Meet Natalie Joe, Ph.D.
Natalie Joe, Ph.D.
Dr. Natalie Joe (she/her) is an enrolled member of the Navajo Nation, and a postdoctoral fellow in the Cancer Prevention Fellowship Program (CPFP) at the National Cancer Institute (NCI). She graduated from Fort Lewis College with B.S. degrees in Cellular and Molecular Biology and Biochemistry as a first-generation student. Dr. Joe holds a Ph.D. in Cellular and Molecular Medicine from Johns Hopkins School of Medicine, where she was inducted into the Edward A. Bouchet Honor Society (2022). Her dissertation work was supported by a Pre-doctoral Ford Fellowship (2018) and focused on studying the efficacy of a repurposed anti-parasitic, mebendazole, in the context of triple negative breast cancer. As part of her first year of CPFP, Dr. Joe received a Master of Public Health degree from Johns Hopkins Bloomberg School of Public Health with a concentration in Biostatistics and Epidemiology. She is currently a member of the Division of Cancer Control and Populations Sciences where she is working with Dr. Kathy Cronin in the Surveillance Research Branch and Dr. Shobha Srinivasan in the Office of the Director. Her projects focus on cancer surveillance research within U.S. Indigenous communities and efforts to achieve cancer health equity for her community.
Let’s focus on Tribal Health:
What inspired you to want to be a researcher, and what did that path look like for you?
My interest started first in medicine for two reasons: (1) I was inspired by Dr. Lori Arviso Alvord’s autobiography as the first Diné/Navajo woman board-certified surgeon in middle school and (2) the history of uranium mining on Navajo Nation that resulted in adverse health outcomes for my family as well as community. When I entered college, I had the intention to fulfill all the requirements to apply for medical school because I wanted to be a gynecologic oncologist. I had already begun shadowing doctors at San Juan Regional Medical Center in the field of obstetrics and gynecology (OB/GYN). In addition, I had successfully secured the Chief Manuelito Scholarship from Office of Navajo Nation Scholarship & Financial Assistance (ONNSFA) and the Indian Health Service (IHS) Pre-Graduate scholarship to fund my collegiate education. The next step within my first year at Fort Lewis College was to seek out a research opportunity. I conducted research with Dr. Aimee M. Morris to synthesize and characterize anti-cancer prodrugs with a cobalt(III) core for three years as a National Health Institute Maximizing Access to Research Careers (NIH MARC) scholar. During this time, I slowly started to realize that I had more interest in biomedical science as a career opposed to one in medicine because of the emotional labor required of physicians and seeking to move earlier in the cancer control continuum.
When I pivoted to pursing a Ph.D. program, I wanted to learn about biological efficacy after new prodrugs were synthesized. In 2015, I was provided a travel scholarship to the SACNAS (Society for the Advancement of Chicanos/Hispanics and Natives Americans in Science) conference to present my science. This opportunity provided me the ability to take my first airplane ride and speak to representatives at different graduate schools in the large expo hall. After the conference, I sat in my parents’ living room with all the brochures on the floor and narrowed down to eight schools. I interviewed in Spring of my senior year and ultimately matriculated to the Cellular and Molecular Medicine at Johns Hopkins School of Medicine in Baltimore, MD, which was 2,000+ miles away from my family support system. My graduate career was the ultimate character-building experience for me as an Indigenous woman and scientist. My dissertation work focused on repurposing an anti-parasitic drug in the context of triple negative breast cancer. I gained a wealth of knowledge of how to conduct cancer research with the utilization of mouse models, cells, and how to determine biological mechanisms of action. In my fourth year, I started to decide on my next career steps, and I was debating on different post-doctoral opportunities that would continue within the same field. However, I also noticed that during my degree I was even further removed from the patients I was aiming to help and my Indigenous community. Additionally, the drug that I was working with was in Phase I clinical trials at this point for glioblastoma and as I looked at separate Phase II as well as Phase III recruitment trials, I knew it would be many years or decades until this work reached the Navajo Nation. The road to get new therapeutics to my family would involve many steps, approvals, and this led me to think about moving into the field of public health.
