Scientist profiles S-Z
Sunnybrook Health Sciences Centre
2075 Bayview Ave., Room T2 053
Note: Dr. Warner is not accepting summer student applications at this time.
Clinical ProfileShow/hide details
Administrative Assistant: Michelle Kuzmich
Dr. Warner is a professor of medicine at the University of Toronto and a staff medical oncologist at the Odette Cancer Centre at Sunnybrook since 1993. Her practice and research is devoted to breast cancer. In 1994, she created a program for hereditary breast and ovarian cancer patients, which introduced genetic counselling and testing to the Odette Cancer Centre. Since 1997 she has led a study to explore the role of MRI in screening women with an inherited predisposition to develop breast cancer. This research helped make annual MRI surveillance the standard of care for this very high-risk population and led to the development of the high-risk Ontario breast screening program. Since 2011 the program has offered annual MRI and mammography to women at very high risk for breast cancer between ages 30 and 70.
In addition, Dr. Warner is the creator and director of PYNK: Breast Cancer Program for Young Women. Launched in 2008, it is the only interdisciplinary clinical and research program in Canada for breast cancer patients diagnosed at age 40 or younger. PYNK addresses the special medical and psychosocial needs of this population and offers these women enrolment in studies focusing on women in this age group. Several members of the PYNK team play a leadership role in the pan-Canadian research program RUBY (reducing the burden of breast cancer in young women). Sunnybrook is one of the 29 Canadian RUBY sites that began enrolling young breast cancer patients in 2015.
Research ProfileShow/hide details
Administrative Assistant: Michelle Kuzmich
- MD, 1980, University of Toronto, Canada
- FRCPC, 1984, internal medicine, Royal College of Physicians and Surgeons of Canada, Canada
- Diplomate, 1986, American Board of Internal Medicine, U.S.
- Certificate of Special Competence, 1987, medical oncology, Royal College of Physicians and Surgeons, Canada
- Specialist, 1988, medical and radiation oncology, Israel Medical Association, Israel
- FACP, 1990, American College of Physicians, U.S.
- M.Sc., 1995, clinical epidemiology, U of T, Canada
Appointments and Affiliations:
- Affiliate scientist, Evaluative Clinical Sciences, Odette Cancer Research Program, Sunnybrook Research Institute
- Professor, department of medicine, U of T
- Medical oncologist, Odette Cancer Centre
- Consulting staff, department of clinical genetics, North York General Hospital
- Screening women at very high risk for hereditary breast cancer
- Women aged 40 years and under with breast cancer
Women with an inherited predisposition to breast cancer (BRCA1 or BRCA2 mutation carriers) have up to an 85% lifetime risk of developing this disease, with most of the cancers developing before age 65. Since prophylactic mastectomy (surgical removal of both breasts) is unacceptable to most of these women, and preventive drugs such as tamoxifen are only partly effective, careful screening for early, curable cancer is essential. In a study in which Dr. Warner's team added yearly MRI to the former gold standard of mammography for screening of 496 of these women, MRI detected almost three times as many cancers as mammography, with only one interval cancer. They also found that the cancer stage of tumours detected in this study was much lower than the cancer stage of a cohort of similar women screened with mammography alone.
The goal is to follow women in both cohorts to prove that high-risk women screened with MRI are less likely to die of breast cancer. In the meantime, breast MRI screening of high-risk women (including but not restricted to women with BRCA mutations) has been incorporated into the Ontario Breast Screening Program. Dr. Warner is leading a retrospective study on the role of screening MRI for women with dense breasts and those who have had a previous breast cancer or pre-cancer.
In response to the evidence for the unique tumour biology, clinical and psychosocial needs of young women with breast cancer, Dr. Warner launched in March 2008 an interdisciplinary clinical and research program for these women in which over 250 women have enrolled. A database for the program incorporates clinical, epidemiological and psychological data. Blood (serum and buffy coat) have also been stored on each consenting patient. The data for the MRI study mentioned above has been incorporated into Sunnybrook’s data biomatrix, led by Dr. Martin Yaffe, which will combine clinical, pathology and imaging data.
In 2014, inspired in part by the PYNK model, the Canadian Institutes of Health Research and the Canadian Breast Cancer Foundation funded RUBY (reducing the burden of breast cancer in young women). The Canada-wide study will prospectively collect clinical data, patient-reported outcomes, blood and tissue from 1,200 women aged 40 and younger who are newly diagnosed with breast cancer at 29 sites across the country. Dr. Warner is a co-investigator of RUBY and principal investigator of the two fertility sub-projects of RUBY, known as SPOKE (surgeon and patient oncofertility knowledge enhancement) and GYPSY (giving young women with breast cancer predictors of sterility after chemotherapy). SPOKE aims to increase early referrals for fertility preservation of young women newly diagnosed with breast cancer. GYPSY will help identify which young women may not need to undergo the discomfort and expense of fertility preservation, and predict which women with chemotherapy-induced amenorrhea will not have resumption of ovarian function.
Additional RUBY sub-projects are focused on the following:
- novel inherited genetic mutations that may cause breast cancer
- effect of lifestyle factors on breast cancer outcome
- standardization of care and quality assurance
- outcome of breast conservation therapy.
Related research includes a study of the clinical and biological features of pregnancy-associated breast cancer and a web-based education program for young women recently diagnosed with breast cancer and their partners. Dr. Warner is collaborating with Dr. Ann Partridge at Harvard University, a leader in this field, to study biological differences in breast cancers of young women of various ethnicities. She is also working with Dr. Irina Nulman, a neurologist at the Hospital for Sick Children, to study the neurocognitive function of children exposed to chemotherapy in utero for treatment of their mother’s breast cancer.
Dr. Warner is also the Canadian principal investigator of the international POSITIVE trial, which aims to determine the safety of interrupting adjuvant hormonal therapy for breast cancer patients who wish to get pregnant.
Related News and Stories:
- Angel nannies ‘bring some humanity’ for mothers coping with cancer (CBC News, June 9, 2013)
- Screen this: Research mounts that magnetic resonance imaging is the best way to detect breast cancer in women at high risk of the disease (PDF from Sunnybrook Research Institute Magazine 2011)
- Breast cancer program for young women first of its kind: Much-needed program launched for women at the busiest life-stage (Nov. 20, 2008)
- Staying abreast: SRI scientist taking strides toward understanding the value of MRI in breast cancer research (Sept. 19, 2007)