Breast Cancer

�鶹��Ƶ grad and her prof share a research history that spans provinces

Christopher.Sorensen — Tue, 08 Nov 2022 16:26:42 +0000

�鶹��Ƶ grad and her prof share a research history that spans provinces

Christopher.Sorensen Tue, 11/08/2022 - 11:26

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Julia Rickard, left, who graduates with a master's degree this week, first met Assistant Professor Amy Kirkham, right, when they were at the University of Alberta (photo courtesy of Julia Rickard)

Jelena Damjanovic

Topic

Our Community

Convocation 2022

Graduate Stories

Breast Cancer

Faculty of Kinesiology & Physical Education

Graduate Students

Julia Rickard was the very first student to join Amy Kirkham’s lab at the University of Toronto – and this week, she became the first student to graduate from it, too.

The pair first ran into each other at the University of Alberta, where Rickard was wrapping up a bachelor of science degree in kinesiology and Kirkham was pursuing her post-doctoral research. After completing a practicum under Kirkham’s supervision, Rickard followed Kirkham to �鶹��Ƶ, where Kirkham had accepted the position of assistant professor in the Faculty of Kinesiology and Physical Education (KPE).

She says being part of Kirkham’s �鶹��Ƶ lab was an eye-opening experience.

“I came in with a mainly breast cancer, cardiovascular disease and exercise background, but projects in the Kirkham lab cover a wide range of different populations with chronic disease, lifestyle behaviours, interventions and data collection techniques,” says Rickard, who earned a master of science degree in kinesiology from �鶹��Ƶ. “Everyone has a different perspective and expertise to bring to the table, which makes for some very interesting and cutting-edge projects.”

For her thesis project, Rickard looked at the relationship between a history of breast cancer and the role of lifestyle behaviours such as physical activity, diet and smoking in risk of cardiovascular disease in women.

Using data from an existing database, Rickard’s research project led to two major findings.

The first was that the Framingham Risk Score, a common clinical tool used by physicians worldwide to estimate a patient’s cardiovascular disease risk, significantly underestimated the actual cardiovascular disease risk in breast cancer survivors. “We found that the Framingham Risk Score did not predict different levels of risk among breast cancer survivors and women without cancer, but the breast cancer survivors experienced significantly more cardiovascular disease events, including death, over the following 13 years,” says Rickard.

The second finding was that the role of physical activity, diet and smoking in risk of cardiovascular disease events was the same in all women, regardless of whether they had a prior breast cancer diagnosis. Rickard’s research also showed that lifestyle behaviours were some of the strongest predictors of cardiovascular disease events in breast cancer survivors.

“Breast cancer is the most commonly diagnosed cancer in women worldwide and, due to improvements in both early detection and cancer treatment, the survival rate for early-stage breast cancer has improved by over 40 per cent in the last 40 years,” says Rickard. “However, this increase in survivorship has been accompanied by an increased awareness of the excess risk of cardiovascular disease in this population.

“Breast cancer survivors are at greater risk for cardiovascular disease at all time-points following their diagnosis compared to the general population.”

The findings from her thesis could have significant implications for cardiovascular disease risk management in breast cancer survivors in Canada and around the world.

“The results of my research show that lifestyle interventions focused on physical activity, diet and smoking cessation would likely be just as effective at reducing cardiovascular disease risk in breast cancer survivors as they are in women without cancer, and that they are important components of risk reduction beyond traditional medical management,” says Rickard.

“They also show that the Framingham Risk Score is not an accurate tool in this population and breast cancer survivors are at a higher risk for cardiovascular disease than predicted.”

The implication is that some survivors at high risk are missing out on receiving adequate cardiovascular risk management care, something that Rickard is hoping to rectify by working with Kirkham on an adjustment to the Framingham Risk Tool that can be used by physicians to more accurately predict cardiovascular disease risk in women who have had breast cancer.

Kirkham says she is incredibly proud of Rickard’s accomplishments, especially given all the ups-and-downs of trying to do in-person research during the COVID-19 pandemic and then having to pivot to an entirely new thesis project requiring advanced statistical modelling techniques.