In 2021, I applied and was accepted in the Cancer Prevention Fellowship Program (CPFP) cohort of 2022 at the National Cancer Institute (NCI) which allowed the flexibility to attain a Master of Public Health degree during the first year. I attended Johns Hopkins Bloomberg School of Public Health with a concentration in Epidemiology and Biostatistics. Whilst in the program, I was able to rapidly build my knowledge within the expansive field of public health and for my practicum work with the Center for Indigenous Health. This experience solidified that I had made the right choice to move from the bench back to the large population level. Now, I am working with Drs. Kathy Cronin and Shobha Srinivasan in the Division of Cancer Control and Population Sciences. Overall, my scientific journey really spanned the cancer research field from inorganic chemistry all the way to cancer screening interventions. My inspiration throughout has been from the stories my families shared of the impact of uranium mining on Navajo Nation and witnessing the difficulty of my own family trying to navigate their own cancer journeys. I have continued to take the next steps in my career to directly give back and strive for health equity for my community.
Tell us about your current work and projects.
Currently, I am working on several projects internal as well as external to the National Cancer Institutes as a lead, collaborator, or workgroup member across the spectrum of Indigenous population health. My main research project at NCI is within the field of cancer surveillance data in the Division of Cancer Control and Population Sciences (DCCPS) Surveillance Research Program (SRP) and the Office of the Director (OD) with my mentors Drs. Kathy Cronin and Shobha Srinivasan. My project aims to determine the implementation impact of the 1997 Office of Management and Budget (OMB) racial and ethnic categorizations on cancer incidence rates for American Indian and Alaskan Native (AI/AN) populations. In addition, highlighting the specific methodological practices used within cancer registry data to reduce AIAN racial misclassification amongst cases. As part of this work, I am a member of the AI/AN Data for Cancer Surveillance Task Force at the North American Association of Central Cancer Registries, Inc. (NAACCR) where I am collaborating on a commentary with the group on this same topic as well as a separate descriptive epidemiology project for prostate cancer within the AI/AN population. Additionally, I have established a working relationship with academic researchers, tribal government workers, healthcare providers, Indian Health Service employees, other federal agency employees, tumor registries, tribal epidemiology center employees and community members while being a member of the Navajo Nation Cancer Workgroup. I joined the team within the first year on-site during my fellowship and I had the ability to contribute to the manuscript based on the 3rd Cancer Among the Navajo report that can be found on the Navajo Epidemiology Center website. This data can now be seen on the inaugural Data Dashboard that is the first of its kind to be housed on a Tribal Epidemiology Center’s website to view the last two Cancer Among the Navajo reports (2005-2013, 2014-2018). A final project I am contributing to is the Cancer Control Plan for Navajo Nation with experts from academia, cancer centers, community non-profit organizations, academia, Navajo Nation, and federal agencies. I am deeply humbled by the opportunity to work with my own community since this was the impetus to even switch fields from bench science to public health work. Two other projects I would like to highlight are with collaborators from the Centers for Disease Control (CDC), academic institutions, the Urban Indian Health Institute, and cancer centers for a manuscript on the leading causes of death for urban AI/AN in 2020. The project is focused on the specific year of the pandemic due to the high impact of COVID-19 on the Indigenous communities with separate groups working specifically on COVID-19 mortality. In addition, I am on the NIH Indigenous Data Sovereignty (IDSov) Workgroup to advance AIAN health research by collaborating to develop the NIH IDSov policy, attending listening sessions with various rightsholders, and develop collaborations across different institutes and centers (ICs). Lastly, I am involved with a few other projects collaborating with fellow fellows, physicians, academics, and federal employees to advance cancer health equity for historically excluding populations.
What sparked your interest in working with American Indian, Alaska Native, and Indigenous populations, and why is this work important to you?
