Carol Joan Swarts, MD
Carol Swarts is a radiation oncologist who has cared for cancer patients during an impressive career that stretched 60 years and is still going. She was born on a farm, spent her childhood across multiple states, and became a doctor at a time when few women enrolled in medical school. Her career has included being the only physician for a hospital in what is now the Democratic Republic of Congo during a revolution in the early-1960s, helping undergraduate students learn about tropical forest ecology in Costa Rica, and treating indigenous cancer patients in rural Alaska. Dr. Swarts, who is in her 80s, continues to work and travel internationally. She is an advocate for women in science and medicine, and a philanthropist who generously funds programs focused on science education and medical education.
What is Radiation Therapy?
Radiation therapy is a form of cancer treatment that uses radiation to damage the DNA in cancer cells to kill them or slow their growth. It is used for the treatment of solid tumor cancers, such as breast, prostate, lung, and pancreatic cancer. Radiation can be delivered externally or internally. External beam radiation therapy involves using a special machine that precisely delivers radiation beams through the outside of a patient’s body. Brachytherapy is an internal radiation therapy that involves surgically implanting seeds or capsules containing a source of radiation in or near a tumor; radioisotopes are also used. Radiation is one tool in the toolbox of oncologists and is often used in tandem with chemotherapy, surgery, hormone therapy, or immunotherapy. Therefore, radiation oncologists work in partnership with medical oncologists and surgical oncologists.
“There are changes going on with the development of new techniques, of electronics, of artificial intelligence, so…you can look at it either from the biological standpoint or from the machine standpoint, there’s something for both of them in radiation oncology.”
— Dr. Carol Swarts
Dr. Swarts's Story
Dr. Swarts was born on a farm in the Sandhills of rural Nebraska during the Great Depression. At the time, it may have seemed unlikely that this little girl would become a doctor, but Dr. Swarts knew at a very young age that it was the career for her. Dr. Swarts grew up with three brothers in a family that was highly supportive of education. Her father was a farmer, but they did not own land, and the family moved frequently as he sought work – living in Minnesota, Dakota, Washington, and back again to Nebraska. The family lived on farms, often many miles away from neighbors and towns. She explained, “we were our own village.” Her mother, Elenore Gakemeier Swarts, was “a pioneer”. Elenore was the first in her family to attend college after her family immigrated to the U.S. from Europe, graduating from the University of Nebraska in 1919. Dr. Swarts’ mother worked as a school teacher and became the first female superintendent of a school district in Nebraska. Later in life, Dr. Swarts endowed a scholarship at the University of Nebraska to honor her mother.
As a child, Dr. Swarts described herself as “a nerd – stubborn and independent.” Her parents greatly valued education, telling her “you don’t want to stay on the farm, you have to get educated if you’re going to have anything in life.” Similarly, her three brothers told her: “Carol, you can do anything that we do, and you should.” However, when the young girl told other adults that she wanted to be a doctor, she was often met with surprise and resistance. Dr. Swarts remarked, “that’s probably when I put my foot down.” That stubborn and independent nature worked in her favor as she pursued her dream of becoming a doctor.
Dr. Swarts left high school early at age 16 to attend Whitworth University in Spokane. After one year, she took some time off to work, and then finished her degree at the University of Nebraska. She then earned her medical degree in 1959.
Dr. Swarts was one of only three women in her graduating class (out of 72 students) at the University of Nebraska Medical School. Though some of her male professors didn’t believe that the three women belonged there, and told them so, Dr. Swarts reflected that her male classmates were supportive and collaborative. Dr. Swarts would later honor her two female classmates, Dr. Margaret Hancock Peterson and Dr. Marilyn G. Meyers, as well as her friend Dr. Gretchen Glode Berggren who graduated the year prior, with a Medical Pioneers Award at the University of Nebraska Medical Center. The award supports outstanding basic science faculty in the College of Medicine.
When she went to medical school, Dr. Swarts at the time had the goal of being a family doctor and working in Alaska; radiation oncology was not a specialty at the time. Dr. Swarts emphasized that she later learned during her residency that “taking care of cancer patients is general practice, if you do it right.” She explained that she was taught that oncology is “a whole family affair” and that “you need to think of all of the nuances, it’s not just a disease.” Dr. Swarts believes that “if you don’t look at the patient and the family, I don’t think you’re being a complete physician.”
