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 Health Sciences Centre 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 magnetic resonance imaging (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 specifically 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, Toronto-Sunnybrook Regional 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 magnetic resonance imaging (MRI) to the former gold standard of mammography for screening 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, which Dr. Warner’s team will be helping evaluate.
In response to the evidence for the unique tumour biology, clinical and psychosocial needs of young women with breast cancer, Dr. Warner launched (March 2008) an interdisciplinary clinical and research program for these women in which over 150 women have enrolled. A database for the program has been developed, which will incorporate clinical, pathological, epidemiological and psychological data. This database (as well as one for the patients in the MRI study mentioned above) will be incorporated into a data “biomatrix,” which will combine clinical, pathology and imaging data. The Canada Foundation for Innovation has funded this project on which Dr. Warner is a co-investigator. Blood and tissue specimens will be collected from each woman for future study.
Related research includes a randomized controlled trial of group therapy and imaging for breast cancer survivors with significant disturbance of body image; a study of factors predictive of local recurrence in women aged under 35 years who have had breast conservation; and the development of a web-based education program for young women recently diagnosed with breast cancer and their partners. Dr. Warner is also 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.
Related News and Stories:
- 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)
- Spotlight on breast cancer research: screening for breast cancer: an exposé: A feature from Sunnybrook Research Institute Research Report 2002–2004