Forging a Path in Thoracic Surgery to Create a Stellar Career

Rian M. Hasson Charles, MD, MPH, FACS, has a first-of-its-kind role at Brigham Women’s Hospital that will focus on health equity.

As a Black woman emerging into the field of thoracic surgery, Rian M. Hasson Charles, MD, MPH, FACS, admitted she faced difficulty determining her presence in the oncology field.

“When I was coming into cardiothoracic surgery, there were only 5 Black board-certified surgeons in the nation; now, we’re up to about 18. The fact that you can count that on 4 hands is crazy, especially when there are close to 8000 cardiothoracic surgeons in the world.”

Hasson began her medical career at UC Berkley as a psychology major, but she knew medicine would always be in her future. Years later, she is stepping into a new role, a first-of-its-kind at Brigham Women’s Hospital. She was named the inaugural vice chair for Diversity, Equity, and Inclusion in the Department of Surgery. She will also serve as an associate surgeon in the Division of Thoracic Surgery.

As this is a new position, Hasson has a chance to build the program from the ground up. Leaving her mark along the way.

Her most anticipated projects? Focusing on health equity and involving the clinicians, residents, and the community in this new initiative.

A Cross-Country Educational Experience

Hasson completed her undergraduate degree at UC Berkley with a psychology major. When thinking about her next steps, she had a counselor suggest she apply to a postgrad program and was accepted as part of the Harvard Extension program. Eventually, she went back to the University of Southern California for medical school.

“I loved it and worked at LA County, which was our main hospital. They just [created] a great experience learning how to be a doctor, working with teams, taking care of the sickest of the sick patients, those who don’t have easy access to care, and helping them get the care that they need,” Hasson said.

She matched with Brigham and Women’s Hospital to complete her general surgery residency and worked under Monica Bertagnolli, MD, the 16th director of the National Cancer Institute and the 17th of the National Institutes of Health. Through her time there, she was able to grow her interest in cancer and research understanding.

Hasson’s first attending job was at Dartmouth Hitchcock Hospital, and when she began her MPH there, the COVID-19 pandemic hit, which increased her curiosity about health equity across various patient populations. During this time, she was able to create a diversity, equity, and inclusion program for the public health school, as well as develop lung cancer screening techniques for patients who are without easy access to care.

“[During my lung screening career, I looked] at our rural populations, and figuring out what the barriers and facilitators are to helping those patients get screened. There is a lot of misinformation. There is a lot of lack of education and lack of access. When you live 120 miles away from the closest screening center figure out how to get there and make that a priority,” she said.

During this time, the inaugural position for vice chair of DEI at Brigham opened, and Hasson jumped at the opportunity because “it’s blending everything that I’ve been working on in separate silos.”

An Inaugural Position

As Hasson is the first to hold this position at Brigham, “the world is her oyster” on how to set this program up. She noted with the “help” of the COVID-19 pandemic, many eyes were opened on how to integrate healthy equity not just in oncology, but across health care specialties.

She hopes that through this position, Brigham can bring health equity to the forefront of everything they do. She commends her department for making her feel included through meetings, hearing her voice on accomplishments or concerns, and having conversations on how to create this DEI program.

While Brigham is an academic center, those who live in the surrounding areas may not have access to care and have significant disparities. To help serve this population, it’s about creating a diverse workforce and retaining them. Some questions that come to her mind include, “Are we keeping [clinicians] here? If they’re not staying here, are they going on to do bigger and better things? Are practices equitable in terms of who we’re hiring and who we're getting to stay here? Are we mentoring correctly?”

She also wants to further enforce cultural sensitivity M&Ms, looking at cases within the institution and surrounding ones to see how they can improve themselves.

Most importantly, she is excited about the community connections she can make in this position, “The [cancer] journey is long, it is often multidisciplinary and involves many different steps for you to go from diagnosis to hopefully treatment and cure or treatment and stability. Even if it’s in a palliative setting, doing that in a humanistic way and having empathy at the core of that and, providing those resources so that patients can travel that journey in a dignified fashion.”