“Thanks to her persistence and adaptability, Julia’s master’s thesis is not only complete, but will be an exceptional contribution to the literature,” she says. “I am continually impressed by the passion and determination of the trainees who join my lab, and it’s a huge part of my daily motivation.”

As she works on publishing her thesis results, Rickard is enjoying having a little more free time.

“I’m not sure what’s to come but I know it will be focused on health promotion and chronic disease prevention,” she says.

Genetic testing is important for women with breast cancer, expert says

Christopher.Sorensen — Mon, 31 Oct 2022 18:19:10 +0000

Genetic testing is important for women with breast cancer, expert says

Christopher.Sorensen Mon, 10/31/2022 - 14:19

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(Photo by fstop123/Getty Images)

Topic

Lawrence S. Bloomberg Faculty of Nursing

Women's College Hospital

For close to two decades Professor Kelly Metcalfe, a senior scientist at Women’s College Research Institute and associate dean of research at the University of Toronto’s Lawrence S. Bloomberg Faculty of Nursing, has explored better treatment paths for women diagnosed with breast cancer – specifically those with the BRCA1 and BRCA2 genetic mutation.

Helping women at this vulnerable stage in their cancer journey navigate their treatment options, which can include decisions about undergoing breast conserving surgery or double mastectomy, has a significant impact on their psychosocial well-being and their rates of survival. To make a well-informed decision, Metcalfe says women need to understand their options and what she calls their “genetic status.”

“Most women who receive a breast cancer diagnosis are not aware that they have a genetic mutation,” says Metcalfe of the need for broader access to genetic testing. “We know from previous evidence that those who do have the BRCA1 or BRCA2 mutation should receive different treatment for their cancer as it may impact their survival.”

Bloomberg Nursing’s Rebecca Biason recently spoke with Metcalfe about an alternate model of care using Direct Rapid Genetic Testing (DRGT) that she and her team are currently evaluating. Metcalfe also shares how her pilot study could help bring genetic testing and changes to treatment decisions to high-risk Canadians when they need it most.

What does this new model of care look like and how does it support a woman diagnosed with breast cancer?

This proposed alternate model of care sees women who have received a breast cancer diagnosis self-refer for Direct Rapid Genetic Testing, or DRGT. Following a brief phone conversation, they are sent an at-home saliva kit, they spit into a tube and they mail in their specimen. Results can be received within a week.

What makes this process more accessible is that women can conduct the test from the comfort of their homes and without having to first speak with a genetic counsellor. Instead, they are provided with access to virtual information, videos and counselling sessions that decrease the amount of time needed for them to make an informed decision about their surgical options. We are, in essence, revolutionizing the way we provide genetic testing to these women.

What are the benefits for a woman who is considered high-risk of having a genetic mutation?

In traditional models of care, genetic testing is provided through a genetic testing clinic. Generally, these clinics are located in large urban centres that can limit access for many Canadians. There are also a few more steps involved that can seem daunting for someone who has just been informed they have cancer. Patients are required to meet with genetic counsellor, pay for parking and meet with their surgeon and oncologist. It can make it difficult for someone to make decisions about their care plan.

Understanding your risk and genetic status is an important part of the treatment process. For the average woman with breast cancer, having a lumpectomy and radiation results in a similar survival rate for a woman who chooses to undergo a bilateral mastectomy. However, our research has shown that women with the BRCA 1 or BRCA 2 genetic mutation should have a bilateral mastectomy because it increases their rate of survival due to the high risk of developing a new breast cancer.

What’s next for this model of care?

We are currently in the evaluation phase and are testing this new model to make sure women are satisfied and that they understand the information they are receiving. We are also evaluating how better access to genetic testing impacts treatment decisions.

In our previous research – which focused on offering genetic testing at diagnosis but through a different process that included a blood test and meetings with a genetic counsellor – we were able to show that 80 per cent of women who were found to have a mutation did elect to have a bilateral mastectomy.

We have also found evidence that there is no negative psycho-social outcome for women by providing genetic testing at time of breast cancer diagnosis. The majority want to know.

