An Interview with Lori Pierce, MD, FASTRO

Lori Pierce, MD, FASTRO

By Tithi Biswas, MD and Colleeen Lawton, MD, FASTRO

The following interview of Lori Pierce, MD, FASTRO, was conducted on December 4, 2020, by Tithi Biswas, MD and Colleen Lawton, MD, FASTRO.

Tithi Biswas: Lori, what was your childhood like? Where did you grow up?

Lori Pierce: I was born in Washington, D.C. - born and raised there. My family moved to Philadelphia when I was in high school. So I consider D.C. and Philadelphia both home. And undergraduate or maybe you don't want to know that yet. You asked me about my life as a young child. Is that what you want to know?

Colleen Lawton: Yes.

Tithi Biswas: Did something excite you? What kind of interest did you have as a child? What did you think about at a young age? What did you want to do in the future?

Lori Pierce: That’s an interesting question. I had a couple of broken bones as a child. I was very active and broke a couple of bones. And so I met the radiology technicians who X-rayed my fractures. I was fascinated by X-rays, absolutely fascinated by X-rays. You know, as a little kid, they'd take you in to do the X-rays and I would ask the technologists so many questions that they would end up bringing in the radiologists. I just thought it was all so fascinating.

That was before I even knew that there was a specialty called Radiology. And a radiologist told me, “You might want to consider going into radiology when you grow older.” And that's how I found out about radiology. And certainly I knew that there were different types of medicine. I just didn't know at that young age that radiology was one of them. Those experiences were a big part of what excited me for the future.

And another part was my travel to North Carolina. My father's family is from a small town in North Carolina. I used to go and spend most of my summers there, and at that time, life there was segregated. The African American people of the town were largely cared for by a single African American physician, Dr. Weaver. He was revered by his patients. As a child, I remembered that he always seemed to have the answers. In retrospect, he was probably a family medicine doctor who had many skills. But his ability to care for so many people, his status in the community, his ability to keep people healthy and take care of a large segment of the people there who largely didn't have other health care options really resonated with me.

And so I think my decision to pursue medicine was actually due to the intersection of those experiences. Seeing the impact of Dr. Weaver on the African American community in that small town and then meeting radiologists and being fascinated with what they did. I think that's why I ended up being interested in medicine.

Colleen Lawton: Do you have siblings?

Lori Pierce: I have one older sister.

Colleen Lawton: And what does she do and what's the dynamic in the family?

Lori Pierce: She is now retired but she was a systems engineer with IBM. She is very gifted in math and science.

Colleen Lawton: What did your parents do for careers?

Lori Pierce: It was very difficult for people of color to go to college in those years. So my father was a chauffeur for the postmaster general.

Colleen Lawton: Okay.

Lori Pierce: He grew up in North Carolina on a farm and never completed high school. But he was one of the smartest people I've ever known. He was excellent in math and had so much common sense, figuring out how best to navigate life. That was my dad.

And my mom also worked for the federal government. She was a secretary in Health, Education and Welfare, which is now HHS. So they both worked for the government in D.C. in various roles.

My parents were extremely focused on education. They were committed that my sister and I would obtain the best education we could, in part, because they knew that was our path to success and, in part, because they never had those opportunities. And so my sister graduated from Brown University. I also started at Brown right after she graduated and then after two years transferred to the University of Pennsylvania. At that point my family had moved to Philadelphia and my mother worked at Penn. And with her job at Penn, if I transferred, I would receive free tuition. It was my decision and I opted to transfer from Brown to Penn. I graduated from Penn.

Colleen Lawton: So you actually had two strikes against you, you are a person of color and you are a woman.

Lori Pierce: Yes.

Colleen Lawton: As a woman, I was told by my father, be sure to take typing and shorthand, then you'll always have a job. And it's like, oh, okay. And that's just the woman piece, and then person of color. Wow.

Lori Pierce: That's very interesting. In my family, my parents told me to decide what I wanted to be and then be the best person I could be in that job. My teachers and the counselors advised me to be a teacher. But I did not want to become a teacher. I don’t mean to be disrespectful because teachers are so important. But telling me that was the highest that I could go... was frustrating yet motivating. It challenged me to reach higher.

Colleen Lawton: Yep.

Tithi Biswas: It's good to hear from both of your perspectives, you know, as the leader of our field, both of you, it's just fascinating to hear about your childhood and how it shaped you to become who you are today. So I'm really, really glad to hear that piece. So let me ask you, like, once you went to college, how your childhood dream kind of took the shape while you were pursuing your education through college.

