When Francesca C. Duncan, MD, MS, was young, she came down with an ill-timed case of pneumonia that landed her in the hospital.
Being in the hospital meant missing out on celebrating her father’s birthday at home with her family. While caring for her in the hospital, her pediatrician noticed her disappointment and offered to help her draw a picture wishing her father a happy birthday, hoping this would lift his young patient's spirits.
“Witnessing my own pediatrician go above and beyond, treating not just symptoms but the whole person, shaped my vision of the kind of physician I aspired to become,” Duncan said.
That small act of kindness is customary in Duncan’s hometown of Fort Valley, Georgia, which reflects the community’s enduring values of care and connection. When she expressed her desire to enter the medical field, that same community of her parents, pediatrician and church family was there to encourage her every step of the way.
Her parents and grandparents all attended Historically Black Colleges and Universities (HBCUs), and as soon as she expressed her interest in STEM, her parents invested in her education, seeking out college-bound programs, summer experiences and scholarships to help her competitively apply to colleges and explore the medical field as early as she could.
It wasn’t just her family who was invested in her success. Duncan’s church community included Sunday school teachers, English professors, retired educators and school administrators who offered support to advance and point her in the right direction.
That interest in becoming a physician never wavered from the ripe age of 7 through her graduation from high school.
“I always wanted to be a physician,” Duncan said. “Growing up, I didn’t see physicians that looked like me, but it was always something I really, really wanted to do. Once I got older, I was blessed to have a Black female family medicine physician in my church, but it wasn’t until I attended medical school at Meharry Medical College, that I really began to see myself in the faces of the Black faculty and physicians I encountered each day.”
Duncan began working on cancer research while pursuing her master’s degree at Tuskegee University, a HBCU in Tuskegee, Alabama. She was in a lab focused on cervical cancer, which disproportionally affects women of color. During her graduate education, she presented her research at the annual conference of the American Association for Cancer Research in Atlanta.
At the conference, Duncan attended a talk given by Francis S. Collins, MD, PhD, then the director of the National Human Genome Research Institute, who would shortly go on to serve as the director of the National Institutes of Health (NIH). He spoke about his career as a physician-scientist, a concept that was unfamiliar to Duncan at the time.
While she loved the idea of caring for patients the same way her pediatrician had cared for her, she was fascinated with the idea of becoming a physician-scientist who could take laboratory findings and translate them into the care of patients. Duncan spoke with Collins, who recommended she pursue the NIH’s Intramural Research Program (IRP), a summer internship that provides participants with bench-to-bedside experience.
Duncan spent a summer in the program before heading to Meharry Medical College in Nashville, Tennessee to begin her medical school education. She’d return to the same lab at the NIH in the summers during medical school, studying breast cancer.
It was during her Internal Medicine-Pediatrics Residency at The Ohio State University Wexner Medical Center and Nationwide Children's Hospital in Columbus, Ohio that Duncan began working on lung cancer research while developing an interest in pulmonology. Duncan’s work in Columbus focused heavily on the lung cancer screening program at Ohio State, which endeavored to make screening more widely available throughout the community with a focus on patients from underserved backgrounds.
With lung cancer research in mind, Duncan sought out mentorship at the IU School of Medicine and found Catherine R. Sears, MD, another physician-scientist whose research focuses on the impact of DNA damage and repair on the development of smoking-related lung cancers.
“She served as my primary mentor very early during my fellowship training,” Duncan said. “I’ve really enjoyed and appreciated her support, especially during my matriculation as a fellow and now as early career faculty.”
With lung cancer, Duncan became fascinated by the disparities she found through retrospective analysis and prospective studies. Her work showed that Black patients are more likely than other racial groups to not only get diagnosed with lung cancer but also get diagnosed at a later stage in the disease’s progression, making curative treatment more difficult. Additionally, she found that Black patients and those from a lower socioeconomic status were less likely to receive certain evidence-based treatments than other groups.
Her research has found multiple barriers affecting lung cancer screening uptake at the patient, health care provider, and health care system levels. These include challenges in identifying those eligible for screening, a general lack of knowledge of screening in the community, lack of awareness of screening criteria by patients and providers, insurance concerns and transportation issues, among others.
Those findings led Duncan to her current work finding ways to inform and intervene in those barriers so that lung cancer is detected earlier and more easily treated.
“I believe we need to be focusing on trying to increase awareness and discussions about lung cancer screening outside of the traditional health care setting,” Duncan said.
Duncan is no stranger to the community, having participated in the health fair at the Indiana Black Expo’s Summer Celebration. Working the fair’s cancer prevention panel, she provided information on lung cancer screening guidelines, spoke with attendees who met screening qualifications, and conducted a survey to find any obstacles that prevent attendees from getting necessary care.
The value of a panel like that extends beyond those who attend, Duncan explained. Word of mouth about the available resources can travel fast, encouraging others to seek out the same information.
“It’s going to take us partnering with communities and reaching out to people outside the health care system to really get the information out there about screening,” Duncan said.
Duncan’s day-to-day work varies. On a given week, she can spend time at patients' bedsides in the ICU, see patients and teach trainees in her pulmonary clinic, screen patients for lung cancer and work on manuscripts or grant proposals for her research.
But whenever she’s spending time on her research, be it writing the next article or working in the field, her thoughts are always on her patients — doing everything she can to help them and others like them.
She looks forward to her Tuesdays in clinic, especially when she gets to hear from patients about how they’ve quit smoking or declare them cancer-free in an annual checkup. Celebrating those moments with patients is special.
That community approach remains important for Duncan, just as it was when she was a child receiving above-and-beyond care in the hospital or receiving encouragement to pursue a career in medicine.
Going out to meet patients where they are, providing information in an environment where they’re comfortable, and seeing patients in the clinic is what drives Duncan’s work. Even if she weren't a physician-scientist, Duncan would be looking for ways to benefit her community, she said.
“Growing up in a community that was so supportive of me just makes me want to give back to the community,” Duncan said. “Wherever I go, I’m always seeking to give back to the community that I’m living and working in.”
