I am a Scientist at the Women’s College Research Institute, Women’s College Hospital within the Familial Breast Cancer Research Unit. I am an Associate Professor at the Dalla Lana School of Public Health and Department of Nutritional Sciences, University of Toronto, and I hold the Cancer Care Ontario Research Chair in Population Studies.
What inspired your interest in prevention of inherited BRCA cancers?
As a graduate student, I was interested in nutritional and other modifiable factors, and whether they might be effective in reducing risk for cancer. I was fortunate to conduct my PhD studies under the supervision of Dr. Steven Narod and his very strong team at the Women’s College Hospital and University of Toronto. In 1995, Dr. Narod established what is now the largest international database of BRCA mutation carriers, which includes extensive information on over 18,000 women with an inherited BRCA mutation. These participants are contacted every two years by questionnaire to collect up-to-date information that relates to the various research studies being conducted. More than 70 collaborators from around the world contribute to this database, allowing our team to conduct well-powered analyses to evaluate various factors that may influence the risk of developing BRCA-associated cancer or dying of the disease. Given that screening for ovarian cancer has not proven to be effective, and since prophylactic surgeries are invasive and, after all, a difficult choice for many at-risk women to make, it became obvious to me that alternative but still highly effective preventative options were critically needed. I became interested in identifying other factors that could help in the management of “previvors.” Given my interest in finding new preventative options which could have a very significant impact on the quality of life and survival of those at highest risk, working with HeritX was a natural fit. I find this work intellectually exciting and enjoy working on a project that could reduce the burden of cancer for those at highest risk in such a significant way.
What is the goal of your research and how would you describe its scope to a layperson?
Although we know that surgical prevention is currently the most effective way to prevent BRCA-associated breast and ovarian cancers, my research focuses on furthering our understanding of what factors influence the risk of BRCA cancer including reproductive factors, exogenous hormone use, such as hormone replacement and oral contraceptives, as well as the role of obesity. We evaluate their impact on cancer risk in this high-risk population to help with evidence-based, informed decision-making regarding risk management. My more recent interests include understanding what is dysregulated in women with a mutation and whether we can target consequences of an inherited mutation to help identify novel targets for prevention. The long-term goal is to identify highly effective, non-surgical prevention strategies to improve upon the options currently available for women at a high risk, and ultimately, to reduce the incidence of cancer in BRCA carriers, as well as to improve outcomes for those who do develop cancer. Other studies I am working on include the evaluation of genetic markers in the blood and whether they can predict risk or recurrence. This is particularly important for the early diagnosis of ovarian cancer, which currently does not have effective screening options. Our group is also interested in evaluating health outcomes among women undergoing preventive removal of the ovaries so that we can provide better management strategies to avoid negative consequences of early surgical menopause.
Where were you trained and what was your thesis research?
I pursued my undergraduate and graduate studies at the University of Toronto and received my PhD in 2007 from the Department of Nutritional Sciences. For my thesis project, I evaluated whether markers that reflect DNA repair capacity differed between women with and without a BRCA mutation and whether these markers of DNA repair could be influenced by exogenous factors including diet – with the goal of identifying factors which might lead to new and improved interventions.
I conducted my post-doctoral research training at the Brigham and Women’s Hospital/Harvard Medical School in Boston where I was involved in various studies evaluating risk factors for breast and ovarian cancer using data and samples from the well-known Nurses’ Health Studies.
Who do you collaborate with on BRCA cancer prevention research?
My closest collaborators include the three other scientists that make up our team in Toronto: Drs. Steven Narod, Kelly Metcalfe and Mohammad Akbari. We also work closely with our numerous collaborators from around the world who make up the “Hereditary Breast Cancer Clinical Study Group.” It includes a large and diverse group of researchers, genetic counselors, clinicians and talented individuals from other disciplines who contribute data and expertise to help strengthen the research studies we conduct surrounding the optimal management of BRCA mutation carriers. I am excited to join the HeritX International Coalition to Prevent Inherited Cancer. because Tthe work being done by this diverse and dedicated group is focused on novel ways to prevent all types of BRCA cancers, which dovetails nicely with my own research interests.
How is your research funded?
My work is funded by various agencies such as the Canadian Breast Cancer Foundation, the Canadian Institute for Health Research (the Canadian equivalent of the NIH), and the Canadian Cancer Society Research Institute, as well as private donors and grateful patients.
What would you like to accomplish in the next five years?
My goal is to help identify less invasive prevention options for high-risk women.
Are you involved in clinical work and/or teaching as well?
I am not a clinician; however, I am involved in educational efforts such as symposia for healthcare providers, genetic counselors, patients, families, and even healthy individuals. I am actively involved in teaching and mentoring students at the undergraduate and graduate level at the University of Toronto.
How will preventing inherited BRCA cancers affect children and families?
If you know your family history, access genetic testing and identify a cancer-causing mutation, you can significantly reduce your risk of dying of breast and especially ovarian cancer. If we could identify everyone at risk and offer them access to high-quality preventive services, fewer children would lose their mothers and more women would be alive to lead happy and healthy lives with their children.
How did you first hear about HeritX and how have you interacted with the organization?
I first heard about HeritX when Dr. Thomas Bock was developing the idea and came to see Dr. Narod … the two teams had an immediate rapport because of our common goals. I was subsequently invited to the meeting at the Banbury Center and have participated in various ways since – through conference calls, teleconferences and face-to-face meetings. I’m very excited to be a part of this important initiative!
How do you like working with the HeritX team?
I enjoy working with the HeritX team because our group and HeritX have the same goal – prevention of BRCA-related cancers. Like us, HeritX is proactive and collaborative. In particular, we are anxious to start getting answers sooner rather than later, and we all understand the importance of focusing on prevention, but science is slow. It’s important to work together and to exploit the strengths of the various groups. HeritX is doing a great job of bringing scientists with different skills together to focus on this important goal.
In your view, what is the impact that HeritX is making? How can they help your work advance faster?
HeritX has identified key players with relevant expertise, and has committed to specific projects that will have an impact on all women and men with BRCA mutations and on all cancers (including pancreatic, prostate, melanoma, etc.) associated with BRCA. HeritX has been very supportive and wants to help fund some of our ideas.