Dr. Brian Lawenda

12/06/2025

Radiation is hard to picture. So I built a simple app that lets patients see how photons, electrons, and protons target a tumor, how arcs differ from static beams, and how we avoid organs at risk. A clearer way to explain treatment, right in the consult room.
https://brianlawenda.substack.com/p/radiation-therapy-visualizer-tool

12/05/2025

Patients constantly ask me: “Is it actually okay for me to drink?”
Not “binge drink,” not “a bottle a night” – just a glass of wine with dinner, a beer on the weekend, a cocktail with friends.

As a physician, I don’t think it helps anyone to say “alcohol is poison” and leave it there. Biologically, alcohol does create cellular damage, but the actual health impact depends heavily on dose, pattern, and everything else you’re doing for your health.

👉 I built the Risk Lens app to make these conversations more evidence-based.
I enter s*x and weekly drinks, and it shows how that pattern relates to:
📍Overall length of life (no clear change vs slightly / moderately / much shorter life)
📍Cancers (all cancers, breast, colorectal, liver, esophageal, oral/throat, stomach, pancreatic)
📍Heart & stroke (major cardiovascular disease, stroke)
📍Brain & nerves (dementia)

Everything is shown as people out of 100, not scary percentages. At low intake (1–7 drinks/week), we often see little or no clear change in lifespan, with small bumps in specific risks like breast cancer or dementia. As intake climbs, you can literally watch where the risk starts to move and where it clearly becomes a problem.

In clinic, I use it like this:
“Here’s what your current pattern looks like in terms of life expectancy and major diseases. Here’s what happens if you cut back. Given everything else about your health and your life, what feels like the right trade-off for you?”

For many people, the app is reassuring: 1-7 drinks a week, in an otherwise healthy lifestyle, is a very small-to-no measurable risk, not a disaster. For heavier patterns, it makes the stakes visible in a way that’s motivating without being shaming.

If you’re curious where your own habits land, I wrote about the science behind the app here:
🔗 Substack: “Alcohol, Risk, and Reality: Why I Built an App That Shows People, Not Percentages”
https://brianlawenda.substack.com/p/alcohol-risk-and-reality-why-i-built

And you can try the app here:
🧮 Risk Lens app: https://risk-lens-6b008c1d.base44.app

I’d love to hear: did seeing your risk as “people out of 100” make you more worried, or less?

11/23/2025

Enter the era of AI-driven oncology.

What if a treatment for cancer or other diseases is already sitting on a pharmacy shelf, or in a molecule AI can design in seconds?

In this new piece, I explore how agentic AI systems like AlphaFold 3, NVIDIA BioNeMo, and MADD are transforming drug discovery from a slow manual grind into a high-speed orchestration of autonomous models.

—Repurposed generics
—Digital twins
—Real-time, on-demand drug design

📖 Read the full breakdown:
https://brianlawenda.substack.com/p/the-multi-billion-dollar-treasure

Why spend a decade inventing a new drug when the cure might already be sitting on a pharmacy shelf, or in a molecule AI designs from scratch in seconds?

11/22/2025

The future of healthcare is arriving far faster than anyone expected.
AI systems are now outperforming clinicians in cognitive tasks, matching humans in empathy studies, and advancing into physical domains once thought untouchable.

This isn’t sci-fi, it’s already showing up in our clinics, our workflows, and even in the questions patients bring to their appointments.

So what happens when care becomes radically safer, faster, and cheaper… while the workforce that delivers it starts to shrink?

I break down the true paradox of AI in healthcare, the part no one is willing to say out loud, in my new Substack essay:

Introduction

11/18/2025

National data continue to show that outcomes after pancreatic cancer surgery depend as much on institutional experience and rescue capacity as on the technical skill of any individual surgeon. In a recent analysis of more than 63,000 patients, postoperative mortality at lower-volume hospitals was nearly twice as high as at high-volume centers. These differences are driven by the entire care ecosystem, including multidisciplinary readiness, rapid complication recognition, dedicated anesthesia teams, advanced critical care, interventional radiology, and vascular backup, which are difficult to replicate outside the highest-volume programs.

This reality has shaped my interpretation of these studies due to my own family's experience.

My father underwent his Whipple at what would be considered a higher-volume regional center with a hepatobiliary surgeon, a center that performed more pancreatic operations than most community hospitals. But it was still not an ultra–high-volume center like Mayo or MD Anderson, where teams manage Whipple-related complications every single week with well-rehearsed rescue pathways.

When a major intraoperative complication occurred, the response reflected that difference.

I had asked beforehand whether a vascular team would be immediately available if complications arose, and was reassured that the team was “experienced in vascular repairs.” But when the complication unfolded, the institutional depth simply wasn’t there. A major vein was removed in an attempt to manage the crisis, a decision that led to catastrophic bowel ischemia and ultimately his death.

The lesson is broader than vascular events.

Pancreatic surgery carries risks of hemorrhage, pancreatic fistula, sepsis, abscess, anastomotic leakage, hemodynamic collapse, and the ability to rescue patients from these inevitable complications is what separates ultra–high-volume centers from every other category. It’s not about the talent of an individual surgeon; it is about the institutional ecosystem built around them.

The evidence and the lived experience align:
For complex pancreatic cancer operations, centralization to the highest-volume centers remains one of the most important, life-preserving decisions patients can make.

Even regional “higher-volume” centers cannot always match the rescue capacity, repetition, and team-based preparedness of the true national referral centers.

Many pancreatic cancer resections are done at low-volume centers, with high mortality rates and shorter long-term survival. Minority and low-income patients are particularly affected.

