Latest / Becker’s Healthcare Podcast / Rick Greene, MD, FACS, Emeritus Chair of Surgery at Carolinas Medical Center and Medical Director of Cancer Data Services at Atrium Health Levine Cancer Institute

Transcript

Rick Greene, MD, FACS, Emeritus Chair of Surgery at Carolinas Medical Center and Medical Director of Cancer Data Services at Atrium Health Levine Cancer Institute · Becker’s Healthcare Podcast

• 0:02
  The most important health care decisions don't happen
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  in isolation.
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  They happen when leaders come together.
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  Becker's sixteenth annual meeting brings together more than
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  barriers, and building clinical teams that translate new
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  Join top decision makers in the room April
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  For the agenda and event details, visit beckers
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  events tab in the upper right.
• 0:45
  This is Scott Becker with the Becker's Health
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  Care podcast.
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  We're thrilled today to be joined by a
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  brilliant physician surgeon leader.
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  We're joined today by a surgical oncologist
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  that also serves as a medical director as
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  part of the Advocate Health System, which is
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  now the second or third largest not for
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  profit systems in the country.
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  He's based in Charlotte. We're here today with
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  doctor Rick Green.
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  Doctor Green, could you take a moment
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  and tell us a bit about your career
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  and and where you focus today?
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  Well, thanks, Scott. It's a real pleasure to
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  be with you today.
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  I've been in Charlotte for twenty eight years,
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  and, I came as chairman of surgery and
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  director of the, surgical residency program here at
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  our academic medical center.
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  And,
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  over the years, I've I've been
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  interested in surgical oncology, oncology, mostly breast cancer,
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  pancreatic cancer, GI tract cancer.
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  And, currently, I serve as medical director,
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  of cancer data services, which means I work
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  with a wonderful group
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  of cancer registrars, which are now called oncology
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  data specialists, and they collect all of the
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  data on cancer patients.
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  So all of the data that we use
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  is used for research, it's used for advocacy,
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  it's used for a number of issues,
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  and, it's just a pleasure to work with
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  a wonderful group of professionals here,
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  in that area.
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  And talk for a moment. You're a surgical
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  oncologist by background. I know UVA and Yale
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  and tremendous career.
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  Talk about the evolving world of cancer and
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  cancer treatments,
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  and how challenging it is for oncologists to
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  keep up today with all the changes in
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  in in what's going on and try not
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  to stay burnt out with the amount of
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  just the the the amount of cancer that's
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  out there and oncology needs that are needed.
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  Talk a bit about the changes and the
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  ability to keep up in the challenges.
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  Well, it's been an amazing evolution, of course,
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  in the many years since I, finished my
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  residency
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  in 1976.
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  And, again, I was going into cardiac surgery
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  when I was at Yale, but I I
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  really had sort of a a feeling and
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  a calling for, what was going on in
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  the cancer world.
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  And so, got involved in that. One of
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  the areas that I've been working on is
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  the staging of cancer, and I've had the
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  pleasure over the last thirty five years of
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  heading up the staging system that we use.
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  I know you're familiar with people when they
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  talk about stage one, stage two, stage three.
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  Well, I head up that system
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  worldwide,
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  and it's called the TNM
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  system, the,
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  tumor
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  node
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  and metastasis system.
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  And so, we,
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  we come out periodically with all of the
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  new data. And so my work here in
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  in Charlotte is really to make sure that
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  every patient who comes into our cancer center,
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  which is the Levine Cancer Institute,
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  is categorized
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  with the proper stage of cancer.
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  I also had the opportunity of be of
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  being the president of the commission on cancer
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  for the United States.
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  And, I'm very much interested in accreditation,
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  making sure that every institution in the country
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  has all of the things it needs to
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  take care of cancer patients.
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  So those are the big areas since I
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  finished my training. And, of course, in my
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  own work in the operating room,
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  in GI tract and breast, I've seen such
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  great,
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  advances.
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  And I'm very happy to say now, of
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  course, there are first few areas like pancreatic
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  cancer. We have a little a little while
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  to go,
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  but we're making some some headway. And, again,
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  as a surgeon who's involved in cancer, I
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  think that, of course, the surgical
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  removal of cancer is very important. But we
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  work very closely,
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  with our radiation oncologist, our medical oncologist. We're
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  very lucky here in Charlotte to have our
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  proton therapy unit, which is really state of
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  the art. So I I think we've made
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  a lot of good progress.
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  Thank you. And take a moment on staging,
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  because this is so scary when somebody gets
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  a cancer diagnosis.
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  You know,
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  I'm obviously familiar with stage one, two, three,
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  four,
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  and and depending on what the cancer is,
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  it could be hearable and treatable at certain
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  stages, not at other stages.
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  Other cancers
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  seem so difficult, you know, so a lot
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  of the brain cancers, the tumors, the pancreatic
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  cancer still seems so difficult to treat.
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  But
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  when somebody gets this diagnosis of stage three,
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  stage four,
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  talk to us a little bit about that
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  because that seems to be, depending on the
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  cancer,
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  incredibly scary or sometimes not quite as scary.
