Madeleine Courtney-Brooks, MD, MPH, is a board-certified gynecologic oncologist. She is an assistant professor and director of the Division of Gynecologic Oncology of the University of Pittsburgh School of Medicine’s Department of Obstetrics, Gynecology, and Reproductive Sciences.
Dr. Courtney-Brooks also is director of the Magee-Womens Gynecologic Cancer Program of UPMC Hillman Cancer Center, caring for women with gynecologic cancers at locations throughout the western half of Pennsylvania, eastern Ohio, and northern West Virginia.
What was your path to becoming a doctor?
My parents say I started telling people I wanted to be a doctor when I was about 4 years old. I don’t know what inspired that in my little brain, but I do remember looking up to my pediatricians. They were all women, and I thought they were incredibly smart. As I grew older, I thrived in the sciences, so a career in medicine became a realistic choice.
My decision to become a doctor solidified during my sophomore year of college. I was on Kenyon College’s swim team, and we did a training trip in Florida. On our way back to Ohio, one of our vans was in an accident. Tragically, we lost a teammate. The first responders at the scene and some of the hospital’s emergency personnel came to campus to talk with our team. The support, compassion, and empathy they showed stayed with me. I realized that medicine isn’t just caring for the patient. You have to care for their family and loved ones, too. I saw that good communication is an important part of being an effective doctor.
Could you talk about your experiences as a young Black woman attending medical school?
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I enrolled at Washington University School of Medicine of St. Louis, Mo., because of the incredible academic opportunities it offered students like me. Its mission was clear: to train a diverse group of medical students to care for patients from a variety of ethnic backgrounds. Underrepresented minorities were invited to spend a weekend on campus to network and connect before committing to attend. That was important to me. It made me feel more comfortable with my decision.
What is the importance of role models for medical students of color, both in the classroom and in patient care?
The day-to-day experiences of underrepresented minorities in medicine can be hard to understand if you’re not a person of color. It’s not that people don’t try. But there’s something to be said for having a colleague or a mentor who has the same kind of daily shared experiences as you.
When your ethnicity or gender influences the way that patients, professors, and colleagues see and interact with you, you start to think this is just how it is, right? But that’s not how it is for everybody, and it’s not right. Being able to name it and share what happens with someone who has similar experiences can take some of the weight and power away.
What led you to Pittsburgh for your residency?
I knew I wanted a large and clinically busy academic ob-gyn residency program. I wasn’t sure which specialization I would ultimately pursue, so I wanted a residency that could expose me to many options. Pittsburgh was my first choice because of the quality of the residency training at UPMC Magee-Womens Hospital. I remember sitting in an office for my interview and being incredibly impressed by all of the residents and the breadth of experience among the faculty. Magee had ob-gyn fellowships that I didn’t even know existed!
The further along I got in my residency training, the more I realized how much I loved doing surgery. In the cancer world, gynecologic oncologists have a pretty unique role. In addition to surgical care, we also provide chemotherapy and surgical care. We also provide chemotherapy and ongoing surveillance for women with gynecologic cancers. As a result, we’re able to have ongoing relationships with our patients and their families that I think is quite unique as a surgical subspecialty.
We are the captains of our patients’ care teams at every stage of their disease — from diagnosis to treatment and, hopefully, remission. For women dealing with recurrent cancers, or transitioning to palliative or end-of-life care, we are still leading those conversations. I often tell my fellows, residents, and medical students that it’s a privilege to help guide patients and families through these times. Even though it is hard, communication is actually what patients and families need most.
For patients with gynecologic cancer, treatment by a gynecologic oncologist is crucial for improving the chances of survival. Yet there are only about 1,200 gynecologic oncologists in the United States — and you are among only a handful of Black women in that role. Are you challenged by that fact?
My race and gender do sometimes make things harder. But the longer I do this, the less personally I take it. At least once a week I’ll meet a new patient, have a great and interactive conversation, and it’s clear they like me. But when I start to talk about their treatment plan, they (or a family member) will ask, “So when are we going to meet the surgeon?” It’s an example of unconscious and unintentional biases held by goodhearted people that come out in the workplace on a regular basis.
Are the issues of minority underrepresentation and racial disparities getting better?
At UPMC, I think we are trying to move in the right direction. The conversation is at least happening, whereas before, nobody ever talked about it. Across the UPMC system, there are some real and important efforts being made to increase awareness about racial disparities, increase minority representation among faculty, and incorporate progressive initiatives and training across the system. I’m optimistic that these interventions are more than just a convenient box to be checked. I’m hopeful, too, that we’ll continue trying to work toward these goals. We still have a lot of work to do.
How are you hoping to improve the recruitment and retention of students of color?
