One Surgeon’s Spirit and Brilliance Lift a Whole Community

Kelly K. Hunt, MD, FACS, FSSO

There’s a question that no child can evade, that we hear occasionally for the first 2 decades of our lives, and often more times than not that childhood answer stays in our youth. But when Kelly K. Hunt, MD, FACS, FSSO, was asked that fated question of “What do you want to be when you grow up?” she never deviated from her answer, because it had been and always would be a doctor.

Hunt would tell you that she has simply continued the work of those who came before her in the breast cancer surgery realm. However, with roots now planted deep in the heart of Texas, the smart-as-a-whip small-towner from Montana has done more than carry the torch, having pioneered an entirely new way of thinking about surgical oncology with ramifications that extend well beyond the Lone Star State.

“Kelly’s commitment to gender balance and diversity has changed the face of the surgical breast oncology workforce,” said Lisa Newman, MD, MPH, FACS, FASCO, surgical oncologist at Weill Cornell Medicine and adjunct professor at The University of Texas MD Anderson Cancer Center (MD Anderson). “Because of her compassion and brilliance, she is adored by patients, colleagues, and trainees alike.”

For the past 2 decades Hunt has partnered with her trusty colleague, Khandan Keyomarsi, PhD in the laboratory. The 2 work together on cell cycle deregulation in various cancer types, particularly breast cancer and sarcomas. Hunt has found a home at MD Anderson, where she joined the staff in 1996 with her husband Stephen G. Swisher, MD, FACS, a thoracic surgeon; 2024 marked the 30th anniversary of working together at the same hospital.

Hunt and husband, Steve G. Swisher, MD, FACS, at the 2023 Society of Surgical Oncology Annual Meeting.

To this day, Hunt and Swisher remain staples among the community in Texas, although the program Hunt is now a part of looks dramatically different. The department has experienced tremendous growth, expanding from approximately 5 breast cancer surgeons on her first day to 30 today. Hunt has been a part of an ever-changing treatment landscape, setting the standard by helping create the American College of Surgeons (ACS) Cancer Surgery Standards Program and the ACS Operative Standards for Cancer Surgery manuals.

When the National Cancer Institute merged the ACS Oncology Group with Cancer and Leukemia Group B and North Central Cancer Treatment Group in 2011 to form the Alliance for Clinical Trials in Oncology, Hunt aided in the creation of clear and practical guidelines.¹

“We realized that many of the studies examining new drugs or regimens for radiation oncology did not have standardized approaches [for] the surgical management of the disease. We were trying to get away from [the practice of asking] ‘What’s your preference in this type of procedure?’ to ‘What are those critical elements?’ We also were able to identify areas of controversy that needed to be answered. As part of the cancer surgery standards manuals, we published the key questions in the disease,” Hunt noted, with plans to design clinical trials around those questions.

Knowledge From Residency Training Turns Into a Game-Changing Discovery

The creation and execution of the phase 2 ACOSOG-Z1071 clinical trial (NCT00881361) examining sentinel lymph node (SLN) biopsy served as a full circle moment for Hunt, who previously worked with Donald L. Morton, MD, developer of the SLN biopsy technique for melanoma, during her residency at the University of California, Los Angeles (UCLA).² At MD Anderson, Hunt learned how to use the SLN biopsy procedure in patients who received chemotherapy, which she noted changes the dynamics of the lymphatic system and how sentinel nodes are identified.

Hunt accepts the 2024 Giant of Cancer Care award in surgical oncology at the June ceremony in Chicago.

When performing the procedure in patients who initially presented with node-positive breast cancer but had a good response to treatment with chemotherapy, the goal was to see whether surgery could be deescalated. Instead of having to perform a full axillary lymph node dissection, which is associated with lymphedema and other significant morbidity, Hunt wanted to see whether she could solely use the SLN biopsy to observe any residual disease.

“That went from my personal research program that I was working on to developing the clinical trial, and it became a multicenter trial that we were able to enroll hundreds of patients on,” Hunt recalled. “We showed that with certain technical standards, it was a reliable procedure. Therefore, we were able to deescalate the extent of surgery for patients while still capturing important information but having less morbidity, lymphedema, and problems with range of motion in the arm.”

Data from ACOSOG Z1071 revealed that at least 1 SLN was detected in 92.7% (95% CI, 90.5%-94.6%) of patients with cN1 breast cancer who received neoadjuvant chemotherapy and underwent SLN surgery followed by a complete axillary lymph node dissection (n = 689). The surgery was more effective when blue dye and radioactive tracers were used in combination to identify at least 2 SLNs; the false negative rate was 12.6% (90% Bayesian credible interval, 9.85%-16.05%) among patients who had 2 or more SLNs and received SLN surgery.³

“In developing the SLN surgery procedure after chemotherapy, I remember thinking, ‘What we need to do is inject blue dye and [a] radioisotope, and we need to recover a certain number of SLNs. It’s not just 1 sentinel node or 2, each patient is a little different, so we need to recover all of the SLNs for each individual patient for us to have accurate staging.’ That was a time when I remember thinking that we had learned details we could share with other surgeons performing the surgery,” Hunt said. “We used that information when we developed the Alliance A011202 trial, for surgeons to have [clarity] about the technical aspects of the surgery [to] make it more precise.”

Cultivating a Community Both In And Out of The Operating Room

When honing her surgical techniques, Hunt lives by the motto she shares with her residents and fellows: precision matters. When she decided to pursue the surgical route during medical school, it was the opportunity to fix the problem that inspired her. With thoughtful and careful hands, she lives out the precision proverb each day in the operating room.

