February 23, 2026
Dr. Jonathan Freberg is the Director of the Wilmot Cancer Institute at the University of Rochester — a practicing oncologist, a lymphoma specialist, and the leader of one of the most significant achievements in Rochester's medical history: earning National Cancer Institute designation. In this conversation with hosts Mark Southwick and Corey Moran, Dr. Freberg traces his journey from political science major in Wisconsin to the front lines of cancer research, explains what the NCI designation means for patients across the region, and shares why he believes we are living through the most exciting era in cancer medicine.
Dr. Freberg grew up in the Milwaukee area of Wisconsin with a passion for politics. He majored in political science in college, volunteered on a state assembly campaign, and spent a summer working as an assembly messenger on the floor of the Wisconsin State Capitol. He expected to pursue a career in policy or government. Then he took a required biology course.
His father is a physician, which he acknowledges played a role in the background. But it was that single biology lecture that redirected the arc of his career. Today, he notes with some amusement, his role as cancer center director involves a great deal of the political skills he developed in Wisconsin — lobbying Congress, building coalitions, crafting messaging, and navigating the internal politics of a major academic medical center.
The National Cancer Institute designation program was established in the 1970s under President Nixon's declaration of a war on cancer. The goal was to distribute cancer research and care capacity beyond the NCI itself, creating a network of designated centers across the country. Today, 73 centers hold NCI designation, of which roughly 60 see patients and function as comprehensive cancer centers. Those 60 centers receive 85 percent of all cancer research funding in the United States.
Earning that designation for Wilmot took eight years and two full application cycles. Each application ran approximately 1,400 pages. A site visit team from the NCI and leaders from other designated cancer centers spent two full days at the University of Rochester evaluating research impact, community outreach, clinical trials infrastructure, physical space, and institutional commitment. The designation was awarded in March of last year.
The designation comes with $10 million in research infrastructure support, but Dr. Freberg is clear that the financial benefit alone does not justify the investment required to prepare. The real value lies in the ability to recruit top researchers who would not have come otherwise, participation in national clinical trial consortia, and a seat at the table where decisions about the entire cancer enterprise in the United States are made.
One of the most striking elements of Wilmot's NCI application was the definition of its catchment area: 27 counties in central and western New York, stretching east to Utica and south to the Pennsylvania border. That region encompasses approximately three million people — larger than many U.S. states and covering more land area than Vermont and New Hampshire combined.
Within that catchment area, Wilmot serves a population with the third-highest cancer incidence rate in the country, behind only Roswell Park in Buffalo and a center in Kentucky. Twelve of the 27 counties are federally designated as part of Appalachia, with high rates of rural poverty, smoking, sedentary lifestyle, and an aging population — all known drivers of cancer incidence. In nine of the top ten cancers, the region's incidence rate exceeds both state and national averages.
Dr. Freberg is unambiguously optimistic about the current state of cancer medicine. Since the peak cancer mortality rate in 1992 — the year he was in medical school — cancer mortality in the United States has dropped by 35 percent. Today, 70 percent of people diagnosed with cancer will live at least five years, and many of those patients may be definitively cured. He identifies four major drivers of that progress.
The first is immunotherapy: the discovery that the patient's own immune system can be retooled to fight cancer, replacing or supplementing traditional chemotherapy. The example he cites is melanoma — former President Jimmy Carter was treated with immunotherapy for brain metastases that would previously have been expected to cause death within weeks to months. He lived for years.
The second is precision medicine: the recognition that cancers bearing the same name are often entirely different diseases at the molecular level. By sequencing a tumor's mutations and targeting specific genetic abnormalities with tailored drugs, oncologists can achieve response rates that would have been invisible in broad population studies. The ALK mutation in lung cancer is a paradigmatic example — a drug that targets only ALK-mutated tumors produces dramatic results in that subgroup, even though it appears ineffective when tested across all lung cancer patients.
The third is screening and prevention, including reduced smoking rates and improved early detection protocols. The fourth, often underappreciated, is supportive care: the holistic management of side effects, exercise, sleep, nutrition, and psychological support that allows patients to tolerate and benefit from treatment. The University of Rochester is one of only two academic medical centers in the country with a large grant to study supportive care interventions in cancer.
One of the most remarkable research programs at Wilmot focuses on the relationship between aging and cancer. Researchers at the University of Rochester have spent decades studying long-lived mammals that do not develop cancer, asking what biological mechanisms protect them. The naked mole rat, which can live 20 to 30 years in the wild — far longer than the typical mouse lifespan of a couple of years — cannot be induced to develop cancer even under laboratory conditions. Compounds discovered in the naked mole rat are now being considered for human trials.
More recently, the same team has turned its attention to the bowhead whale, which can live more than 200 years. Researchers established the whale's extraordinary lifespan in part by finding pieces of a 19th-century harpoon lodged in a specimen that had died on land. Through a relationship with the Inuit population in Alaska, who are permitted to harvest whales, the team has obtained specimens and published novel discoveries this year that may have applications for human cancer prevention.
Looking ahead, Dr. Freberg points to cellular therapies — particularly CAR T-cell treatment — as one of the most transformative developments on the horizon. The process involves extracting a patient's immune cells, genetically engineering them in the laboratory to recognize and attack cancer, and reinfusing them as what he calls a living drug. Those engineered cells can persist in the body indefinitely, providing ongoing surveillance against recurrence.
The technology, which shares principles with CRISPR gene editing, has transformed the management of blood cancers and is now being studied in solid tumors. Dr. Freberg also addresses the role of artificial intelligence in oncology — from ambient AI that generates clinical notes during patient visits, to decision-support tools that help synthesize complex mutation analyses and clinical literature. He embraces the concept of the Centaur: the combination of human intuition, empathy, and moral judgment with the pattern-recognition speed and encyclopedic recall of AI systems.
The Pluta Cancer Center joined the Wilmot network approximately a dozen years ago, and the Pluta Foundation has since invested significantly in integrative oncology — the supportive services, yoga, exercise programs, dietary counseling, and psychological support that make the cancer experience more bearable and, research suggests, improve outcomes. Many of those services are provided to patients at no cost, funded by the foundation.
Dr. Freberg also speaks candidly about the personal weight of delivering difficult news — a role he describes as a privilege, not a burden. His specialty in lymphoma means that a large proportion of his patients can either live for many years with their disease or be cured outright. But the conversations that stay with him most are the ones where he has had to help patients and families navigate the end of life with dignity and without suffering.
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