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Andrea Miyahira: Hi, I am Andrea Miyahira at the Prostate Cancer Foundation. Joining me today is Dr. Veda Giri, a professor and medical oncologist at Yale University. Dr. Giri holds many leadership roles, and so we're excited to have her today on the Women in Science Channel. Dr. Giri, thanks for joining me today.

Veda Giri: Oh, it's a pleasure to be here. Thank you.

Andrea Miyahira: So first, tell us about all of your titles and the roles that you play at Yale.

Veda Giri: Sure. So as you mentioned, I'm a professor of medicine in medical oncology. And my roles are as director of the Cancer Genetics and Prevention Program. I'm also the division chief of the Division of Clinical Cancer Genetics, and I also wear the hat as director, co-director of the Early-Onset Cancer Program at Yale Cancer Center.

Andrea Miyahira: That is so impressive. So I'd love to hear about your career path and how you got to all of those roles.

Veda Giri: Absolutely. So what I'll say is I didn't necessarily pre-plan to arrive at the place that I'm at today. I, of course, went to college and medical school, always had a very deep interest in medicine and science from a very young age. And in medical school, I really was interested in the learning that was applicable to patients. So I really went into medicine with clinical interest. And along the way, there were specific subjects that I really took to such as genetics. And it's just so interesting that in light of things coming full circle, how genetics has played such a key leading role in the work that I do. But I was very interested in genetics. I was very interested in clinical work and thinking about patient care from a rather comprehensive or holistic approach. And so I went into my residency in internal medicine.

And from there, I actually met one of my mentors who remains my mentor to this day. I think no matter what stage in our careers we are, we all need mentors. One of my mentors I met when I was on the floors in my residency actually, and she convinced me to think about oncology as a fellowship. And part of the reason was because there was a lot of interest and a need for advances in oncology. These patients really need that holistic approach in thinking about their treatment, their ongoing care, survivorship, and for their families. So it really drew me to this field of oncology. And stayed in for my medical oncology fellowship at the University of Michigan. And during our fellowship, we actually had an integral part of our fellowship was to conduct research. And as I mentioned along the way, I was actually much more clinically driven. That was my interest. And with this opportunity in our fellowship to do research, I worked with my mentor in her laboratory to study the genetics of prostate cancer.

And this brought back my interest in genetics from medical school back into the current research that I was doing at the time. And there was this real gap in knowledge of what is leading to hereditary prostate cancer. At that time, BRCA1 and 2 had been discovered for hereditary breast and ovarian cancer. And very soon to come would be Lynch syndrome testing for hereditary colon cancer. But there was really this gap in understanding what is leading to hereditary prostate cancer.

So this was really exciting. So we were in the laboratory conducting research, looking to see if we could identify hereditary prostate cancer genes. And also doing research in other avenues such as epidemiology research to see what are some risk factors for prostate cancer and taking a much more broad approach as well. So it really got my interest in research through that experience in my fellowship. So much so that I actually stayed on as thinking of a career in academic medicine. So one of the things that also really helped me is that for me, in my college and medical school, I did need financial aid as many students do.

And one of the things that I also then applied for was a loan repayment program in my residency and fellowship to help pay back loans if you stayed in academic medicine. And I just bring that up because financial hardship can be a big part of challenges for students and then for individuals who go into residency and fellowship and then become either young faculty or physicians in practice. And just keeping an open mind about opportunities that may come along to help offset some of those financial burdens. So I took that. And what that did was if I stayed in academic medicine, the government would pay back half of my loans. And so the two came together, my interest in research and this opportunity.

And so then I went to Fox Chase Cancer Center and did a postdoc after my fellowship in cancer genetics and cancer risk assessment. Soon at Fox Chase, there was an opportunity to lead a Prostate Cancer Risk Assessment Program when I was there. And these opportunities at the time as very junior faculty at an academic center can feel overwhelming, can I do it? Am I cut out for it? Do I have what it takes? And once again, I connected back with my mentor. And she said, "You need to try to give this a shot." And I think that's one of the things I also try to pass along is you may never feel ready, a person just may not fully feel ready. But I think what happens oftentimes is we grow into the role that we're in.

And so, I led the Prostate Cancer Risk Assessment Program at Fox Chase Cancer Center for about nine years. And during that time, I really devoted to building my research career as well as seeing patients for treatment of prostate cancer and their risk assessment. And in terms of building my research career, there was a strong dedication to getting a career development award to really protect my research time and foster my research path. And I became very interested in population science research because what I was noticing was the gaps in disparities in understanding risk factors for prostate cancer, outcomes to prostate cancer, and what can we do about it from, again, that overarching holistic approach. And so my career development award was looking at genetic markers not only of risk for prostate cancer, but in African-American males as well.