Training to become a physician includes medical school, where a medical degree (MD) is earned. Then, exams are taken for a medical license and a residency is completed. A residency program is a special type of training focused on clinical work, usually at a teaching hospital. It usually lasts between 3-7 years, during which time the medical board exam is passed and a specialty certificate is issued. Dr. Swarts completed residencies in radiation oncology and nuclear medicine.
During her residency at Swedish Hospital’s Tumor Institute in Seattle, Dr. Swarts was introduced to radiation as a treatment for solid tumor cancers. There, she worked with surgeon Dr. William Hutchinson who would later form the Fred Hutchinson Cancer Research Center in memory of his younger brother Fred. Dr. Swarts noted that the radiation program at Swedish “took care of patients, but it was also challenging, technically.” Dr. Swarts reflected on being impressed at the time by the technology, dosimetry, and physics involved in radiation treatment.
“Setting up a treatment plan is almost like being an artist. When you look at the computer plan and what you want to treat and what you don't want to treat, you color the doses and end up with a work of art. So a little bit of everything is involved in radiation oncology.”
— Dr. Carol Swarts
Educational Pathway
Dr. Swarts’ educational journey included the following:
- Undergraduate: Bachelor’s degree (chemistry major, with a double minor in biology and psychology) from the University of Nebraska - Lincoln in 1955.
- Medical School: Medical degree from the University of Nebraska Medical School College of Medicine in 1959.
- Residency: Completed residencies in radiation oncology and nuclear medicine at Swedish Hospital’s Tumor Institute (Seattle, WA) and University of Cincinnati Hospital (Cincinnati, OH).
Dr. Swarts's Career
Most of her career was focused in northern Kentucky and the Greater Cincinnati area where Dr. Swarts worked as a radiation oncologist in a group practice at hospitals. She treated many patients, including Major League Baseball pitcher and manager of the Cincinnati Reds, Fred Hutchinson, who is the namesake of the Fred Hutchinson Cancer Research Center. Dr. Swarts was also the first female president of St. Luke Hospitals, a hospital system in Kentucky and the Greater Cincinnati area.
Being a radiation oncologist involves working with a team of professionals dedicated to patient care. Dr. Swarts commented that it all starts with the front office person who greets patients by name and checks them in. There is a medical dosimetrist and a medical physicist who work together to develop the technical plan. Together with the radiation oncologist, they examine patients’ medical imaging (by fusing together CAT, PET, and MRI scans) to determine which organ receives how many doses of radiation at what strength, and which areas they want to protect from radiation. There is a radiation oncology nurse that meets with patients and helps them to understand their treatment plan, and the radiation technologist or therapist that does the technical work of setting up and positioning patients and working the machines.
Watch the video An Introduction to Radiation Therapy (embedded below) for more information.
Radiation treatment plans vary based on the type of cancer, its location, the tumor’s size, and the severity of disease. As an example, for breast cancer a typical radiation therapy plan may involve five high-dose radiation treatments administered over a week, repeated for three to four weeks. This is a reduction from treatment plans that used to take six to eight weeks. Dr. Swarts explained that research and clinical studies at places like Fred Hutchinson Cancer Research Center have helped oncologists develop strategies for using higher dose treatments to smaller areas of the body over shorter periods of time. By shortening the treatment period, it reduces the burden on patients who need to take time off from work or may need to travel long distances to their closest treatment center. Dr. Swarts stressed that the financial impact of cancer treatment is something that oncologists need to consider, as they balance treatment plans and patients’ life plans.
Video: An Introduction to Radiation Therapy
Watch the below video to learn more about radiation therapy.
Medical Missionary Work
With a drive toward service, medical missionary work took her across the globe. Dr. Swarts joined her medical school friend and roommate Dr. Gretchen Glode Berggren and her husband Dr. Warren Berggren (who was also born on a farm in Nebraska) on many medical missions. The Berggrens worked with organizations like Save the Children, World Health, and Schweitzer Hospital in Haiti and Belgian Congo, offering their expertise in public health, community health, and tropical medicine in under-resourced communities. Dr. Swarts joined the Berggrens in Haiti and South Pacific island nations on medical mission trips where she focused on reproductive health and childhood nutrition.
