Women are Supporting Other Women: Interview with Victoria Smart

Victoria Smart, Senior VP of Mission at the Susan G. Komen Foundation, joins Dr. Gevorg Tamamyan from OncoDaily for an insightful discussion. Victoria details her journey from law to cancer advocacy, highlighting Komen’s impactful work, including a 42% reduction in breast cancer mortality since 1982.

Gevorg Tamamyan is the Editor-in-chief of OncoDaily, President-Elect of SIOP Asia Continental Branch and Pediatric Oncology East and Mediterranean (POEM) Group, and the CEO of the Immune Oncology Research Institute (IMMONC). He is the Chairman and Professor of the department of Haematology and Pediatric Oncology at Yerevan State Medical University.

He is a Co-Founder and Board Member of the Armenian Association of Hematology and Oncology, City of Smile Charitable Foundation, Co-Founder and Chairman of the Board of the Institute of Cancer and Crisis, the Former President of the Harvard Club of Armenia.

Victoria Wolodzko Smart is the Senior Vice President of Mission for Susan G. Komen. She leads Komen’s Center for Public Policy. Victoria has been working in the fight against cancer for more than 20 years. She began her career in scientific grants and program management with the American Association for Cancer Research (AACR). Prior to AACR, Victoria was Director of Association Services for the Pennsylvania Trial Lawyers Association (now Pennsylvania Association for Justice), and a member of the legal support teams for several law firms in Philadelphia focused on patent law and civil litigation.

Gevorg Tamamyan:  Hello, everyone. Welcome back to Onco Daily. Today on Onco Influencers, we have Victoria Smart, the Vice President of Susan Komen Foundation. Thank you very much, Victoria, for having the time for us.

And I’ll just briefly introduce yourself, and then we’ll go ahead with our interview, okay? Victoria, as I mentioned, is the Senior Vice President of Mission for Susan Komen Foundation. She leads the efforts to achieve Komen’s vision to end breast cancers.

She oversees all aspects of Komen’s missions through groundbreaking research, evidence-based education, high quality patient care services, and public policy. She joined Komen in 2010 to establish Komen’s Research Programs Department to provide in-house strategic leadership of a billion dollar research investment. Before that, she has been working in the fight against cancer for more than 20 years.

And before that, she was working at the AACR, American Association for Cancer Research, and was working with the program management for the scientific grants. She is native of Philadelphia and a graduate of Temple University, and now she resides in Denver. Her bio is much larger, but I’ll leave it to our Q&A to get more insights from her personally.

Thank you very much again, Victoria, for being available for this interview.

Victoria Smart: Well, thank you so much for having me and having the opportunity to talk about the work we’re doing to support the world in the fight against breast cancer. I’m really excited to be part of today’s episode.

Gevorg Tamamyan: Thank you. Can you explore a bit more what the foundation is doing or has been doing throughout these years?

Victoria Smart: So let’s start from the beginning. And it’s a long story because the Susan J. Komen Breast Cancer Foundation has been working since 1982.

When you think back to that time, the world was a very different place for healthcare and for women especially. So we’re talking about time when people had so many misunderstandings about cancer. Some people thought that cancer was contagious.

They thought that they had to cross the street if they saw a patient. They couldn’t actually say the word breast in polite company. Women really weren’t at the table making decisions.

We really weren’t talking about screening and early detection back then. And so as you can imagine, the survival rate from breast cancer was pretty low. And anyone who was diagnosed with metastatic breast cancer had a very low chance of survival.

So this is what inspired our organization to start. Our founder had a personal experience. She watched her sister be diagnosed at the age of 33 with two young children.

That was Susan J. Komen, a real person who lived in Illinois. And three short years later, she had died of breast cancer because she didn’t get the right care at the right time and was able to make the right decisions.

And so with that experience, we decided that we had to put women in the driver’s seat of their healthcare and start with empowering people with evidence-based education and information and a call to arms to get people into early detection. The other thing that Komen was very instrumental in was being a funder of breast cancer research at the very beginning. Our very first grant, this number will be funny, our very first grant was for $28,000 to a researcher in Texas.