With respect to our current trial and study, our hope is to be able to provide evidence to policymakers that this is an effective model to provision treatment at the time of breast cancer diagnosis. If it were up to me, every woman would have access and I need to see that change. But in order to make that a reality, we need evidence to support [the idea] that this model of care – and this change in how treatment decisions are made – would be beneficial to patients.

Percentage of breast cancer survivors in Canada doubles over past 15 years, study finds

Christopher.Sorensen — Thu, 27 Oct 2022 15:37:10 +0000

Percentage of breast cancer survivors in Canada doubles over past 15 years, study finds

Christopher.Sorensen Thu, 10/27/2022 - 11:37

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A study shows there are 2.5 times as many breast cancer survivors in Canada today as there were in 2007 – a success story that brings some new health challenges (photo by Boogich/Getty Images)

Topic

Faculty of Kinesiology & Physical Education

Rersearch & Innovation

It was the information she couldn’t find that led Amy Kirkham, an assistant professor in the University of Toronto’s Faculty of Kinesiology & Physical Education (KPE), to her latest discovery.

Asked by the Canadian Women’s Heart Health Alliance to co-author a scientific statement paper in 2020 on the state of women’s heart health in Canada, Kirkham - whose research is focused on preventing and treating the risk of heart disease related to breast cancer treatment – needed to know what percentage of the Canadian female population has a history of breast cancer.

But the most recent statistic she could find – one percent – was from 2007.

“Nearly 15 years had passed and I could not find a more recent citation about the prevalence of breast cancer survivors in Canada,” says Kirkham. “Breast cancer mortality rates had continued to improve 26 per cent over this time period, so I suspected that this number was no longer accurate.”

Amy Kirkham

So, in collaboration with Katarzyna Jerzak, a medical oncologist at Sunnybrook Odette Cancer Centre and assistant professor in the department of medicine in �鶹��Ƶ’s Temerty Faculty of Medicine, Kirkham embarked on a new study that would determine an up-to-date estimate of the prevalence of breast cancer survivors in Canada in 2022 using the Canadian Cancer Society’s annual cancer statistic reports.

The study, recently published in the Journal of the National Comprehensive Cancer Network, found that in the 15-year span from 2007 to 2021, there were 370,756 patients (2.1 per cent of the adult female population in Canada in 2022) diagnosed with breast cancer and 86 per cent of these women would have survived breast cancer by 2022.

“This indicates that the prevalence of breast cancer survivors in the Canadian female population has doubled and that there are 2.5 times more survivors since the last estimate in 2007,” says Kirkham.

The prior estimate did not include the age group of survivors, but according to the new estimate provided by Kirkham and Jerzak, breast cancer survivors represent one per cent of Canadian women in the typical working and/or child-raising age group (20 to 64 years) and 5.4 per cent of senior (aged 65-plus) Canadian women.

But it’s not all good news.

Many of the treatments that have improved breast cancer mortality rates also cause short-term and long-term side effects, which, in turn, can raise the risk of death from other causes such as heart disease, stroke, Alzheimer’s disease, liver disease and other non-fatal health outcomes.

“The most common cause of death in women with breast cancer is heart disease,” Kirkham says.

Such conditions also affect overall health-care costs.

To demonstrate the excess health-care costs related to heart disease, Kirkham and Jerzak performed an additional analysis using Canadian data on rates of hospitalization for heart failure and their costs. They found that two per cent of the women diagnosed with breast cancer between 2007 and 2021 would likely experience heart failure hospitalization costing $66.5 million in total. As much as 25 per cent of these costs, or $16.5 million, were in excess of those costs that would be associated with women who did not have breast cancer.

“Given the excess health-care costs, potential for reduced contributions to the workforce and reduced quality of life associated with long-term side effects and risk of excess death among breast cancer survivors, our work highlights that there is a growing segment of the population who require services to support recovery following breast cancer treatment," says Kirkham.

“The goal of my research lab is to develop new therapies to improve the health of women after surviving breast cancer.”

