Dr. Sandford - Alaska Breast Care & Surgery

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From the Desk of Dr. Marilyn Sandford…

I am, among many things, a storyteller. Surgeons may get where they are by working hard and studying, but there are so many seemingly random choices along the way that lead us to where we are today. I find those little details and choices fascinating and often important in everything you do; from understanding and helping a patient, to the writing of this bio. So, with that introduction, here we go.

I was born and raised in the beautiful state of Minnesota. When time came to go to college, I didn’t want to leave. I settled on a small liberal arts college nearby, Carleton College. While I was there, I think I considered just about every possible career. My mother encouraged creativity and wanted me to be an author. My father just wanted to make sure that I applied myself and worked hard. My brothers had their opinions too…

Medicine always struck me as a potential career, as I came from a family filled with doctors. My brother Paul and his wife were both in their medical residencies, exhausted from the long hours of call. Paul wanted to “save me” from that lifestyle, so he devised a plan: If I spent one night on call with either him or his wife Chris, he was 100% certain I would write off my idea of a medical career. A few weeks later I found myself in a hospital in Michigan following my sister-in-law around. That night, I saw: my first baby being born, my sister-in-law putting a chest tube into a patient’s chest to relieve a pneumothorax, another patient having a heart attack and the subsequent care, and a plethora of phone calls about fevers and nausea. Riveting! By morning, I knew that I wanted to be a doctor.

Summers are when young scholars are supposed to try out different experiences. Keeping that in mind, I applied for and was selected to do a research internship in the jungle of Costa Rica. But when a cute upper classman mentioned that he thought he could get me an internship in the lab next to his at the University of Chicago, I started reconsidering my summer. He raved about how fun Chicago was, and how amazing the University was. I learned that there were more Nobel Prize winners there than anywhere else in the world. What was a 20 year-old girl to do? Hang out with the handsome guys in Chicago or exile herself to a mosquito-y jungle… I chose Chicago.

That summer, I worked for Dr. Michael Press. Dr. Press was interested in the expression of oncogenes (embryologic growth factors) and the role they played in cancer. He was particularly interested to know if amplification (an increase in the number of the gene or the protein) played a role in the behavior of a cancer, which could ultimately help us understand and treat cancers. He was on to something! We went looking for oncogene amplification with our microscopes, and I was assigned two relatively uninteresting genes. However, other lab mates were assigned Her-2, which led to groundbreaking discoveries! Some of our most successful breast cancer treatments are based in part on that work that I participated in years ago, and have followed with great interest ever since…all because of a cute boy.

My summer at the University of Chicago was an amazing experience. I had fun in the city but, more importantly, I found the medical school that was right for me. The University of Chicago was looking for students who were intensely curious about specific corners of medicine. They focused on creating doctors who will do research, who will think outside the box, and who will lead. In my mind, this was the only medical school for me. Thankfully, I got in.

The University of Chicago exceeded my expectations. I became intensely interested in anatomy and was hired on as the anatomy lab assistant my second year of medical school. I took in as many lectures about anything and everything. I’m sad to say I missed having a future President as the lecturer by 1 year. After exploring everything I could, I decided that I wanted to become a surgeon. Anatomy taught me that I loved working with my hands. Surgeons also struck me, in my naïve understanding of medicine, the most likely to come in and make someone better or to cure them. They worked hard and, hopefully, did a lot of good. So after my four years, I was off to a General Surgery residency.

My first choice for surgical residency was Virginia Mason Medical Center in Seattle, which was unique for several reasons. First, the residency had a training method where each resident trains one-on-one with the doctors. Second, it focused on cancer and provided residents with more advanced cancer experience than almost any other residency in the country. By then, I knew I was going to be a cancer surgeon. The Virginia Mason Medical Center offers only 3 spots for residents, and I’m elated to say I was one of them. I left the program well equipped to be a surgical oncologist.

My first job was with a large multi-specialty group in Olympia, WA. In that clinic, the surgeons did a bit of everything. I found myself operating on cancers of the lung, colon, liver, breast, and thyroid. On top of that, I saw and operated on other general surgery issues that came in, such as appendectomies and car crashes. I was the jack of all cancers- but master of none. I began to re-evaluate where I was headed. Breast cancer patients were some of my favorite patients to work with, and they seemed to gravitate towards me. Within two years of finishing my residency, I redefined my goals and narrowed my focus down to breast surgery. The choice worked well for me. I felt like I could master all the information within the field and this guide my patients with confidence.

The year 2000 was a watershed year for my family. My husband, a professor, learned that the college he was working at would not be expanding his department, so he did not have long term prospects there. The clinic I was working for experienced a significant amount of business turmoil and eventually closed their doors. We decided it was time for a coast-to-coast dual job search. There were several options, but none seemed quite right. We considered each offer and prospect, but then noticed an advertisement for a job at the University of Alaska, Anchorage. My husband grew up in Anchorage and whenever he talked about it, it seemed too good to be true. We visited in March and with the blue skies and white snowy mountains, I too was sold.

Not knowing what to expect, I was surprised by the high quality of medicine that was being practiced in Anchorage in regards to breast cancer care. A small group of dedicated physicians seemed to be doing everything right. They integrated the latest technologies and research into their care. They worked as a strong multidisciplinary team and met regularly as a group to discuss difficult cases, and even tracked patient outcomes. I realized that I could come to Anchorage and immediately join a strong team that was providing excellent care. Soon, we were packed our bags and moved to Anchorage. I landed in a wonderful medical community where we all work together to make sure that all patients receive high quality state of the art care.

Breast cancer care is one of the most vibrant fields in medicine. I’ve heard it said that if you are not changing how you practice every six months, you’re not keeping up. Much of my work to keep up in the field involved going to national meetings and reading the research published in the English language. I learned that the Europeans and European trained surgeons who practiced in South America were taking breast cancer surgery in a completely different direction than American surgeons. After researching what options I had and looking in to places I could go to learn more, I was ultimately able to arrange for a breast surgery fellowship with two highly regarded European trained Brazilian Breast Surgeons. Finally, the time I had spent on the beach learning Portuguese as a young college student paid off. It was such a treat to go and study in a foreign country a discipline that I had mastered in my own country. As part of my fellowship, I was invited to help them co-author a textbook they were working on in English in order to bring these European techniques and ideas to the United States.

So where am I now? I’m blessed to get up every morning and come in to my office to do something that I am passionate about: caring for patients with breast cancer and other breast concerns. When I’m not at work, you can usually find me doing something with my family. If you can do it on skis, my family will probably be there. I have kids who Alpine Ski Race and others who are Nordic ski racers; I even have a ski jumper. I take things at a different pace. You’ll usually see me training for the Tour of Anchorage or hiking in the backcountry to get some fresh powder turns with my husband and kids. In the summer we transition to mountain bikes, hiking, camping, and sailing. If time permits, I even try to catch some salmon.

So that’s me; A busy mom, a devoted scholar of breast cancer, and a tireless advocate for my patients. For now, that is enough. If I ever get another hour in my day, perhaps my house will be a bit cleaner.

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