So my career really kind of took off at the time that I got the career development award, started building collaborative networks for research, which once again, mentors become really important in terms of helping us make those connections, going to scientific meetings, being on national committees. So it really fostered the way that I could then take the next step, which was an opportunity that came along to really develop and lead a larger initiative for cancer genetics, leading for prostate cancer, but also across cancer populations.

So then I moved to Thomas Jefferson University to Sidney Kimmel Cancer Center and had the opportunity there to develop and lead the Cancer Genetics Program. It was during that time that actually genetic testing for prostate cancer really hit the scene and really presented this opportunity to think about how do we implement genetic testing for prostate cancer from a population science, a clinical implementation lens? And so therefore, that work really took off in multiple directions with grant funding that came along to support how do we think about this from the clinical aspect for disparities increasing access to genetics. And that work has been really exciting for me to think about the implementation.

We know that scientists are working and having deep insights about the genetics and genomics of drivers of prostate cancer, risk for prostate cancer. The important thing is how do we then ensure that there's uptake of that? Really getting that message out to our communities and our clinical populations, but then also engaging. A lot of the work that we've been doing is increasing that engagement.

Now I'm at Yale Cancer Center, and here the opportunity came up to lead the Cancer Genetics Program at Yale. And this is again, a large Cancer Genetics Program. And the exciting part was taking the models and work that we had done in prostate cancer and applying that across cancer populations, again, in terms of thinking of disparities and access to care. And in the state of Connecticut, Yale Cancer Center touches the cancer care of about 50% of the population. So we have a real opportunity to make a real impact in our state. And so that's how the cancer genetics role really evolved out of this work.

The Early-Onset Cancer Program came very naturally because along the way, through my work in cancer genetics, we see patients who are young with cancers. And it's always been something that has been a growing interest and passion of mine to think about not only why are they developing these cancers, but what can we do to support them better? So this program is designed to think about that in a very comprehensive, translational way. So it's really exciting to think about how we can lead that effort as well.

Andrea Miyahira: Well, thank you so much for sharing all of that. It's just so impressive. So you have all of these roles and you're a physician scientist, that's a lot. So how do you manage work-life balance?

Veda Giri: It's such an important question. I talked a little bit about my work, which involves the research that we do. I also see patients. Right now I'm seeing patients focused in clinical cancer genetics. And of course in terms of the time spent in leading these programs. From the personal life perspective, along the way, I've had two kids and I had my children when I was in fellowship. And so throughout my career, it has been that how do I balance raising my family and advancing my career as well? And I think for every person, it can be different in how they approach this. For me, it really was recognizing that we can do it all, but we may not be able to do it all all at the same time, always. And so there were times when I had to prioritize my career and maybe miss the basketball game.

And there were times when I went to that basketball game and missed a meeting at work, and it was really having to prioritize. The key was building in some flexibility. And I think for me, that meant that if I had to leave work one day to make it to one of my children's events, I would then pick that up at night and continue the work in the evenings. And so to myself, that was a good way to go forward because I could finish the work that I needed to get done, and I could be there and present as a parent.

Sometimes it can be hard. This is not an easy thing in terms of a work-life balance. And I think having strong supports really also helps with that work-life balance. So whether it's family supports or caregivers who can help you at different times, but also I think professional supports. So building a network of women who are also having career paths and families to raise or other responsibilities too is really important because recognizing that you're not alone, that you're going forward and everyone is thinking about this, it brings a sense of community, for me, it brought a sense of support that I really thought was important, that I wasn't the only one trying to navigate this work-life balance. But I also think it takes prioritizing and reprioritizing on a daily basis, what's going to matter today, what needs to matter tomorrow, and being flexible.

Andrea Miyahira: So that is all such great advice. Thank you. So what other advice would you have for young women who are interested in pursuing a career in research medicine and academia?

Veda Giri: In reflecting on my own experience, I would say that I think it becomes really important when we are students in terms of medical school or then in trainees as residents and fellows, to keep an open mind about what a career could look like. What I will say is, I didn't really envision that I would be doing what I'm doing today all those years ago. And the only thing that I did do was I did look at opportunities as exactly that, opportunities to try something new. And so it is this breadcrumb model. I would just pick up the next breadcrumb, and if it felt right and felt interesting, then I would pick up the next breadcrumb.