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  But talk about I guess it's always scary,
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  but talk to us a little bit about
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  that staging.
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  Well, you're absolutely correct, Scott. And, you know,
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  when you talk when you sit down with
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  a cancer patient and and their loved ones,
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  what what's the first thing they do when
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  they leave the office? They go to the
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  Internet.
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  They go to the Internet to try to
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  figure out what's going on, how long they're
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  going to live. And, of course, there are
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  so many things in the Internet that are
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  incorrect. You can't legislate the Internet. And so
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  they use certain staging systems and plug them
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  into these data calculators to figure out if
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  you're gonna last five years or ten years.
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  So one of the things we try to
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  do
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  is,
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  in the group that I've been working with
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  is create
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  calculators
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  that put the proper stage in in patients.
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  And so if they do go to to
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  the Internet, we work with, many institutions, and,
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  of course, my own institution is involved in
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  this, to make sure that patients have the
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  right data, especially in what you're talking about,
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  advanced cancer stage three, metastatic cancer stage four.
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  And so these are the things that we
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  try to do so people don't get the
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  wrong information.
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  And that that's really the problem. And so
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  we try to proliferate this all through,
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  journals and and papers and everything that cancer
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  patients go to. And so stage is the
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  bedrock, the absolute bedrock, and that's,
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  that's,
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  what we call, the the most important part
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  of what goes on in in a cancer
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  diagnosis. And that's why we want all clinicians
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  to be well aware
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  of the stages of the cancer they work
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  with, and that's why I do a lot
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  of lecturing around the country
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  of trying to talk to physician groups as
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  well as patient groups
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  and registry groups to try to make sure
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  they're using the right data.
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  Thank you. No. That is fascinating. How did
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  the state system develop? When did that develop?
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  Because now it's
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  anytime somebody gets a cancer diagnosis from
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  breast cancer or prostate cancer to
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  to other cancers,
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  the first thing you start to hear is
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  the staging of it. How long has that
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  been in
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  been part of
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  cancer diagnosis?
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  That's a great question. Actually, the TNM system,
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  the system that we use today,
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  started in the nineteen forties, and it started
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  by a surgeon named Pierre Denois. He was
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  working in Paris,
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  and he first developed a staging system for
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  breast cancer. So I'm I'm very happy to
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  tell you that it was a surgeon who
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  started this entire staging system. Now, of course,
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  what happened,
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  this morphed into,
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  many different sites,
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  for especially adult cancers,
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  that we use. And I got involved,
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  in the,
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  late nineteen eighties, early nineteen nineties.
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  So now we're into the ninth version. I
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  took over in the sixth edition.
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  Now we're into the ninth version or ninth
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  edition of our cancer staging system. But it
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  started, with a surgeon back in the nineteen
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  forties and fifties.
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  And and cancers are so different.
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  But when you think about the staging system,
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  even though treating cancers is so different depending
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  on the types of cancers, some
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  much more susceptible to treatment, some much more
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  difficult to treatment,
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  Does the uniformity of the staging system work
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  across all cancers?
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  Well, again, a great question. When we when
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  we started or when the TNM system started,
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  it started as an anatomical
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  system only. The tumor, the node, the metastasis.
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  And what we've done over the years is
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  add biological markers
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  and molecular markers to the system because, again,
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  personalized medicine, of course, as you know, is
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  the key. So every patient has a little
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  different marker to their cancer, a little different
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  biology.
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  So we've added these markers, for instance, in
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  testicular
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  cancer,
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  and and breast cancer,
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  over the years because it's not just an
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  anatomical staging system. But I will tell you
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  the reason that we've had to keep the
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  anatomical system.
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  If you're a surgeon working in Sub Saharan
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  Africa,
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  where all you have is a surgeon and
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  a pathologist, you don't have,
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  an academic center that can do all of
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  the testing that you need. So you still
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  need the anatomical system
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  as well as the molecular system that we've
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  developed. So this is this is really the
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  key, and that's why we have to keep
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  adding genetics,
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  to all of this. The key to all
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  of this is the genetic markers in cancer,
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  and they will be added to many of
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  these different sites in the
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  future. Fascinating.
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  Could could you also
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  talk about
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  sort of
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  the biggest trends you're watching currently and what
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  you're most focused on and excited about
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  this year and heading into 2026
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  that we're now into 2026?
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  Well, I think, again, as I've as I've
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  stated, the collection of data
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  is so important and making sure it's accurate.
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  One of my jobs at our Levine Cancer
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  Institute is do the quality review as well.
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  And and I think it's so important for
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  every institution to make sure that the data
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  that's put into our registries locally
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  is correct because what do we use the
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  data for? We put it into our state
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  registries. Every time we have a patient in
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  Charlotte,
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  that's entered into the North Carolina state registry,
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  and then it's added into our large database
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  developed by the American College of Surgeons, which
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  is called the National Cancer Database. So
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  my my point is that I think today,
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  accuracy is the key.
