversations that I get to have with other BCRF scientists. And I very much look forward to having the conversation with you looking back at what was cancer and getting to discuss how that was put behind everyone.

Dr. Larry Norton: Thank you. Thank you.

Chris Riback: Dr. Norton, thank you. Thank you for what you do and for what BCRF and all BCRF researchers around the world do every day.

Dr. Larry Norton: And thank you for this opportunity.

Outro: That was my conversation with Dr. Larry Norton. My thanks to Dr. Norton for joining and you for listening. To learn more about breast cancer research or to subscribe to our podcast, go to