All amount of money, but that led to enormous impact. You shared the big number, a billion dollars in research, and we’re proud to say that nearly every breakthrough in some way can be traced back to Komen’s involvement. So when you put these two things together, commitment to scientific discovery and the empowerment of patients through education and supportive services, the field has seen a 42% reduction in the mortality rate from breast cancer today.

These things working together work. But coupled around all of that is this, we often have a challenging healthcare system. So we can educate people and put the right treatments on the market, but if policies don’t exist to break down barriers, ensure that patients can access and afford their care, we haven’t won a battle.

So we have an arm of public policy that works on the federal, state, and local levels to ensure that policies support patients. We call all of this our 360-degree approach. We’re gonna surround breast cancer on all sides to ensure that we’re taking the fight where it needs to be.

And so that’s where we are today. We’re continuing that work to ensure that no one dies from breast cancer and that everyone, everywhere, has the best chance to survive and thrive if they’re diagnosed with breast cancer.

Gevorg Tamamyan: Thank you very much, Victoria. It was really very inspirational. And coming back to you, can you share your journey of becoming the senior VP of a huge foundation, a senior VP of mission specifically, right?

And what inspired you to dedicate your career to the fight against cancer? Why did you come and how was your journey?

Victoria Smart: Oh, it’s a 25-year story, but I promise I’ll do it in a shorter amount of time. So, you know, in my early career, I thought I might be a lawyer and might be working in the legal profession. So when I was in university getting my bachelor’s degree, I worked full-time.

I put myself through college. I’m a first-generation child of immigrants and I worked in law firms to help pay for my college education. I thought this might be my profession.

One of my first jobs was working for the Bar Association in Pennsylvania, where I’m from, and it was a terrific job. It was focused on protecting consumers and everyday people, you know, and upholding their rights. And it was a wonderful, wonderful position, but that started my inspiration about my career should really be about giving back to the greater good.

And I started thinking about, is the legal profession the right thing for me, or was there something more where I could take my passion and make a difference? And the organization that I found was the American Association for Cancer Research, which is the world’s leaders in really positioning success in the cancer research field. And it just so happened to be headquartered in Philadelphia, where I was from.

And it was my first experience working for an incredibly accomplished female leader, Dr. Margaret Fodey, who really set the vision for this organization, who believed that success was possible, that there should be no barriers to us fulfilling our mission, really inspirational. And she gave me the support and the mentorship to believe that I could be part of that as well. Not to say that it was easy, tough job, right?

Big mission, a lot of high expectations to do things the right way, to be accurate, be rigorous. But it taught me all those things that are important when you’re working on something as critical as cancer. I was young at the time, right?

So when I started, cancer had not yet touched my family or my friends, but that changed very, very quickly when I joined AACR, that one of my close colleagues was diagnosed with breast cancer. And she and I were about the same age at the time. So she was young and we were both at the beginnings of our career.

And while my career was advancing, hers was stopping because she had to go into treatment. She had to leave her job. She had to go to endless appointments and deal with all the financial toxicities.

And it was her that really inspired me to think about what more could I do for people like her and support patients. AACR was an amazing scientific organization, but I felt really called to do more for people like my colleague, who are dealing with the day-to-day, not the promise of research tomorrow, which was important, but where was she right now?

And when I looked around at organizations that I wanted to work for, who I felt got it right in terms of patient centricity, Susan G. Komen was that organization. Starting with the story that it was founded by a sister who cared for her sister. And that story resonates with millions of people who are watching their friends and their loved ones and their families, their sisters and their moms fight this disease.

Komen was that organization to me that gave an outlet for people to be powerful against a disease that left them powerless. A place to come and be that strong advocate. And I very desperately wanted to be part of that family.

So I was very lucky that with my work at AACR, I got to meet very incredible people. And one of those incredible people that I worked with during my tenure had gone on to be the leader at that time of mission at Komen. She knew my work in the sciences and she was the one who gave me the opportunity to come to Komen and build their first in-house research department.

This is important, right? This is 15 years ago when patient advocacy was really reaching the inflection point. And Komen recognized that there was a need to better connect all of this investment they were making and really bring science closer into the patient advocacy community.