A precedent Hasson hopes to set involves making DEI something we think of in our everyday lives. She wants to be able to create equitable care and work with patients for those who may not have access or the finances for it.

One day, she hopes that this position won’t be required for institutions and academic centers.

Paving the Way for Equitable Lung Cancer Screening

At the beginning of her career, Hasson worked with Bertagnolli on the Adenoma Prevention with Celecoxib (APC) trial (NCT00005094). It assessed 2035 patients receiving 200 mg of celecoxib twice daily or 400 mg of celecoxib daily.¹ Working on this trial, she learned that there was the opportunity to change how medicine is practiced, and everything should not always stay the status quo.

At Dartmouth, she began working with Bill Black, MD, a radiation oncologist. He was one of the key principal investigators for the National Lung Cancer Screening Trial (NCT00047385) that compared low-dose helical CT scan with chest radiography in older current or former heavy smokers.² They hypothesized that lung cancer treatment would be more effective and the likelihood of death would be decreased if cancer was detected through early screening.

Looking at the geographic region that surrounded Dartmouth, Hasson began to question how she could give these patients equitable access to care, and still allow them to be screened. She began to create a process to bring mobile lung cancer screening units to these rural populations.

“I was lucky enough to get funding from the National Institute of Health through a grant for Dartmouth Hitchcock to do this work and help pilot this.” However, Hasson was not able to complete this as she accepted the new position at Brigham. She is excited to bring the mobile lung cancer screening idea to Boston and begin working with the surrounding populations.

When asked about the future of lung cancer, Hasson said it’s constantly evolving, and the wheel is being reinvented. She cited how lung surgery originally began as a pneumonectomy, then removing 1 lobe, and finally being able to only sample lymph nodes.

She believes the field is transitioning to more minimally invasive techniques and patient-specialized care; and the addition of immunotherapy has helped transform lung cancer care overall.

“Even with stage IV disease we are seeing patients that are not just living 3 to 6 months, but they’re living years. I’m excited. We’re always innovating. It’s not just in one field, it’s in many, and it’s at many different stages of the disease process,” she said.

Women in Oncology

Hasson noted that being a woman in the oncology space can feel very lonely at times. She was chief cardiothoracic fellow, and the only woman in her program. “People don’t understand the things that you miss out on; [those] conversations that [are happening], and then you get to the men’s locker room, and the conversation continues, but you break off. Small things like that.”

As a Black, left-handed woman in cardiothoracic surgery, Hasson noted there was not much else that could impede her progress. She is very grateful for her mentors who looked out for her and guided her.

She noted that she didn’t necessarily need to see mentors who looked like her to emulate the type of surgeon and doctor she wanted to be.

For future surgeons, her advice would be to not feel like “you’re in a box”—that there are several options and career paths that those practicing medicine can fall into. Nevertheless, students or clinicians just starting should surround themselves with multiple mentors.

Finally, she reminds everyone to cultivate their relationships with their friends and family because they will be the ones who will be with you long after your career is over.

“The world is your oyster. I encourage people to find their focus, find their passion, find the thing that keeps them up at night or that wakes them up in the morning. You can do whatever you set your mind to. With today’s resources, there should be nothing that limits you. There may be things that seem like they’re discouraging, but you have the power to overcome those and collaborate with people that will help generate success.”

References

1. Bertagnolli MM, Hsu M, Hawk ET, Eagle CJ, Zauber AG; Adenoma Prevention with Celecoxib (APC) Study Investigators. Statin use and colorectal adenoma risk: results from the adenoma prevention with celecoxib trial. Cancer Prev Res (Phila). 2010;3(5):588-596. doi:10.1158/1940-6207.CAPR-09-0271
2. National Lung Screening Trial Research Team, Aberle DR, Berg CD, et al. The National Lung Screening Trial: overview and study design. Radiology. 2011;258(1):243-253. doi:10.1148/radiol.10091808