And so for example, I started up with an interest in clinical medicine, and then this part of my fellowship came along for research. So I picked up that breadcrumb, and then the opportunity came along for extending my research, so I picked that one up, leadership roles, picked that one up. Even if I didn't feel like I was fully ready. And so, one thing I would tell women is keep that open mind and give yourself the chance to try the next thing that might be coming forward and really put that in the realm of what are your priorities.

So one of the things is if let's say it's an interest in academic medicine, it's an interest in research, that has to be prioritized because otherwise research time does slip away because there are so many competing priorities. Patient care takes a lot of time, family obligations take a lot of time. And so it is a balance, but if that research is really important, that has to be reprioritized every day. And so, I would say really connect with mentors to help with how to prioritize these things. This I think is critical. And I think having a group of mentors becomes really helpful so that you get that different types of expertise, different types of connections that can be made for careers. So I would say those are the things to help with advancing our careers.

Another big thing is building the networks. And I keep coming back to that because each of us needs that at any stage of our careers so that we can think about what others are going through at the same time, we can really bring our experiences to the table and we can learn from each other, but also we can support each other. And I think that's big when we forward, because at the end of the day, this becomes about relationships as we build, as we go forward.

Andrea Miyahira: Those are all such great pieces of advice. So what personal qualities do you think have been most critical to your success?

Veda Giri: Yeah, that's a really good question. I think a few things are, and I mentioned this already, is keeping an open mind. Again, because we don't always foresee what can come out of anything, a meeting, a paper, a grant, a project, any opportunity. So I would say keep an open mind is a really big one.

Another one that I think also that has been really helpful is curiosity. So again, I may not have all of the answers or conclusions about something, but if I'm curious, then I know I'm headed in the right direction. Because either I'm going to learn that I like to do something or I may not be as interested in it, but regardless, I learn something from the process. I would say curiosity is the other one. The other one is keeping it really front and center, that, as I mentioned, what ends up happening is we think about successes in our career, discoveries or our contributions, they really are important.

I'd still think that the relationships that we build as we go forward to me are the most personal. And also when I think about it, they stand out as number one to me. So what I would say is take the opportunity to also build those friendships in careers because there's something very precious about those things. When we are junior faculty, those friendships that we develop are so precious. And when we see those friends now 20 years later, we know what we were doing at that time. And so having that basis of those friendships becomes really important too.

Andrea Miyahira: Okay. Thank you. How do you think institutions can better support women in research and medicine throughout their careers?

Veda Giri: Yeah, I think this is critical. A few ways that we are thinking about it at our institution as well is really having forums for women to come together and really bring the issues, the concerns and opportunities to the forefront. So we have these opportunities at our institution, but then also, for example, at the Prostate Cancer Foundation with women in science, these are now national ways to link with women and to bring all of our experiences to the table. So I think having forums is number one.

The second thing is ensuring that committees, that the voices that are at the table in any capacity at an institution are absolutely inclusive of women. And that includes diversity in many different ways. We need diverse voices at the table so that the decisions that are made are really reflective and consider all of the individuals that could be at an institution. And the other one is really ensuring that there is opportunities for mentorship for women at any point in their careers and ensuring that factors in, whether it's a research career, a clinical career, or both, to have those mentors be invested in the next generation. I think now as a mentor, that's one of the most gratifying parts, is to be able to help women advance in their careers and really get them to the point where they feel that they can then become mentors as well.

Andrea Miyahira: And what research projects or achievements are you most excited about?

Veda Giri: The work that we've been doing over the last several years, thinking about disparities in prostate cancer genetic testing, and now expanded across populations has been one of the most, I think, impactful and meaningful because we've been working in communities that are underserved and thinking about ways to increase awareness and engagement in genetic testing. So I think that body of work has been really important and I'm very proud of it, and I also recognize how much more we need to do.

The second part of it is how do we enhance systems to really streamline genetic testing for our patients? It's a revolution in oncology, and it's impacting treatment and risk assessment and hereditary cancers and families. And so, it has a major impact, but now we need to think about systems that are going to roll this out, and there's a lot of avenues for work. And so that's also been very gratifying.

The third part that I am really excited about is the Early-Onset Cancer Program. This is such a unique population of patients. They are at a very busy time in their lives. And to have a cancer diagnosis and go through everything that entails really adds a lot of strain and burden. And so thinking about how we can support them clinically, psychosocially out in the communities becomes really important. And again, disparities becomes critical in that aspect of work. So I'm very excited about that body of work, too.

Andrea Miyahira: Okay. Well, thank you so much Dr. Giri. Your leadership and your research have been so important. Thank you for sharing your career path and advice with us today.

Veda Giri: Thank you so much. It's been a real pleasure to be here.