It’s a long way from where I grew up in Karachi, Pakistan, to the dining room in Vice President Joe Biden’s home at the Naval Observatory in Washington, D.C. Yet that’s where I found myself one day last December, along with a handful of other cancer specialists. We had been invited to offer our perspectives on the current cancer landscape, which contributed to shaping the “cancer moonshot.” I’m convinced that my perspective on medicine as an immigrant is what ultimately got me to the table.
Early in my career as an oncologist at Roswell Park Cancer Institute in Buffalo, N.Y., I treated a woman who was terminally ill with acute myeloid leukemia (AML). As her disease progressed, I watched her struggle to write letters for her 2-year-old twin daughters. She wanted them to read a letter from her on each of their birthdays until they turned 21. She died before she got to the ones for their 13th birthday.
That experience nearly broke my heart. It also suddenly clarified the purpose of my career. I realized that we needed a more comprehensive understanding of her disease. I needed to learn how pre-leukemia develops into leukemia, how it continues to evolve, and how it can be treated.
Had I received my scientific training in the United States, my immediate instinct probably would have been to develop a sophisticated mouse model to work on each of those steps. But because I was educated in Pakistan, I thought about taking a simpler approach — examining the cells of patients with myelodysplastic syndromes (MDS), an early-stage version of leukemia.
So I began banking the blood and bone marrow cells of MDS patients at every encounter and following them as they progressed to leukemia. I also saved their normal cells to serve as germ-line controls. Thus began the MDS-AML Tissue Repository. Since 1984, it has banked some 60,000 samples from thousands of patients. The repository is backed by a state-of-the-art computerized data bank that is the ultimate in one-click efficiency. I can safely say that no more than a handful of patients in all those years turned down my request to donate their cells for research purposes.
This repository has helped my colleagues and me define the molecular and genetic milestones that must be covered for pre-leukemia cells to cross over into leukemia cells. It will also help us define potential therapeutic targets that could be used to intercept the disease before it is too late. This work will likely apply to the evolution of other cancers as well.
Cancer is slated to become the leading cause of death in the coming decade, with 1 in 2 men and 1 in 3 women suffering from the disease at some point in their lives. Over the next 10 years, the number of new cancer cases in the United States will increase by 42 percent, and the number of cancer survivors will rise from 15.5 million to 20.3 million. During the same period, the number of oncologists will increase by only 28 percent. Many of the new doctors will be immigrants.
The leader of the group gathered at Vice President Biden’s home that day was another immigrant, Dr. Patrick Soon Shiong, a South African-born, Chinese-American surgical oncologist. He developed a way to transplant human islet cells to treat type 1 diabetes, performed the world’s first encapsulated human-to-human and pig-to-human islet transplants, and the first full pancreas transplant on the West Coast. Thanks to this immigrant’s development of the drug Abraxane, the first FDA-approved chemotherapy agent based on nanotechnology, the lives of thousands of patients with breast, pancreatic, and lung cancers are being prolonged.
Many immigrants have brought their unique talents to serve their new country by fighting cancer as healers and researchers. A 2013 study by the National Foundation for American Policy found that 42 percent of the researchers at the top seven cancer research centers across the country were foreign born. According to a recent study published by George Mason University, immigrants make up 28 percent of all physicians and surgeons in this country.
My parents chose to live in Pakistan but encouraged all seven of their children to emigrate to the United States in search of higher education. We were brought up to believe that it would equip us with the means of contributing to the knowledge of this world. My parents were deeply moved by the welcome their children received in their new homeland, a place where merit was recognized and rewarded regardless of race or color or religion.
My older brother is a cardiac surgeon, my older sister trained as a pediatric oncologist, and my younger sister is a radiologist and breast imaging expert. Another sister has a PhD in international relations, a brother is a professor of aerospace engineering, and my youngest brother is an electrical engineer.
We are Muslims, we are immigrants, and we are enriching, prolonging, and saving American lives. We are just seven of the many immigrants, from many lands, of many faiths, who are — and have always been — an essential part of America’s strength. We are hard workers, people with big ideas and big dreams, believers in this great country and our shared responsibility to make it even better for all of us.
Closing America’s door to immigrants will never be the answer to the challenges we face. Instead, America needs to bring in the best minds — and the most minds — to fight cancer and solve other seminal issues of our times.
Azra Raza, MD, is a medical oncologist at NewYork-Presbyterian/Columbia University Medical Center, director of the MDS Center at Columbia University, and professor of medicine at Columbia University Medical Center.