However, precision doesn’t just stay in the surgical aspect of treatment for Hunt, it follows her, encompassing all that the care of her patients entails. Surgical oncologist Irvin Durant Fleming, MD, showed her what the gold standard of care looked like, inspiring her with his practice and care for patients. During the month Hunt joined him during medical school, she saw that not only did Fleming’s reach extend across Memphis at the University of Tennessee and St Jude Children’s Research Hospital, but he also cared for patients with all different types of cancers. She recalled thinking “he was an amazing human being and I felt like if I could be like him, that would be a satisfying career.”

Hunt in the operating room working with one of the surgical oncology fellows.

“Something that’s so important to me is teaching people to be kind and to appreciate what everyone brings to the table. We’re all critically important to making cancer [care] history where I work,” Hunt said. “I’m [also] passionate about trying to help women find their voice. In all fields, not just oncology and surgery, women have typically had a harder time speaking up [and] feeling like they have something to offer. That’s an area that I’ve been passionate about in mentorship, sponsorship, and other things [where I’m] trying to help women see their worth and find their voice so that they can bring that forward and not wait to be asked to speak up but can contribute and feel confident in their skills.”

Her guidance has touched the lives of many, with Newman noting that “Her mentorship has launched the careers of many renowned and accomplished surgical breast oncologists as well as researchers.”

The People Make the Place: Finding Community in Texas

It’s a rare thing to work with the same person for decades and to work at the same hospital with your husband for even longer, but what about also seeing a talented scientist grow over the course of 20 years? At MD Anderson, Hunt has fostered a community where the sky truly is the limit.

“Hannah Wingate, PhD, was a graduate student with Dr Keyomarsi 20 years ago, but now she’s a scientist in her own right, doing important work that’s helping all of us and our programs at MD Anderson,” Hunt said. “Dr Wingate has been so important—she completed her PhD and postdoctoral [training], and now she works full time with me and my partner Dr Keyomarsi.”

Hunt’s loyal team continues to push the field forward with not only research but also education through the Breast Surgical Oncology Fellowship Program at MD Anderson. Hunt has helped guide 72 fellows through the fellowship—now 4 per year—since the program’s inception in 2002.⁴

Hunt and Keyomarsi, front row in middle, with the KeyHunt laboratory team.

“It’s an incredible joy to see these individuals come in and be so dedicated toward breast cancer care,” Hunt shared. “Every time I go to a national meeting and I get to see all these people thriving and doing incredible work, it’s exciting. The trainees keep me on my toes and teach me new things all the time.”

Hunt is actively involved with the fellowship program, in addition to her role as chair of the Department of Breast Surgical Oncology at MD Anderson, but her talent and expertise do not stop there—she also sings. In fact, she sings so well that her mother felt a twinge of disappointment when her daughter opted for medical school, as she thought Hunt would go into the entertainment industry. It’s safe to say that her colleagues were shocked to hear and see her bring the house down with a rendition of Lady Gaga and Bradley Cooper’s duet, “Shallow,” at a Society of Surgical Oncology fundraising event in 2023.

Although the entertainment industry would’ve been lucky to have her, Hunt believes she ended up exactly where she was meant to be. “I was at the hospital [recently] and happened to run into my husband, and it’s just so amazing. I’m walking across the sky bridge, and I see him there,” Hunt explained with a smile. “He says, ‘Hey, how’s your day going? What are you up to?’ He’s my biggest supporter, and I have 2 children who also constantly support me and say how proud they are of everything that I do. Of course, I’m [also] proud of them. It’s so exciting when I tell them about some of the things that I do in research and clinical care and [they] say, ‘Wow, that’s so awesome.’”

Hunt and Swisher with their family: son, Christopher Swisher who is an attorney, and daughter, Dr Shannon Swisher, who is a resident in general surgery.

With the support of her husband Steve, son Chris, and daughter Shannon, Hunt is ready for the next chapter in her career and research. She’s currently involved in clinical trials centered around using fluorescence imaging to identify where the cancer is during surgery, allowing for more precision in removing it.

“Despite being, truly, a giant among us, Dr Hunt treats every person she encounters with respect, dignity, and care. She is an incredible person and the epitome of excellence in surgical oncology, serving as a gold standard for many of us,” said Mediget Teshome, MD, MPH, FACS, chief of breast surgery and director of breast health at UCLA Health. “She has undoubtedly been one of the most influential and transformative personal and professional mentors in my career. The meaningful impact she has made on the lives of others is immeasurable.”

References

1. History of the alliance. Alliance for Clinical Trials in Oncology. Accessed July 31, 2024. https://www.allianceforclinicaltrialsinoncology.org/main/public/standard.xhtml?path=%2FPublic%2FHistory
2. Oncology visionary: Donald L. Morton, MD. Saint John’s Cancer Institute. Accessed July 31, 2024. https://www.saintjohnscancer.org/about-us/oncology-visionary-donald-l-morton-md/
3. Boughey JC, Suman VJ, Mittendorf EA, et al; Alliance for Clinical Trials in Oncology. Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) clinical trial. JAMA. 2013;310(14):1455-1461. doi:10.1001/jama.2013.278932
4. Breast surgical oncology fellowship program description. The University of Texas MD Anderson Cancer Center. Accessed July 31, 2024. https://www.mdanderson.org/documents/Departments-and-Divisions/breast-surgical-oncology/BSO_Fellowship_Flyer.pdf