I am a part of the Indigenous community, and my scientific interest has always been to help my family as well as the entirety of Navajo Nation. Between 1944-1986, there was ~30 million tons of uranium ore that was extracted from my community and many people, including my family suffered the adverse health outcomes from uranium contamination. Therefore, I grew up hearing first-hand accounts of the impact on my family and how there was a consistent lack of personal protective equipment as well as communication of risks. This atrocity left over 500 abandoned mines across Navajo Nation and learning about this injustice was truly the first spark in my interest of addressing cancer at the community level. Secondly, my work focuses on AI/AN and Indigenous population because our communities have consistently been seen through the colonial lens and the initial goal of colonization was to cause complete erasure of our entire communities. Even currently, we face erasure in the data when our statistics are not shown nor discussed. We are reminded of stereotypes each October and during some sporting events, which negatively impact the mental health of Indigenous adolescents. Therefore, it is important to have positive Indigenous representation in positions of power to positively impact Indigenous health. As a people, we are the first stewards and inhabitants of what is currently known as the United States, but our health, wellbeing, and existence has never been prioritized. Therefore, I would like my work to be done in collaboration with other Indigenous people – be it in community, government, academia, non-profits or elsewhere – to work toward health equity for Indigenous people. We are still here. We are resilient and thriving. In addition, we have our own solutions and the foresight to think of not only us in the present but the many generations that will come after us.
What are the main challenges that remain to be addressed in your area of research, and how will your research tackle these challenges?
Two main challenges in cancer surveillance data for the AI/AN population is an imperfect system to get counts of cancer cases (numerator) and the entire population estimate (denominator). Each process has specific nuances that make it difficult for there to be one best system to reduce racial misclassification while trying not to exclude large amounts of community members. For instance, ~70% of the AI/AN population live in urban areas that are usually excluded when calculating the numerator for national AI/AN cancer incidence and mortality rates. Therefore, my current work incorporates methodology developed by the CDC and the Urban Indian Health Institute to be begin getting data for the urban AI/AN population. In this way, there can be a fuller picture of what is ongoing in the entire AI/AN population. Secondly, the updated racial and ethnic categorizations from the Office of Management and Budget (OMB) with the inclusion of a multi-racial population among alone-race categories might cause racial groups like AI/ANs to have lower counts because multi-racial individuals are no longer counted into the AI/AN category. It also makes it difficult to interpret a rate of the multi-racial population and how to address disparities found within the group. Thus, my main project focuses on trying to determine the overall impact of these changes and work with a team to develop best practices when reporting AI/AN cancer surveillance data.
What are some of the challenges you have faced getting to this point, and how did you overcome them?
Some challenges that I have faced prior becoming a Cancer Prevention Fellow at NCI have included (1) discouragement to pursue a biomedical career (2) toxic mentorship (3) feeling isolated from community and (4) navigating academia as a first-generation student. I overcame each challenge in part due to my own tenacity and the overwhelming support system that I have developed throughout my training. In undergrad, I double majored in two STEM fields and consistently took over the recommended credit hours every semester to fulfill all the requirements for both fields of biology and chemistry. In my first year, I received a high B for my introduction to biology course and was told by my academic advisor that medical school was out of the question. In addition, when applying for graduate schools I was encouraged to place more “safety” schools on my list. Each event at first caused me to question my ability to achieve a goal that I had set for myself and seek other advice as well as information. I spent time learning that one B would not eliminate my chances of medical school and that I could apply for a post-baccalaureate program at the same time as “reach” graduate schools for a Ph.D. program to gain more research experience. I spoke with others that had pursued the same path I was interested in and learned that the advice I had received may have come from a place of good intention, but the result was the same, both people that were supposed to help guide my collegiate career had inadvertently discouraged me from pursuing a career in the biomedical field. Therefore, it is key to have multiple people to discuss with, perform informational interviews of possible career paths, and it is best to prepare a plan B, C, and D just in case plan A is not what life had in store for you.