Lori Pierce: These interviews provide opportunities to sit back and reflect. Again, my parents did not ask me to transfer from Brown to U Penn but it seemed crazy to me not to -- both Brown and Penn are excellent schools, and in one I would have free tuition. So I transferred.

I took almost all of my pre-med requirements when I was at Brown. When I transferred to Penn, I decided to transfer into engineering. So I was a biomedical engineering major with a minor in chemical engineering. I choose my major because engineering was a competitive discipline and I thought it would position me well for medical school.

But I also chose engineering because part of me questioned whether I was absolutely sure I wanted to go into medicine. Was there another career that would give me the same sense of satisfaction? So, I thought, okay, I'll major in engineering. And engineering is great on many levels because it teaches you to think in a methodical way. And if I did choose a career in medicine, thinking methodically would be an asset.

So I majored in engineering and applied to medical school. And if I was going to go to medical school, I had to figure out how to pay for my medical education. My parents had an agreement with my sister and me about costs for college and graduate school. My parents would cover the costs for our undergraduate education but anything beyond graduate school was our responsibility to pay. So I had to come up with a plan for how I could pay for medical school.

When I was accepted to medical school, I deferred my admission to work as an engineer to earn the money needed to pay for medical school. In retrospect, that's probably one of the smartest things I ever did because not only did working as an engineer allow me to save money for medical school, it also made me realize that I absolutely was making the right decision to go into medicine.

At the time, I thought, I'm losing two years of my life and I'm going to be so far behind my peers. In retrospect, it was a smart move because it really made me motivated to pursue a career in medicine. So, I was two years behind those who had gone straight from college to medical school but I matured a lot in those two years.

Tithi Biswas: That's great to hear. So we kind of heard what influenced you to, you know, pursuing to medicine. Now, the next question would be like, what -- we kind of heard that radiology fascinated you. And we all know that radiology and radiation oncology kind of are probably siblings, and it started at from one in the past. So what influenced you to kind of change your childhood track to go into radiation oncology?

Lori Pierce: I think we all have stories about how we found our way to radiation oncology because at that time, there weren't a lot of programs that actually introduced radiation oncology to medical students. And so we all have stories as to how we found radiation oncology.

I was planning to go into radiology and I went to Duke for medical school. At Duke, your third year was dedicated to research. You did all your classroom didactics in your first year and did all your core rotations in your second year. And your third year was a research year. In the fourth year, you rounded out your clinical rotations.

Long story short, when I went to see my advisor in Radiology, in my second year, she reviewed my options for my research year. One of the options happened to be in a radiation oncology lab. At that point, radiation oncology was a division of radiology at Duke. The radiation oncology option just so happened to be the most interesting option. And I said to her, well, I don't think I want to take this even though it sounds interesting, because I want to go into radiology. She said, “Radiology programs appreciate radiation oncology research. If that's the option that appeals to you, you should choose it.” So I did.

During my research year, Dr. Leonard Prosnitz was recruited to Duke to be the first radiation oncology chair. Radiation oncology had become a separate department and he was recruited to be the chair. I met him and he invited me to come to the department and see patients with him. I was doing my experiments in the lab and when I had downtime, I'd come down and go on rounds with Dr. Prosnitz. And I just loved it. It was the best of all worlds. It gave me the X-rays that had fascinated me as a child and it afforded me the opportunity to learn about cancer biology.

But the main opportunity it provided that I had not factored in before was to have patient contact. I love working with patients. And I think if I had gone into radiology, I would have really missed that. In Radiation Oncology, you're interacting with patients, working with their families, listening to their stories, helping them to process the cancer diagnosis and think through therapies for their cancer. Working with Dr. Prosnitz made me realize that radiation oncology encompassed many of my professional goals. And so I switched my career goals from Radiology to Radiation Oncology and I never looked back. It was absolutely the right choice for me.

Tithi Biswas: So tell us a little bit about your residency. Do we know some of your co-residents? How was it getting the training at that time in radiation oncology?

Lori Pierce: The time I was a resident was a great time to train in Radiation Oncology. Dr. Bob Goodman was the chair of Radiation Oncology at the University of Pennsylvania which is where I did my residency. Howard Sandler, which is a name a lot of people know, and I were co-chief residents. Eric Radany, who’s at the City of Hope, was also in our class. There were five of us. Steve Arrigo and Dave Horvick were also co-residents. They went into private practice. Funny, you never forget your co-residents. You go through so much together and we all worked well together. It was a great time to be at Penn as a resident.