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  You have to have accurate data put in
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  because if you don't, you won't know how
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  these prognostic factors will work using the TNM
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  system. The other point I think I wanna
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  make to you,
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  is the trend of accreditation.
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  Accreditation is so important. And, again, I was
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  very proud to head up the commission on
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  cancer, which is in charge of all the
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  accreditation
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  of institutions in The United States,
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  for their cancer work. So what we try
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  to do is make sure that accreditation
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  cuts down on the variance. In other words,
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  when a patient goes to a small community
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  hospital
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  that's accredited,
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  we wanna make sure that they get the
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  same care as going to an academic center
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  that I serve in in in Charlotte. And
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  this is so important. So,
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  accreditation is important
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  and registry information is important. And that's why
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  I think we're making head roads in cancer
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  because, again, ultimately,
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  research is based on all of the data
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  we collect.
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  You've
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  had this remarkable
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  career,
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  surgical oncologist,
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  leader,
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  cancer leader,
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  really remarkable career, headed up the commission on
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  staging of cancer, I mean, an amazing career.
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  Now I know that you've got
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  at least one brilliant child and probably more.
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  What advice would you give to young emerging
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  leaders,
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  regardless what field they're in? Any any advice
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  that you would give to young emerging leaders,
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  and do they listen to advice from their
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  father?
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  Well, it's it's a great question,
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  and I I do a lot of mentoring.
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  I think one of the things is that
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  you have to open doors for people,
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  and networking is so important. And so what
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  I try to do to young people who
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  I talk to from in high schools and
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  colleges and even later in residency
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  is make sure they they do something they
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  they enjoy,
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  and that's that's so important.
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  You have to learn something every day. I
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  take I tell my children and grandchildren,
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  make sure you learn something every day.
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  And for me in my career,
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  we always wanna be relevant.
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  And, and that's why I love what I
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  do. And medicine, of course, I've spent almost
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  fifty years in medicine.
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  But, to me, relevancy is is important.
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  Learning something every day is important,
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  because you can contribute in so many different
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  ways. And I and, again,
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  talking to you, I I find is a
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  wonderful contribution, and certainly, I'm aware of the
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  work that you're doing,
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  in in in your work to to make
• 13:44
  sure that all health care is is is
• 13:47
  achieving its goals. So, you know, I think
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  those are the kinds of things that I
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  like to tell, the up and coming individual
• 13:53
  today, whether it's a surgeon or a nonsurgeon.
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  I I I think that's just as fantastic.
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  You know, and and I and I I
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  love this concept of, one, I'm a huge
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  fan as you are of lifelong learning.
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  And, you know, if if you're not learning,
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  you're not growing, and you're not even staying
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  fresh, you're not even staying static if you're
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  not learning and constantly trying to learn.
• 14:15
  And this concept
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  and doing it in
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  this
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  this wonderfully professional way that you do it
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  of of staying relevant as we end up
• 14:24
  in the middle of our careers and so
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  forth
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  and staying in the game and staying relevant
• 14:29
  that resonates so well. I can't even tell
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  you.
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  Doctor Grane, before I let you go, anything
• 14:35
  else you'd like to share today with the
• 14:37
  audience about what you do or any advice
• 14:39
  you'd like to give?
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  Well, I think, again,
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  what I try to tell people is
• 14:47
  we wanna think not only about therapeutic measures,
• 14:50
  but we certainly wanna think about prevention.
• 14:53
  And,
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  I I think prevention
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  and screening are so important
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  in my work, in the cancer work that
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  I do,
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  and I've done over the years.
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  So we don't wanna wait, of course, until
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  somebody has an issue with cancer. And I
• 15:09
  think the role of a a physician
• 15:11
  and especially somebody in surgery is to make
• 15:14
  sure that they're giving good advice to people
• 15:17
  on how to live healthy lives. And that's
• 15:20
  what we try to do, and I think
• 15:21
  that's that's the important thing. And I'm I'm
• 15:24
  so glad that there's so many issues coming
• 15:26
  out. I have the opportunity, Scott, of of
• 15:29
  hosting three podcasts,
• 15:31
  on cancer related activities. And many of the
• 15:33
  things that I talk about
• 15:35
  are prevention and screening in these, and I
• 15:38
  try to make sure that that my audience,
• 15:41
  hears the message that I'm trying to give
• 15:42
  to them.
• 15:44
  Just fantastic.
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  Amazing what you do and the career that
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  you've had, the the people that you've helped
• 15:50
  to to mentor. Doctor Green, what a pleasure
• 15:53
  to visit with you on the Becker's Healthcare
• 15:55
  podcast.
• 15:56
  We're a huge fan of the Levine Cancer
• 15:58
  Institute, the Levine Cancer Center, and what you've
• 16:01
  done with it, what they've done with it
• 16:02
  with Atrium Advocate and and so forth. Remarkable.
• 16:06
  Thank you so much for joining us today.
• 16:08
  Well, I look forward to to seeing you
• 16:10
  in April in Chicago.
• 16:12
  God bless you. Thank you so much.
• 16:15
  Thank you.