And really understand and leverage what investments we were making. And so the organization asked me to come and build that capability for Komen. And I was very delighted to get that phone call.

I often joke that if they would have invited me to come wash their windows, I would have said, yes. I’m really glad that wasn’t the job offer, that it was something more aligned with my passion. But that’s where I started with my first love is bridging that development of the patient voice in science.

And so in the ensuing 15 years, as I grew in my understanding and my leadership, the organization afforded me the opportunity to take on more and to grow my influence based on what I brought to the table and what I knew to be able to lead in areas like our community health work and our educational work and our health equity work and our public policy work and our global work, you know, end to end to end.

Everyone who works for a nonprofit understands that the number of pluses in the other duties as assigned can be quite extensive. But for me, that was really exciting. What I’ll, I’ll share one more thing before I’ll stop is, you know, my career trajectory reflects the belief that we have about what’s needed to fight breast cancer.

All of these things have to work together. None of these things that I’ve talked about, research, education, policy, they do not exist in a silo. And that was really important that, you know, we brought all this together under one banner rather than having different departments work in a silo because these things need to, these things need to work in concert in order to have the best impact.

And that’s what Brantwood brings us to today. So that’s a very long story, but it is 25 years in the making.

Gevorg Tamamyan: What’s the, like, the thing you’re proudest of during this, like, 25 years? If you mentioned just one.

Victoria Smart: Oh, you’re asking me to pick my favorite child. I’d say I’m going to do something very recent. What I’m really excited about, there’s two things I’m going to wrap into one thing.

During the COVID pandemic, we were all sheltering in place, but unfortunately, breast cancer was not sheltering with us. Breast cancer was moving on. What we decided to do is ensure that no one was really alone during their breast cancer care, especially at this most vulnerable time.

And we built a patient navigation program through our patient care center. This is entirely virtual. You can either access us on phone or via email and get connected to a patient navigator to understand how you can access care, have some psychosocial support, talk about your financial needs, and have someone on the other end of the call who can understand and support you.

We built that during the pandemic. Last year, we served nearly 50,000 people with services. So it’s grown exponentially in a very short time.

So I’m very proud that here at Coleman, we recognize the need to serve people exactly where they are with what they needed. We build it quickly and we’ve been incredibly impactful. We do these services in English and Spanish and we’re open Monday through Friday.

So please call 1-866-GO-COLEMAN. There’s my advertisement.

Gevorg Tamamyan: Thank you very much. What was the most challenging thing for you and how you managed it?

Victoria Smart: I’d say one of our biggest challenges is being able to serve all of the people who need to be served and respond to all of the challenges that are happening in the world. I mentioned that we support about 50,000 people a year. That’s a subset of the over quarter of a million people who are being diagnosed every year in our country.

So there’s a lot more help that we can give than we can at this time. That’s always a challenge. The other challenge for us is keeping up with the pace of discovery.

There is an explosion of new information coming about breast cancer care from all fronts. It’s difficult to help patients keep up with the pace of technology. We’re inundated with stories about the promise of AI, new diagnostics, new therapeutics, new drugs on the marketplace.

And one of the challenges we have is helping patients sort through this information, make the best decision based on rigorous evidence. We often have to balance wanting to give patients hope about what’s on the horizon, but also the reality of whether these new modalities are thoroughly tested and are right for them. This is a huge thing, as you know, and oncology is the promise of precision medicine.

Our goal in all of this investment and the work we’re doing is to ensure that every patient gets the right care at the right time. And boy, has that needle moved. Every day we’re learning something new about breast cancer, new targets, new mutations, new pathways.

And the more complexity means more decision-making for our patients and for our healthcare providers. It’s a lot. It’s a lot to sort through.

That’s one of the roles that we hope that Coleman provides for all patients is that single source of truth. Come to us, learn the facts, take it to your healthcare provider and make the best informed decision for you. We try to stay ahead of that.

You know from ASCO, there’s always an explosion of information. We have to stay one step ahead.

Gevorg Tamamyan: On one hand, as you mentioned, there is an explosion of new information, research, a lot of new knowledge. But on the other hand, I mean, there is a different reality in the world. I mean, in the United States, elsewhere in the world.