And for someone interested in breast radiotherapy, it was also a great time to be a resident in radiation oncology particularly at Penn. Radiation as a component of breast conserving therapy was relatively new. Being at Penn with Barbara Fowble and Larry Solin, mentors in breast radiotherapy, and the breast data base they created - it was an exciting time.

It was a challenging residency but I like challenges. I believe I was the first black resident to come through that program. And I felt pressure that I had to do well.

Tithi Biswas: That’s great. So after you’ve finished your residency, tell us a little bit about your first job. And your decision to accept your first job, and then what led you to your future employment? So tell us a little bit about that.

Colleen Lawton: May I ask one another question regarding residency?

Lori Pierce: Yes.

Colleen Lawton: Tell me about any discrimination or I mean, again, you had two strikes against you - you're a woman, which is its own anomaly at that time and being African American. So how was that?

Lori Pierce: I have to say I never felt discrimination during my residency. I think the biggest issue was self-imposed pressure. I felt I had to perform at a level higher than my co-residents. My chair and other senior members of radiation oncology had to tell me to relax. They were clear that I had not been accepted into the program because I was black. As one of my attendings told me, “You got here because you're good.” They said you need to understand you deserve to be here.

And so the short answer to your question, Colleen, is I didn't feel from others or see any signs of discrimination or indicators that expectations were higher. Perhaps some signs where there and I just didn’t see them. It took me about a year to be feel comfortable in the residency program. At that point, I began to feel just like another one of the residents.

Colleen Lawton: So I appreciate you answering that because I think the reality is that it -- let's just take the color out of it for a moment.

Lori Pierce: Yeah.

Colleen Lawton: Women felt that all the time. Every woman who walked in the door at that time was not the average Joe, and literally using the term Joe. And so I think we all felt that, right? And then you have that color piece as well. I think it's useful because whether you felt it or not it's something to either appreciate that there was bias or appreciate that somebody actually said to you just what they said, which is so laudable.

Lori Pierce: The dynamics are interesting. And while I don't want to make this conversation all about race, having been born and raised in D.C. and having spent a lot of time in the South, you are very conscious about race. That is why I am so happy with the current generation. They seem to focus so much less on race. Now, of course, with all the highly visible displays of racism and hatred in this country, race is probably very much on their minds. But I am confident they will handle it much better than previous generations. But you were very much aware of racial differences as a person of color in those days.

Colleen Lawton: Yeah. Anyway, I didn't mean to. I just had to ask that question because --.

Tithi Biswas: No, I think it's good to hear your perspective, what you have experienced. I think it's an important part for the current generation and future generations to understand that part. So it is important. Let's go back to you, again, your first employment, you know, what it’s like, how was it.

Lori Pierce: So my first job was at Penn. I was completing my residency and Barbara Fowble was planning to take a one-year sabbatical. She asked me if I would stay for a year and run the breast service to free her up to take a sabbatical. If you know, Barbara, you know it's hard to say no. And actually, it was another one of those fortuitous things because to have the opportunity to lead the breast service for a year, given the status of Penn's breast service at that time, and to work with the exceptional surgeons and medicine oncologists that I knew so well, was a great opportunity. And to be able to work longer with Larry Solin was also a wonderful opportunity.

So I stayed an additional year and then I went to the NCI to work with Eli Glatstein. The NCI was a unique environment. As a young investigator with a focus on research, the NCI was a phenomenal place. So I went to the NCI as a senior investigator and learned a lot about clinical research. I stayed at the NCI for two years. And then Allen Lichter recruited me to come to Michigan. And so I've been at Michigan since ‘92. I came in as an assistant professor, and have been promoted and tenured through the years.

Tithi Biswas: So tell us a little bit about your research interest. We heard that you ran the breast service for a year. Did it influence or shape your future research activities? Or is there any other aspect that led you to your research interest?

Lori Pierce: Sure. I had decided during my residency that my career would focus on breast cancer. I think, in part, that was because I enjoy working with women, and, in part, because I was so impressed with Barbara Fowble. When she was with patients, she was exceptional. The respect that she garnered from patients was absolutely due. She was a great role model in how she engaged with her patients.

So, yes, staying on a year to help to lead the breast service was pivotal for my career. Even though I probably seemed in some people's minds to be a glorified resident, in that on June 30th I was a resident and on July 1, I was an attending. And so, I had to win people's confidence. But it was all good.