Common diabetes drug not effective against early-stage breast cancer, researchers say

Christopher.Sorensen — Wed, 08 Dec 2021 03:53:19 +0000

Common diabetes drug not effective against early-stage breast cancer, researchers say

Christopher.Sorensen Tue, 12/07/2021 - 22:53

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(Photo by andresr via Getty Images)

Amanda Ferguson

Topic

Breaking Research

Princess Margaret Cancer Centre

Temerty Faculty of Medicine

Institute of Health Policy Management and Evaluation

Lunenfeld-Tanenbaum Research Institute

Breast Cancer

Cancer

Dalla Lana School of Public Health

Mount Sinai Hospital

Research and Innovation

University Health Network

A widely used and inexpensive type 2 diabetes drug, once hoped to hold enormous promise in treating breast cancer, does not prevent or stop the spread of the most common forms of the disease, according to new research.

The study, which has yet to be peer-reviewed, was led by Toronto researchers and run by the Canadian Cancer Trials Group under the umbrella of the Breast International Group network. It is the largest study of its kind to date, tracking more than 3,600 breast cancer patients from across Canada, the U.S., Switzerland and the U.K.

Pamela Goodwin (photo courtesy of Sinai Health)

The randomized, double-blind trial enrolled patients who were treated with two pills a day of either placebo or the diabetes drug metformin. Overall, researchers found the addition of metformin to standard breast cancer treatments did not improve outcomes in the two most common types of breast cancer, hormone receptor-positive or negative.

“The results tell us that metformin is not effective against the most common types of breast cancer and any off-label use of this drug for the treatment of these common types of breast cancer should be stopped,” said Pamela Goodwin, a professor in the department of medicine at the University of Toronto’s Temerty Faculty of Medicine, who also is a medical oncologist at Sinai Health and a clinician scientist at the Lunenfeld-Tanenbaum Research Institute.

Goodwin presented the findings this week at the 2021 San Antonio Breast Cancer Symposium.

While metformin was found not to be effective in treating the most common forms of breast cancer, Goodwin said the trial found a potentially important result for individuals with a less common but aggressive form of the disease called HER2-positive breast cancer.

For this subtype of breast cancer, researchers found there was evidence that use of metformin for five years might lead to a reduction in deaths. HER2-positive cancer makes up about 20 per cent of all breast cancers.

“Metformin is not beneficial for use in most common breast cancers, but in the cases of HER2 positive breast cancer, our findings suggest it may be beneficial,” said Goodwin, who is also a professor in the Institute of Health Policy, Management and Evaluation at the Dalla Lana School of Public Health.

“These results need to be replicated in future research before metformin is used as a breast cancer treatment, however, it could provide an additional treatment option for HER2-positive breast cancer,” said Goodwin.

Metformin belongs to a class of drugs called biguanides, which are used to treat high blood sugar or diabetes. Previous observational and pre-clinical studies suggested metformin may also reduce the risk of development and increase survival of some cancers, including breast cancer.

It was theorized the drug may slow breast cancer growth by improving patient metabolism, notably insulin levels, leading to reduced growth of cancer cells, or that it might impact cancer cells directly.

The results have been submitted for publication. A potential next step will be to prospectively test the impact of metformin in patients with HER2-positive breast cancer in a randomized clinical trial.

The multinational trial involved a large team of scientists including Goodwin and Vuk Stambolic, a professor of medical biophysics at �鶹��Ƶ and at senior scientist at the Princess Margaret Cancer Centre, University Health Network.

Professors Wendy Parulekar and Bingshu Chen of Queen's University and the Canadian Cancer Trials Group were also involved with the study.

The research was funded by the Canadian Cancer Society Research Institute, National Cancer Institute (U.S.), Canadian Breast Cancer Foundation, Breast Cancer Research Foundation, Cancer Research UK, Hold’Em for Life Charity Challenge and Apotex (Canada).

After being diagnosed with breast cancer, �鶹��Ƶ alumna pushes for patient focus in research

Christopher.Sorensen — Wed, 25 Nov 2020 16:30:42 +0000

After being diagnosed with breast cancer, �鶹��Ƶ alumna pushes for patient focus in research

Christopher.Sorensen Wed, 11/25/2020 - 11:30

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Margaret Loniewaka, who completed her PhD at the Leslie Dan Faculty of Pharmacy in 2013, says her breast cancer diagnosis caused her to think more deeply about the importance of patient perspectives in research (photo courtesy of Margaret Loniewaka)

Topic

Leslie Dan Faculty of Pharmacy

As a former researcher, University of Toronto alumna Margaret Loniewska knows the thrill of discovering something new in the lab.