Her partnership with the Berggrens also led her to Africa. During a revolution for independence in the early 1960s in what is now the Democratic Republic of the Congo, foreigners were evacuated from the country. However, President John F. Kennedy made a call for medical volunteers, which led to the creation of the Congo Protestant Relief Agency by American Mennonites and doctors. Dr. Swarts, who was doing a residency at Swedish Hospital at the time, was called to run a 100-bed hospital in the Congo. She joked, “that’s when they called me and said, we’ll send you over, and I’m not real bright; I said, okay I’ll go.” At the Congolese hospital, Dr. Swarts relied heavily on her broad training as a physician as she took on the roles of surgeon, pediatrician, and tropical medicine doctor. She said that this experience impressed upon her the importance of treating not just patients, but their families.
Dr. Swarts currently acts as a volunteer mentor for medical students at the University of Nebraska Medical Center’s SHARING Clinics in Omaha, which provide free and low-cost healthcare to under-resourced populations. Dr. Swarts stresses with these students, who are driven toward service, that a MD (medical degree) is more than just their area of specialty. As she learned through experiences serving in medical missions, physicians can give their time and effort to communities in need, but they’ll likely be asked to help with pressing needs like maternal and child health, rather than practicing radiation oncology.
In her retirement years, Dr. Swarts continues to serve rural communities in Alaska. Dr. Swarts works as a locum tenens, which is a physician that acts as a substitute for another physician. Dr. Swarts explained that in the state of Alaska, there are only a few cancer treatment centers that each serve a large geographic area, and some may have only a single radiation oncologist on staff. When that physician needs to take a vacation or travel to a conference, they call Dr. Swarts. She flies to Alaska for about two weeks at a time, taking over the role of the local radiation oncologist.
Dr. Swarts stressed in particular the importance of caring for indigenous people in rural Alaskan communities. For example, the Alaska Native Medical Center in Anchorage provides medical oncology services, but she noted that airfare and hotel costs, as well as time off work and away from family responsibilities can be barriers to patients who must travel long distances to the clinic. As part of her advocacy work supporting public health in American Indian communities, Dr. Swarts has funded a professorship in public health at the University of Nebraska Medical Center that honors two sisters from the Omaha Tribe – Dr. Susan and Susette LaFlesche. Dr. Susan LaFlesche received her medical degree in 1889, becoming the first Native American physician. Both sisters were strong advocates for public health focused on American Indians in rural Omaha.
With a drive toward service and philanthropy, Dr. Swarts has donated to endowments, professorships, scholarships, and facilities. Her generous giving has benefited Fred Hutch’s Science Education Partnership, Northern Kentucky University, and the University of Nebraska as a way for her to “give back” to organizations focused on science education and medical education. Some of these gifts have honored her family and friends. She enjoys meeting with the professors and students who benefit from these programs.
Video: Giving Back and Paying it Forward
Watch the video Giving Back and Paying It Forward: The Carol Swarts Story to learn more about Dr. Swarts' incredible career.
With a passion for the outdoors, Dr. Swarts enjoys hiking and backpacking. She chose to retire in Seattle because she says it is a “paradise” where she embraces the fog, rain, and clouds, and where she has family. She also enjoys traveling but isn’t much of a big city person.
Advice for Students
When asked about what her advice would be for students, Dr. Swarts said, "I would like to encourage students who might be interested in a career in medicine that radiation oncology is an area that is always changing and developing, which creates challenges using new and exciting technologies to benefit people. They can focus on research or clinical work, or combine them. The field is not just ‘science’, but utilizes and benefits from art, humanities, and fields like music. They would never be bored!”
U.S. Wage Information
According to the 2023 U.S. Bureau of Labor Statistics’ Occupational Employment and Wage Statistics, the mean annual wage for radiologists in the U.S. is $353,960.
Additional Resources
Credit: Credit: Thank you to Dr. Carol Swarts for generously sharing her story. Information used to develop this profile is from an interview with Dr. Swarts, as well as the following sources: University of Nebraska-Lincoln, University of Nebraska Medical Center, UNMC News, University of Nebraska Foundation, and a UN Foundation video. Career profile written by Dr. Kristen Clapper Bergsman.