Then I went to the NCI. It was a good time to be there, be engaged in research, and to participate in and write up some of the results from trials conducted at the NCI. And then I went to Michigan.

At Penn, one of the research projects that actually I’m still proud of was a paper I wrote looking at outcomes of African American women following breast-conserving surgery and radiation. It seems so obvious that rates of tumor control in the breast would be the same as in white women, regardless of race, if treatments were the same, but it wasn't obvious then. There were stark differences across the country between the rates of breast conservation in women of color and white women. So I wanted to show that the rates of local control should be the same whether a person was black or white.

The results did show similar rates of tumor control in the breast. We also saw, however, that African American women experienced more nodal reoccurrences and poorer survival. Looking back on our data, more African American patients had ER negative disease. I suspect many of them would now be diagnosed with triple negative disease. We had more younger patients who were African American women compared to white women. When you look at the national trends, we see that younger African American women have a higher risk of being diagnosed with breast cancer than younger white women. And many of these women have cancers associated with biologically aggressive disease.

So looking back, knowing what we know now, I can understand why survivals were worse for the African American women in our series. But at that time, I just had to say that the survivals were worse without postulating the reasons why. But the main reason we wrote the paper was to show that breast conservation resulted in similar tumor control rates in the breast regardless of race so this option should absolutely be offered to women of color.

From then on professionally, I focused my research on treatment planning to minimize toxicities, and on those 10 percent of cancers where, despite receiving adequate surgery, standard radiation, and often systemic therapy, they recur in the breast. What is it about those 10 percent of cancers in whom therapies are less effective? Well, we've now learned that it is likely due to an inherent radiation resistance in those cancers.

I've done studies looking at radiation sensitizers, including gemcitabine and PARP inhibitors. Some of the previous studies were done in collaboration with Dr. Felix Fang, previously at Michigan and now at UCSF, and with Dr. Corey Speers at Michigan. And now, Corey Speers and I are looking at androgen receptor inhibitors with radiation. So trying to find ways to make those radio-resistant tumors more radiation sensitive has been a major focus.

And another area of research has been examining the outcomes of breast cancer patients who harbor BRCA1 or BRCA2 mutations following radiation. I developed this interest when I heard researchers saying these carriers should never receive radiation because side effects would be prohibitive. I thought at that point, there should be a way to study this using data already obtained. Once the gene had been cloned, we could go back and look at patients previously irradiated who were subsequently found to carry a mutation. So that was what got me started to study outcomes in BRCA1/2 carriers treated with radiation.

So I would say my major areas of focus have been treatment planning, particularly minimizing cardiac toxicity, radiation sensitization (trying to increase sensitivity in those tumors that are radioresistant), and radiation effects in BRCA1/2 mutation carriers.

Tithi Biswas: That’s fantastic to know. Any controversies during your early life regarding any of your research or career that sort of impacted the future about anything?

Lori Pierce: Not sure I would call this a controversy, but if you look at where our field was early in my career with respect to breast conservation, there were still a lot of naysayers who felt mastectomy was best. I still remember Barbara Fowble saying she had to make surgeons listen that randomized trials showed equivalence in survival between breast conserving surgery with radiation and mastectomy. Changing surgeons’ minds was challenging.

I also think appreciating the importance of multidisciplinary treatments was challenging for some. Breast cancer was the perfect model. Breast cancer was one of the earliest cancers focusing on multidisciplinary treatment and its importance from both a systemic perspective and a local perspective. Not really a controversy but rather a change in approach going forward.

Perhaps one controversy was the fact that people thought that the toxicity with radiation was going to be prohibitive in BRCA1/2 mutation carriers. It was quite satisfying to address that controversy.

Tithi Biswas: Just one curiosity, I mean, these days we take for granted to have a multidisciplinary clinic, to have our surgery colleagues, our med onc colleagues. We're all driven to make a combined decision. What was it in your early life, like did you have that? Did you have to build that with your colleagues? I'm just curious to know.

Lori Pierce: Yes. We did have to build that. When I was a resident at Penn, we didn't have a multidisciplinary conference. While our approach was multidisciplinary in that we worked closely with the surgeons and the medical oncologists, we saw patients separately. We did not have a multidisciplinary clinic at the time.

When I was at the NCI, we did have a multidisciplinary breast clinic. And that model was introduced at University of Michigan -- Allen Lichter was at the NCI before he came to Michigan. He helped start the multidisciplinary breast clinic at the University of Michigan, transferring his experience from the NCI. So by the time I got to Michigan, a multidisciplinary clinic was very much in place for breast cancer.

