Biologically informed ovarian cancer prevention: Promoting education and awareness



  • Shaina Lee
    University of British Columbia

Over 11 percent of cancers and 9 percent of cancer deaths in women are from reproductive cancers. This represents a substantial disease burden; however, public dialogue levels and research funding doesn’t reflect this. Breast cancer, which has more public awareness, received 60 percent higher investment between 2005 and 2014 in research compared to reproductive cancers on a per case basis; this gap is even greater when comparison is based on cancer-related deaths. This team will create knowledge dissemination tools focusing on reproductive cancer prevention, to raise public awareness, and start a discussion about reproductive cancers. Public education could improve outcomes and lead to a national focus and investment in clinical care and research on reproductive cancers.

Prevention initiatives could reduce 1/4 of the 12,000 reproductive cancers that occur in Canada each year. Videos will be created and aimed at the target audience (women who can benefit from prevention), focused on three areas:

  1. Opportunistic salpingectomy (removal of fallopian tubes during hysterectomy or other pelvic surgery) to prevent ovarian cancer.
  2. Cervical cancer screening and prevention.
  3. Genetic testing for inherited risk factors.

These will be short, animated videos, less than three minutes, and succinctly describe the preventive strategy and current state of research. They will be posted on the OVCARE (BC’s multidisciplinary research group focusing on reproductive cancers) website ( and linked through other outlets (other websites and online news sites, social media). A parallel set of videos will be created to convey the same information but designed for selected patient waiting areas and silenced to minimize disruption. Once created, these videos can be used at speaking events, fundraising events, and other venues. Along with inadequate funding for prevention research, participation in prevention activities has been identified as a barrier to uptake of prevention strategies. Education is one strategy to increase uptake.

This team has a strong track record of successful educational campaigns, informing clinicians and the public about opportunistic salpingectomy in 2010, and more recently to inform health care providers about new molecular stratification of endometrial cancers. It is hoped that this initiative will increase uptake of prevention activities and lead to greater public awareness of reproductive cancers.

Molecular classification for stratification and improved clinical management of endometrial cancers

In the current landscape of endometrial cancers (ECs), there is a shortfall in the management, treatment and evaluation of EC patients. Treatment tends to not be standardized, patients are commonly over- or under-treated, and diverse ECs are grouped together in clinical trials. Because of this inconsistency in diagnosis, it is difficult, if not impossible, to properly assess and compare how different treatments work.

In response to this gap, Dr. McAlpine has developed a molecular-based classifier called "ProMiSE” –  Proactive Molecular Risk Classifier for Endometrial Cancer, which assigns EC patients to one of four prognostic groups. This classification would greatly improve the reproducibility and reliability of pathological diagnoses of endometrial tumours. The tool can be used to help categorize ECs into different risk classes to help guide surgery, treatment and surveillance based on the molecular features of the individual cancer. It can also identify women who may have inherited conditions placing them at increased risk of other cancers.

The next step for ProMisE is making the tool available across Canada. Although it is low cost and uses methods familiar to pathology laboratories, one of the testing components is currently unobtainable outside of a research lab setting. Dr. McAlpine is currently working with a Vancouver-based company to acquire, add and test this component in order to make ProMisE widely available.

Then, collaborating with eight other cancer centres across Canada, Dr. McAlpine will collect EC data, classify the data with ProMisE, and compare the treatment given with how molecular classification would have directed care.

This study is the last step in bringing this new molecular test to clinical use. With access to ProMisE, not only will there be immediate changes to how women with EC are managed, but it will allow the design of new studies to define the best, most personalized therapies for every woman with EC.

Assessment of breast cancer and response to systemic therapy before surgery using diffuse optical imaging technology

Breast cancer is the most common cancer in women. Patients with large breast tumour or palpable lymph nodes often receive chemotherapy first, followed by surgery. During chemotherapy, a doctor performs serial breast exams and occasional imaging to monitor tumour shrinkage, but this is not good enough to capture shrinkage accurately. It is important to develop a better way to measure breast cancer response on chemotherapy before surgery, as it can predict outcomes and change treatment plans.

Diffuse Optical Imaging (DOI) takes advantage of different light scatter properties in different biological tissues (for example, normal tissue, cavities, cancer and blood have different scatter properties in infrared spectrum). Our team has developed a hand-held DOI-Scan probe (optical probe) which has shown promising preliminary findings in patients without prior diagnosis of breast cancer. 

We will use this real-time, easy-to-use, point-of-care imaging tool to examine normal breast and breast tumour characteristics in patients with locally advanced early breast cancer prior to and after each cycle of systemic therapy, alongside serial breast examinations and ultrasound imaging, to see how breast cancer appears and responds to chemotherapy given before curative surgery. The results will be compared with the final surgical specimen and patient outcomes.