As for overcoming toxic mentorship within my scientific training was a very arduous and overwhelming. At first, my desire to attain higher education sustained my ability to work through each situation, but eventually the excitement wore off and I heavily relied on my support network. My family, spouse, therapist, friends, peers, mentors, and sponsors were really a huge influence on my ability to endure these ordeals. Toxic mentorship really made me question my ability to keep moving forward on a daily or even hourly basis and I almost left my graduate program due to this challenge. Ultimately, I remained because through everything my support network uplifted me to the point where I felt confident enough that I was capable of finishing and fulfilling the expectations set for me. In addition, I learned the valuable lessons of documentation, self-advocacy, navigating difficult situations, noticing early signs of red flags in a mentor and how to build self-confidence as a scientist.
When I started my graduate school journey, I moved over two-thousand miles away from the Navajo Nation. I started to feel extremely isolated as my program started because I had never lived further than one hour away from home. Overcoming this challenge is an ongoing struggle because nothing will ever be exactly like home or feel as fulfilling as a visit back to the Navajo Nation. Thus, I started to form new relationships with other BIPOC (Black, Indigenous, and People of Color) trainees, mentors, and sponsors since we have a similar experience in homesickness as well as a sense of community loss in spaces without BIPOC leadership or representation. By expanding my network, I was able to start to form a community of my own on the East Coast. In addition, through some visits back home – sometimes via a 36-hour road trip – phone calls, and family visits, I began to feel less and less isolated from community. Also, Indigenous peoples are everywhere and often, you do not have to travel far to find community or get connected with a person that really knows just about everyone.
Overcoming the enormous challenge of being a first-generation college and graduate student can feel daunting at times, but many generations of people have been able to successfully navigate this journey. My ability to plan, research, and ask questions really helped me throughout the course of my career journey. I truly attribute this skillset to my mom who consistently invested the time to teach me these critical life skills. She discussed honestly the price of education, the ability to interact with people in positions of power, to speak up for myself, and even let me observe her take community college courses while I was in grade school. In fact, my entire family has consistently encouraged and supported my pursuit of education which led me to seek out opportunities to enroll in dual-credit courses at the community college in high school, to apply to scholarships, and to apply to undergraduate and graduate school. Aside from family, I would like to highlight the importance of school advisors, counselors, teachers, professors, and mentors that take the extra time to help students navigate the hurdles that first-generation students face such as filing paperwork, choosing a major, or discussing career options.
What has been the most impactful advice you received during your journey?
The most impactful advice that I have received during my journey has been to shift my thinking to a growth mindset because people are not innately great at what they do. It will take time, effort, perseverance, and failure to continue to grow as a scientist. This advice has helped me reframe my thinking when I am learning something new, and I am feeling frustrated when I compare myself to others that have more experience in the area. I can take time to step away and remember that I am learning this new technique, field, etc. and if I am putting in the effort my resiliency will pay off in the end. Thus, I am more excited to learn more, challenge myself, learn from each mistake, and reach out to those that have already developed the skillset to provide insight into their own growth journey.
What words of advice would you give to the next generation of scientists?
Dear next generation of scientists,
Continue to question current systems, processes, and ways of doing today’s science because it helps us continue to build better and more inclusive systems. STEM fields still do not have representation and people in power who represent the diversity that we see within our everyday lives. Therefore, current scientists such as I can continue to decrease barriers, we have faced in our careers so you can address others that you have faced during yours. Sustainable DEIA (Diversity, Equity, Inclusion, and Accessibility) change can be made through the continued positive mentorship, investment of resources, and uplifting of you as the next generation of scientists. In addition, your successes should never come at the cost of your health, and I encourage you to create the boundaries that you need to show up as your best self. Be your own best advocate and as early as possible build your support network to lean on during the journey of your scientific career. Lastly, I want to let you know that you are already a scientist in your own right, you come with your own ideas as well as experiences, and we have a lot to learn from you as well. So don’t ever feel or let anyone make you feel that you are entering a space with nothing to contribute.
Please feel free to reach out at any point in your journey and I truly hope I can help a few of you thrive to be amazing changemakers in your fields.