I believe we had one other multidisciplinary clinic at the time. Now, of course, everything is multidisciplinary. But then, the breast cancer multidisciplinary clinic was relatively unique.

Tithi Biswas: That's fascinating to hear. So tell us about your experience working in this major national organization that you were part of and both in various roles including leadership roles and your experience.

Lori Pierce: I have been involved since early on as a resident in ASTRO and have continued to be heavily involved as a faculty member. And thanks to John Glick, the cancer center director at U Penn and a previous ASCO President, I joined ASCO during my residency also. Both Barbara Fowble and John Glick were mentors and they influenced my involvement in ASTRO and ASCO early in my career.

Then I went to the NCI and then the U of Michigan, and I remained active in both societies. I have participated on many committees in ASCO and ASTRO. Although I am a radiation oncologist and most members of ASCO are medical oncologists, ASCO has been very welcoming and I am now proud to be ASCO President.

Having worked with ASCO over the years gave me an appreciation of what ASCO is and what its impact can be on so many levels. So I was happy to have been elected president of ASCO.

Tithi Biswas: That's great to hear. Because, you know, I'm glad that you shared that story. I do work with ASCO as well in their committees. And I participated in various activities through that committee. And I agree that they are welcoming to all the specialties, not just medical oncologist. And I'm so proud and glad that you are the president now of ASCO representing not only all medical specialties, but particularly radiation oncology. I think that is a great honor for all of us. So thank you.

Lori Pierce: Thank you. It is keeping me busy, that's for sure.

Tithi Biswas: Yes. Yes. So in your long and successful career as a female physician and radiation oncologist, could you make some comment about anything that you have seen that kind of made our specialty, you know, great or any development that you have seen in our field?

Lori Pierce: Our field is truly great. What we do is so important to the outcome of millions of patients worldwide. Obviously, radiation has to be delivered precisely to maximize the positive outcomes and minimize potential complications. And having an increased focus on quality is extremely important. So I think the fact that we are focusing and publishing on quality, that we are delivering radiation with precision and analyzing and publishing our results allows us all to learn and be excellent oncologists.

What also makes our field great is assessing where our therapies work, seeing where further treatment intensification is needed, and also focusing on potential toxicities so we can improve the overall quality and effectiveness of the treatment we’re giving. So finding metrics to assess effectiveness and quality of treatment is extremely important. These are just some of the many things that ASTRO and radiation oncologists do so well.

Tithi Biswas: So standing here today, what is your vision about the future of our field? Where do you think that it would be heading, and would you like to go there?

Lori Pierce: I think our field is heading toward further individualization of treatment. We've already come a long way. One size does not fit all. And so much of what we've done by looking at failure patterns and analyzing outcomes have helped us to decide the appropriate fields that should be used, and that's individualizing therapy. But I think adding biological markers such as gene profiles that are prognostic and predictive of radiation response, is where the field is going.

Along with collaborators in Sweden, colleagues at Michigan and I published a paper last year of a gene profile that we created and then validated in the SweBCG 91 randomized trial of radiation for breast conservation. And we showed that that marker, called the ARTIC, was both prognostic and predictive for radiation response.

This is an example of where I think the field is going. These kind of markers will help us know those tumors that will likely be controlled with standard doses of radiation and those that are resistant to standard doses where intensification of treatment may be needed either with higher radiation doses or with the addition of a radiation sensitizer. Harnessing biology to inform treatment decisions is the future direction of radiation oncology. We are taking a page from medical oncology. They've already been using gene profiles to help them decide when to intensify and when to de-intensify therapy. I predict that for many disease sites, we will learn where we can safely omit treatment.

We want to make sure that when we treat someone, they need to be treated, right? Because we know that even with very precise delivery, there are always a risk of side effects. So if there are patients who will not derive a benefit from treatment, every radiation oncologist would want to know those patients in whom treatment could be omitted. I think we’ll learn over the next ten years how better to make that call.

Tithi Biswas: If you don't mind, can you tell us a little bit about your family, your personal life, your children?

Lori Pierce: Sure. I am married. And my husband, Anthony Denton, is the chief operating officer of the University of Michigan Health System. And we have one son who is 23. He graduated from Northwestern, Medill School of Journalism, and is a budding sports journalist. He works at the ABC television affiliate in Eau Claire, Wisconsin. We have a Golden Retriever - I can't leave her out - Sienna. And Sienna is a member of the family. So that is our family.

