Evaluative Clinical Sciences

Education:

• 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

Research Foci:

• Screening women at very high risk for hereditary breast cancer
• Women aged 40 years and under with breast cancer

Research Summary:

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. Based on these results, in 2011 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. The goal over the next year is to present and publish the long-term recurrence and survival outcome of the women diagnosed with breast cancer during the study screening period from 1997 to 2009.

Dr. Warner recently published a retrospective study that showed a very promising role for screening MRI for women with dense breasts 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, in March 2008 Dr. Warner launched 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.

Related research includes a study co-led by Dr. Kasia Jerzak, in collaboration with investigators in Europe, of the clinical and biological features of pregnancy-associated and postpartum breast cancer. 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.

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 is prospectively collecting 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 by their surgical team 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.

Dr. Warner is 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.

Selected Publications:

See current publications list at PubMed.

Related News and Stories:

• Exercise can help reduce risk of breast cancer recurrence (Feb. 21, 2017)
• 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 (SRI 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)

Related Links:

• Centre for Research in Image-Guided Therapeutics
• RUBY research team, Women’s College Research Institute
• Young women with breast cancer PYNK program, Sunnybrook