We’re very dedicated to increasing the number of underrepresented minorities in our residency training program at Pitt and Magee. We continue to do holistic reviews of all applications, but we also know that relying on traditional measures of assessment — such as board scores — has been shown to be biased against underrepresented minorities. We now look at those things in context with other factors. One of my colleagues, Alexander Olawaiye, MD, is our area’s new vice chair of Diversity, Equity, and Inclusion. He is working on creating formal mentorships for both trainees and faculty members. These are important steps in the right direction.
The mortality rates for Black women who are diagnosed with gynecologic cancers are markedly higher than those of white women. Can you speak to these higher death rates?
Black women are more likely to be diagnosed with endometrial cancer when it’s at an advanced stage. Then, stage-for-stage, they have decreased survival rates. The reasons behind those numbers are likely multifactorial. Many hold an understandable generational mistrust of the medical system. Some of the risk factors related to endometrial cancer — like hypertension, diabetes, and obesity — are seen more frequently among Black women.
But it is also important to recognize that access to regular and good gynecologic care is simply harder for Black women. There’s also evidence that their symptoms are often not addressed the same way as they are for non-Black women. Their voices are not heard, and they are not taken as seriously.
Unfortunately, this problem is not unique to gynecologic oncology. It happens in many cancer fields. Evidence tells us that on a national level, women who are Black, poor, or both are less likely to get the appropriate standard of cancer care. They are also less likely to receive continued treatment and be enrolled in clinical trials. Collectively, all of those factors contribute to decreased survival rates.
What is being done at UPMC to offer broader access to gynecologic oncology care?
As the director of the Magee-Womens Gynecologic Cancer Program at UPMC Hillman Cancer Center, I can say we are working every day to address both racial and rural health disparities in Pennsylvania.
We see patients at our inpatient facilities in Pittsburgh at UPMC Magee and UPMC Passavant. But we also provide care for women with gynecologic cancers throughout the tri-state region. We perform surgery at UPMC Hamot and UPMC Altoona. UPMC Horizon is one of the outpatient facilities where we see patients. We work closely with our medical oncology colleagues throughout the region. When travel to Pittsburgh is not practical or feasible for patients, we are happy to collaborate with the network of medical oncologists throughout the UPMC Hillman Cancer Center system to ensure that patients can access care closer to home.
UPMC Passavant is especially interesting. While the hospital serves as a hub for residents of Pittsburgh’s northern and western suburbs, it’s also where we provide gynecologic oncology surgical services for women from more rural communities farther north. Areas like Franklin, Hermitage, and New Castle represent a surprising range of socioeconomic and ethnic diversity.
I tell my patients that having surgery at UPMC Passavant is no different than at UPMC Magee. We offer a seamless collaboration that delivers excellence in care on every level. UPMC Passavant–McCandless isn’t far from downtown Pittsburgh, but it offers cancer patients a less intimidating and more relaxed environment. When you’re traveling from a distant community, navigating unfamiliar streets and finding parking can be stressful.
Sometimes, there are clinical trial options available at Magee and patients come to Pittsburgh for treatment. But more and more of these trials are now available throughout the region. That’s good news for all women — and particularly underrepresented minorities — because they offer improved access to those trials closer to home.
Is telemedicine playing an increasing role in patient care?
Right before COVID-19 hit, I was at a meeting to discuss how we could better integrate telemedicine into our care. I have to admit — I was skeptical. I wondered how we could make it practical and relevant to our patients. And then COVID happened. We just had to do it.
Telemedicine is now an incredibly valuable resource for my cancer patients, especially those from more distant locations. We want to eliminate as many barriers to their care as possible, like reducing how often patients need to travel to Pittsburgh. It’s true that some aspects of care need to be done in person. But telemedicine makes it easy to stay in touch with patients. We can review imaging studies, talk about care plans, and discuss other important topics.
For more than a century, UPMC Magee-Womens Hospital has provided high-quality medical care to women at all stages of life. UPMC Magee is long-renowned for its services to women and babies but also offers a wide range of care to men as well. Our patient-first approach ensures you and your loved ones get the care you need. Nearly 10,000 babies are born each year at Magee, and our NICU is one of the largest in the country. Our network of care – from imaging centers to hospital services – provides care throughout Pennsylvania and Maryland, giving you a chance to get the expert care you need close to home. The U.S. Department of Health and Human Services recognizes UPMC Magee as a National Center of Excellence in Women’s Health, and the Magee-Womens Research Institute is the largest research institute in the U.S. devoted exclusively to women’s health and reproductive biology.
When you are facing cancer, you need the best care possible. UPMC Hillman Cancer Center provides world-class cancer care, from diagnosis to treatment, to help you in your cancer battle. We are the only comprehensive cancer center in our region, as designated by the National Cancer Institute. We have more than 70 locations throughout Pennsylvania, Ohio, and New York, with more than 200 oncologists – making it easier for you to find world-class care close to home. Our internationally renowned research team is striving to find new advances in prevention, detection, and treatment. Most of all, we are here for you. Our patient-first approach aims to provide you and your loved ones the care and support you need. To find a provider near you, visit our website.