My husband's career is, obviously, very busy as well. Luckily, he doesn't have to travel as much as I did, that is, before the pandemic. He was often able to be home when I could not.

Tithi Biswas: How do you balance your busy work life and family life? How did you do it when your son was young and you're busy with your career?

Lori Pierce: All of us who have chosen to have families have had to figure this out. As I’ve mentioned, my husband traveled less than me. But even with that, you still want to be there for your child. My son is very athletic. He was on just about every athletic team you can imagine in middle school and high school. And I tried to make as many of those games as I could. There were some times when I couldn't. But I tried to do as much as I could.

My husband and I always balanced things so at least one of us was home. We never left our son with another adult. We always figured it out. Our secretaries stayed in contact, so they knew when one person was going to be away, the other one couldn’t be. They helped us to coordinate our schedules.

And those times when I had to travel and had to be away, we always had a commitment that we would talk by phone before my son went to bed. And we did prayer time together every night. We never missed that. So you find ways to bring the family together. And that was our way. No matter what time zone I was in, that was our time. You have to find a way, right?

Tithi Biswas: Yeah. Yeah. I agree. I agree. Any advice or any word of wisdom to young physicians, particularly young women physicians who are in our field?

Lori Pierce: For physicians in academics, look at your overall life and decide what your priorities are. Certainly, family for many will be a major priority. But in terms of your professional life - I think it's easy when you're a junior faculty member to perhaps become too diffuse to the point that you can't make the impact that you want to make.

I always tell junior faculty to play to the strength of their institution. When you first come in, try not to do something totally different than what others in your institution do. Get your footing on the strengths of your institution and work with a mentor while you're learning the ropes and then become independent with your own new ideas. You want to be focused, then bring new ideas into an existing infrastructure and go from there.

One of the questions you asked was how do you achieve global impact? When you're a junior faculty, it's hard to walk in the door and say, okay, I'm going to achieve global impact. But what you can do is to publish. Publishing has a global reach. You put your head down and just do the work, do the research and you publish. And when you publish, your work is disseminated and your name starts to become widely known. That is how you have impact.

So I think it's a long answer to your short question. But I suggest junior faculty focus on the strengths of their institution. You grow in the existing infrastructure, and then you get to the point where you can create new programs on your own.

Tithi Biswas: Thank you. I think all of us are more used to seeing Dr. Lori Pierce busy, you know, serious - although that's my made up comment, an adjective, who have been a leader in our field. But I think people would like to know what does Dr. Pierce as a person do for fun. Anything interesting that --

Lori Pierce: Well, I am a fierce University of Michigan sports fan! And so I'm a bit depressed right now because the football team did not do well this year. But I very much enjoy sports. I also personally enjoy working out and exercising. It helps to clear my mind, and exercise is certainly important for all of us. As a family, we exercise together. Because of COVID, my son has been able to be with us and work remotely until recently. And so we were able to exercise together, enjoy sports, and hang out with our golden retriever!

I have always had a dog. I love dogs with a passion. They help me to have quality downtime.

Tithi Biswas: Thank you. Anything else that we are missing? Dr. Lawton, do you have any other questions?

Colleen Lawton: Lori, just to your point -- I don't mean to interrupt but I know we're getting short on time. Just listening to your story, how did you balance the family, and the reality is everyone wants it all but you can't have it all. You're going to have to make decisions. And you're going to have to make the best decisions you can, and you did. And you have a successful family. But not everybody does. How do you manage all that? And just to give up the, "Oh, well, she has it all or he has it all." Nobody has it all. We all have to make decisions. Anyway, it’s just fascinating to see that, how people make that work.

Lori Pierce: You're absolutely right. And that's why I said in the beginning, it sounds so silly but you have to sit down and ask yourself what are your priorities. And they have to be your priorities. You can't let other people decide what the priorities should be for you. The decision needs to be yours to then structure your life accordingly. Everyone has different challenges. Everyone has different situations. And you have to figure out what's right for you.

Colleen Lawton: So profound. Yeah. Thank you.

Tithi Biswas: Thank you. Thank you, Dr. Lawton. Thank you, Dr. Pierce, for your time.

Lori Pierce: Thank you Dr. Biswas. You did a great interview. Thank you so much.

Tithi Biswas: I think both of you are kind of iconic especially among women, you know, younger physicians. So I appreciate your time. And for me, basically, the opportunity to ASTRO. So I would like to thank the committee, ASTRO, so that I could hear your story. That was great.

Lori Pierce: Thank you.