11/14/2025

🚴‍♂️ Finished a HIIT bike session this AM and here’s why it matters beyond fitness.

A new study published in Breast Cancer Research and Treatment (https://link.springer.com/article/10.1007/s10549-025-07772-w) looked at breast-cancer survivors and found something compelling: a single bout of high-intensity interval training (HIIT) or resistance training significantly increased anti-cancer myokines (muscle-secreted proteins) and reduced the growth of a breast-cancer cell line by about 20–30%.

More about HIIT: https://en.wikipedia.org/wiki/High-intensity_interval_training

Here are the key takeaways:

📍 Myokines surged 9–47% after a single workout.
📍 Cancer-cell growth in vitro dropped 19–29% after HIIT and ~20–21% after resistance training, with HIIT showing the strongest immediate effect.

The study applied just one 45-minute session of RT or HIIT to 32 breast-cancer survivors (16 per group) and measured blood samples before exercise, immediately after, and 30 minutes later.

A quick explanation of the “in vitro” part (in simple terms):

Researchers didn’t test exercise on real tumors. Instead, they:
1. had survivors do a HIIT workout,
2. took their blood before and after, and
3. put that blood on breast-cancer cells growing in a lab dish.

Blood collected after HIIT slowed cancer-cell growth by up to 30% in this controlled lab model.
This doesn’t mean HIIT directly shrinks tumors in the body, but it does show that exercise immediately changes your blood chemistry in ways that make cancer cells less likely to grow.

So when you finish a HIIT session, know that it’s more than just sweat and speed, you’re activating muscle as medicine. Even short, intense sessions can trigger biological processes that may help create a physiology less hospitable to cancer.

If you’ve been asking how exercise “actually fights cancer” instead of just “helps you get in shape,” this is one of the clearest mechanistic links we have.

11/13/2025

I was truly honored to serve as the guest speaker this evening at the American Cancer Society’s Hope & Honors — A Night to Remember.

This remarkable group of donors came together with one shared purpose: to support patients and families facing cancer. Their generosity raised an incredible $300,000 for the ACS. Seeing that level of commitment and compassion in one room was inspiring. 🙌🏻

Grateful for the opportunity to speak, to share stories of hope, and to witness the power of a community that refuses to stand still in the fight against cancer.

11/11/2025

It’s Dark, Cold, and Early… Move Anyway (or Whenever You Can).

This morning I was up at 4:00 a.m. — coffee, a 45-minute workout, shower, and off to clinic. And yes, it’s actually cold here in Florida — the kind of rare “30s” cold where the weather alerts warn about iguanas falling out of trees. (See my comment below for our weatherman post on the iguanas 🦎)

Now, I don’t get up early because I enjoy it — I do it because if I wait until the end of the day, it just won’t happen. But that’s me. You don’t need to be a 4 a.m. workout person. The best time to exercise is whenever it actually fits your life.

You can break it up — a 10-minute walk after each meal, a few sets of squats or push-ups between meetings, a brisk bike ride with the kids, or resistance bands at home. It all adds up. You don’t need a fancy gym, and you don’t have to do it every single day. Consistency over time is what counts.

Here’s what the science says:
• 150–300 minutes of moderate aerobic exercise per week (or 75–150 minutes of vigorous activity) lowers your risk of cardiovascular disease and early death by 25–30%.
• Add two strength-training sessions per week, and your risk of death from any cause drops another 10–20% — including lower rates of heart disease, cancer, and diabetes.
• Regular movement keeps your brain sharp and lowers dementia risk, even if you’re just walking most days.
• And on a cellular level, exercise reduces inflammation, strengthens your immune system, improves insulin sensitivity, and helps preserve muscle mass and metabolism as you age.

You don’t have to be perfect — just consistent. You don’t need a gym — just gravity. And you don’t need to do it all at once — just move a little more, a little often.

So tomorrow, when it’s dark and you’re tempted to hit snooze, or later in the day when you finally have 10 free minutes — take them. Move your body. Your heart, brain, and future self will thank you.
(And if you’re in Florida… watch out for falling iguanas on the way.)

11/10/2025

No. We’re not related. 😜

To the Wallenda Family, thank you for making Sarasota your home.
Nick Wallenda starting his world record walk, with his sister, at UTC on 11.6.25. Photo: Eilyn, thank you!

11/10/2025

A few months ago we got big news in breast cancer care: smarter, not harsher

A major 2025 study in The New England Journal of Medicine called NSABP B-51 is changing how doctors think about radiation after chemotherapy.

For years, anyone whose breast cancer had spread to lymph nodes was almost certain to need radiation after surgery. But this new study found that some people whose chemotherapy completely cleared their lymph nodes might not need radiation if they meet very specific medical criteria.

This is not a “no more radiation” story. It is a sign that care is becoming more personalized and precise. The goal is to tailor treatment to each individual, reducing side effects for some while maintaining excellent outcomes for all.

It is a big step forward in creating more compassionate, evidence-based cancer care that uses radiation only when it truly helps.

Learn what this means for patients in 2025 👇
🔗

My two cents

11/08/2025

You may have heard recent news headlines indicating that there's no benefit for radiation therapy after mastectomy. These headlines have sensationalized a recent study called SUPREMO, which looked at the use of radiation therapy after mastectomy in a particular population of breast cancer patients investigating whether there would be a benefit with or without radiation therapy after mastectomy.

These are my two cents, and why I think the study does not change the standard of care for patients who still have a risk that is not insignificant of additional metastatic disease within the axillary lymph nodes.

My two cents.

11/05/2025

Everyone wants a magic pill 💊 to lower cancer risks and improve cancer outcomes. If exercise was an anticancer drug it would be worth $$ Billions.