So, I mean, people are not able to access even the basic stuff like what was the standard of care maybe 20 or 30 years ago. And I know that Common Foundation has its health equity programs and you’re a lot investing in that regard. And as well as I know that you have partnerships with more than 30 countries.

I mean, how is that evolving? How you are working and trying to bring the care, not just like locally, but also, I mean, those people who are in real need.

Victoria Smart: This is really important. This is our vision. It’s a world without breast cancer.

Not the United States without breast cancer. So this is part of our ethical mandate is to ensure that all people everywhere can survive and thrive. You know, the issues of access are really important to discuss.

Even here in the United States, our scientific advisors estimate that about a third of breast cancer patients are losing their lives, not because we didn’t have the right therapies on the market, but because they didn’t get.

The issue of access to care on the market today is really important. I’ll talk about the global perspective in a minute. But even here in the U.S., we estimate that as many as a third of breast cancer patients are losing their lives because they are not accessing the care that exists today.

So that’s not the need for another research breakthrough, but really a breakdown of the barriers that are preventing them for getting the very best that’s on the market today. When you extend that to the global setting, that number is even higher. As you rightly pointed out, many countries around the world are facing an enormous burden of all kinds of cancers, including breast cancer.

But many of the countries are least equipped to respond because their ministries of health or their formularies don’t have the right treatments available for their patients. It’s a huge advocacy conversation that COVID is having right now. If you look back to our history in the global setting, it mirrors what we’ve done here in the United States where we started.

Much of our early work was focused on helping our colleagues in other countries establish the same level of patient advocacy and education that we had here, building the capacity to have the conversation about breast cancer and prioritize women’s health. We’ve been very successful, and there’s wonderful advocacy organizations all over the country and the world now. But what’s needed is to elevate the conversation to demand the therapies coming on the formularies that are going to best help patients.

We’re doing this work on a number of advisory boards right now to talk about how can we encourage countries to prioritize breast cancer as a leading issue for the health of their population but also for the health of their economy. Supporting people and having the best possible outcome is a mandate for organizations, and we’re working to do that.

One of the ways that we’re going to lean in is to try to help our colleagues in other countries understand how to do policy advocacy work very effectively, how can they take their patient voices to the elected officials and to the ministries and tell their story about why prioritizing breast cancer and providing the best possible care supports the population and supports the economy.

These are important conversations that we need to have.

Gevorg Tamamyan: If you are the Secretary of State of the United States, what you would do? Now is the election period. Maybe there is a chance.

Victoria Smart: You’ve noticed that we’re having an election here. It’s suddenly gotten very interesting here.

Gevorg Tamamyan: What would you do in the breast cancer field? The first things.

Victoria Smart: Here for the United States or to my global colleagues? If I was elected President or perhaps joined the ticket, here’s the ask that I would make. I would like the President to sign into law coverage for diagnostic services without financial cost to our patients.

Let’s go back to the Affordable Care Act, which was really groundbreaking for the breast cancer field. It provides coverage for screening services without cost to patients. Fantastic.

However, a screening does not diagnose you with breast cancer. This is really important. It just tells you that something is abnormal.

Women and men need to go on for further tests to determine if they have breast cancer and also what kind of breast cancer it is. Those tests are not covered without cost sharing to the patient. This is important.

If we as a country prioritize early detection and best outcomes and to get people into that right therapy, we need to ensure that patients can do that without cost and financial toxicity. With the stroke of a pen, our next President could make that a reality by mandating that coverage for all patients and eliminating that financial cost.

Think about all the barriers that exist for people just to get into screening, days off from work, child care, transportation costs, and then they have to do it all over again to get diagnostic services and also pay additional fees.

Some of those diagnostic tests can run into the thousands of dollars. What happens for some people is rather than choosing the high cost of those tests, they have to pay mortgages, they have to put their children in school, they have to pay for food. What’s happening is people wait and they wait too long and the breast cancer progresses to later and later stages and it leads to poorer outcomes.

Eliminating the cost would alleviate a significant burden and a barrier to those outcomes. That would be the first thing that I would ask for. Let’s fix this.

Let’s do it right. Isn’t this what we worked for as a country? We put all this money into R&D to get people into the right care.

Let’s eliminate this barrier and make it happen.

Here’s what’s interesting. Here’s the reason why I believe this can be done because it already has been done. This was done in the colon cancer setting.

It was recognized that we were leaving this part out of the journey. I don’t mind standing on the shoulders of the giants who have gone before us. Someone has paved the way and it’s worked.

Let’s keep doing more of it. Do it for breast cancer, do it for others. We can do this.

Gevorg Tamamyan: I’m sure. I’m sure. What’s this big data for breast cancer program is about?

Victoria Smart: It’s my other favorite thing. I only have some children but this is one of my favorites. One of the big challenges we have in research across the board is it doesn’t represent the community that experiences the disease.

That’s true in breast cancer. A lot of research is done in women who look like me but I’m not the only type of woman who gets breast cancer. A lot of the barriers that we see in patient involvement in research is one very simple thing.

They’re often not asked. If they are asked, sometimes there’s a lot of distrust with the medical system. What’s going to happen to my data and how is it going to be used?

We’re going to build a reputation over our more than 40 years of being a trusted broker of information and a place where people can come to make a difference. We believe this could extend to research as well. Our big data program has developed a project called share for cures.

We believe we can make a difference by going directly to patients who have been impacted by breast cancer and inviting them to share their data to help find that next cure. So they don’t have to worry about their data being siloed somewhere or not understanding how it’s going to be used. Our Share for Cures platform will tell patients all of that information and give them a safe place where they can share, but also learn about how their data is being used and be part of the process of finding the next cure.

We’re really excited about this. And because our community reflects the community who is diagnosed with breast cancer, we hope to have the most diverse and richly annotated database available for science. Not only are we asking patients to report their data, but we’re also obtaining medical records, which we’re going to abstract.

We’re also getting saliva samples from our patients. It’s going to be an incredibly impactful asset and we need everyone to join. So if I’m allowed to say, if you’ve been diagnosed with breast cancer and you’d like to make a difference for the next person and help find those lifesaving treatments, think about joining us in Share for Cures.

We make it very easy. Come to common.org, search for Share for Cures. It’s entirely free and we do all the hard work for you.

Gevorg Tamamyan: Is it only in the United States?

Victoria Smart: Only in the United States. You know, the GDPR regulations are real. So right now we’re focused on any adult living in the US who has ever had a breast cancer diagnosis.

We’ve talked with our colleagues at the EORTC about how we might partner in the future. They have an incredibly rich project called SPECTA that we’ve learned a lot about that we’re very intrigued with and we maintain a great relationship with them. So hopefully in the future, we can explore how these ideas can come together for the benefit of the world.

Gevorg Tamamyan: Wonderful. Coming back to your own career, what qualities do you believe are essential for leaders in the non-profit and healthcare sectors to make a meaningful change?

Victoria Smart: You have to be relentless. The challenges are tough, but most of us are coming into the non-profit space from a deep sense of compassion and the feeling that you’ve been called to do something greater than yourself. That’s the definition of advocacy.

We’re all coming together to show up, stand up, speak up on behalf of others who can’t. And I think that’s the heart of the non-profit leadership is to lead from that place of personal compassion and this need to give back. But it also requires a very strong business sense.

Let there be no mistake, right? A non-profit is still a business. Millions of people are trusting us with millions of dollars to make an impact.

And you have to have very solid business processes to understand the challenges, the best way to address them and to be really rigorous with your investments and measure your impact. If something is not working, to be nimble enough to admit it and change, right? And to do something different.

That’s been a hallmark of Komen is this consistent evolution in response to the environment that’s around us. Very, very important to change quickly. Our big organizations like Komen and others, that can be difficult.

We’re very big, we’re very established, but to have that responsiveness and that respect for business rigor while also maintaining that human compassion, it’s a very important balance to strike. Very important balance to strike.

Gevorg Tamamyan: Can you tell us a bit more about your mentors?

Victoria Smart: This is an interesting topic to talk about my mentorship over my career. And it’s an interesting hot button today when we talk about female leadership. I’ve been very unique in my career that all of my adult jobs, I have had female bosses along the way, very unique.

And so we all have heard that women can be the most difficult bosses for other women. And I always like to unpack this. I posted something to my LinkedIn probably about a year ago celebrating the women mentors that I’ve had and challenging this notion that women have to be characterized as difficult bosses for other women.

And I wanna push back on that notion because are we perpetuating that stereotype by repeating that and should we get beyond it? The truth is there are bad bosses cut from all genders. Right, everyone, when I just said that, everyone just thought of that one person.

Is this really unique? Are women uniquely challenging just to other women or have we all found some really bad bosses in our career? So for me, I wanna think about and celebrate those women who get it right and who do the things that are important to me in my nonprofit career which is leading from that place of compassion and patient centricity, but also providing me that roadmap to good business acumen and showing me how both of these can come together.

I mentioned Margaret Fodey, who was one of my first mentors, Paula Schneider, who’s our CEO at Cullman who has such a great balance. She’s a breast cancer survivor, but also a businesswoman who has come from the retail industry and marries those two things together really well. We have a predominantly female leadership team.

I am blessed to have two chief scientific advisors who guide our research investment who are both women, Dr. Ann Partridge from Dana-Farber and Dr. Jennifer Peet and Paul from Vanderbilt, both of which are also incredible thought leaders but amazing mentors. You know, when you look at their track record of who they’ve helped succeed, it’s pretty amazing. And they’ve also been very generous of their time here with me and to my team here at Susan G. Cullman.

There’s another piece of mythology I wanna share that’s really interesting, right? When we think about things that we tell women about imposter syndrome, you know, and we tell them all the things, you know, why you won’t be a good leader.

There was this mythology about something called Bicycle Face. And you all need to Google this to see a woman named Reshma, I think her last name is Seljani, that did a speech at a commencement at a women’s college to say, don’t believe in the myth of imposter syndrome. Bicycle Face was invented when women started riding bikes and they were warned against it because they may get something, a syndrome called Bicycle Face with a flushed look and they might be sweaty and, you know, look like they’re concentrating.

And it was a way to convince women that they should not have the freedom of transportation. Instead, they made something up to make women feel that they should not be doing something that would benefit them. So think about that.

You know, we’re thinking about this mythology about women in leadership and mentorship. Women are good leaders. Women are supporting other women, you know, and women are capable of succeeding in a female led environment because we’re showing that over and over and over again.

That story said, I’d say one of the strongest things that I received throughout my career was the belief that you can do it. Regardless of whether I had the deep scientific background or decades of experience doing one particular function, my bosses believed that I was smart and capable, could hire the right team around me, could identify the right resources, and that success was possible. Not that failure was inevitable.

You can do it. Why not you? Why can’t you do this?

And I think that’s important when we’re looking to cultivate the next generation. Why not you? You can do this.

You know, the letters after your name doesn’t always matter. We can do this together. Success is possible.

And I think that’s a place where I think we really should be starting from.

Gevorg Tamamyan: I’m like with my two hands for the women leadership and I’m a strong advocate for women leaders.

Victoria Smart: And I totally believe that- Right, women hold up the sky

Gevorg Tamamyan: Thank you so much for all these insights and for the great discussion.

I really enjoyed it a lot. One last question. Who we should interview next?

Victoria Smart: Oh my goodness. There are so many exceptional leaders in the oncology space. I’d like to give a shout out to Courtney Bugler who is leading Zero Prostate Cancer.

I think she’s doing extraordinary work. I think you should consider interviewing Jennifer Pietenpol, who is our Chief Scientific Advisor and the Executive Vice President for Research at Vanderbilt University. Talk about an exceptional woman who has done amazing work leading the field of research.

I think she would have a terrific story to tell. So those are two ideas for women who I greatly admire, who I think are doing terrific work.

Gevorg Tamamyan: Wonderful. We’re going to contact both of them. Thank you so much, Victoria.

I really enjoyed our discussion and I’m sure our audience also will enjoy it a lot. Thank you so much for your time.

Victoria Smart: Thank you again for this opportunity. And thank you again to your audience for listening in and to learning and for joining the fight against cancers.

Gevorg Tamamyan: Thank you.