But her recent experience of being diagnosed with, and treated for, metastatic breast cancer gave her a new perspective on the importance of moving such discoveries forward so they are accessible to patients.

“When I was doing bench research, I would be so happy to get a good result,” says Loniewska. “But a result in a lab is often disconnected from the patient. How do we translate that research into something that actually helps patients?”

In a bid to help address the issue, Loniewska recently started volunteering as a patient advocate with ReThink Breast Cancer, a charity focused on breast cancer in young women. As a member of the Metastatic Breast Cancer Advisory Board, she provides a patient voice in meetings with industry organizations and government officials on issues that include metastatic breast cancer research and patient access.

Loniewska earned her PhD in pharmaceutical sciences from �鶹��Ƶ’s Leslie Dan Faculty of Pharmacy in 2013, working with Professor Peter Wells.

“Margaret was a hardworking student and one of the first in my lab to examine the biological similarities between degeneration in the adult brain and brain development in the fetus,” says Wells, who studies the effects of drug exposure on both fetal brain development and degeneration in the adult brain.

After completing her degree, Loniewska worked in project management and later studied pharmaceutical regulatory affairs. But in October 2019, she received news that would change her life: Within just a few days, she found out she was pregnant – and that she had breast cancer.

Loniewska’s tumour was small and thought to be early stage, so she had surgery to remove it. But a month later she was admitted to hospital with severe back pain. She was then diagnosed with metastatic breast cancer; it had spread to her bones and caused her ribs and spine to break and compress.

With such a serious diagnosis, her oncologists recommended starting chemotherapy right away. But Loniewska was still in the first trimester of her pregnancy. Given her experience in the Wells lab, she was acutely aware of how drugs – including chemotherapy and anti-nausea and pain medication – could affect her baby’s physical and neurological development. She dove into the scientific literature to find out what she could about the safety of taking such drugs during pregnancy.

She ultimately received a chemo regimen that is considered the safest for pregnancy and she and her baby were closely monitored with weekly ultrasounds. Unrelated to the cancer or her treatment, Loniewska gave birth prematurely in January. Her new daughter, Marianna, spent three months in the neonatal intensive care unit and came home in March.

Survival rates for breast cancer are climbing. But metastatic breast cancer is a different story. It is not curable. Treatments aim to help those with the disease live with good quality of life for as long as possible.

Some of the critical gaps in cancer care – such as more precise and non-invasive diagnostic and monitoring technology, as well as targeted treatments to reduce side effects – are being addressed by researchers at the Leslie Dan Faculty of Pharmacy, including those at the precision medicine initiative PRiME and the Centre for Pharmaceutical Oncology.

“I hear about research into all of these developments and new targets for treatments,” she says, “but, as a patient, how do I get access to them?”

Loniewska says her experience has underscored the importance of having researchers in the faculty focused on clinical, social and administrative pharmacy issues working side-by-side with biomedical researchers.

“Basic research is often just focused on molecules and mechanisms, which is important, but it doesn’t consider the barriers patients face in accessing new treatments,” she says.

Margaret Loniewaka’s cancer is currently under control and her daughter Marianna is healthy. She recently started volunteering as a patient advocate with ReThink Breast Cancer (photo courtesy of Margaret Loniewaka)

Wells, a longtime �鶹��Ƶ researcher, agrees. He says he has seen the faculty grow its research program over the years to include an expanded emphasis on clinical and social research. He adds that the two different streams not only help biomedical researchers to consider the relevance of their work, but can also inspire new research directions.

“Working collaboratively, we see problems from different perspectives,” he says. “This wouldn’t be possible without that cross-fertilization of basic and clinical sciences.”

Loniewska’s treatment now consists of regular targeted and hormone therapies. With her cancer currently under control and her baby healthy, she is once again thinking about returning to post-graduate studies.

“A year ago, I was in a hospital bed thinking that I was never going to get better. I thought I would spend the rest of my short life in a lot of pain and worried about my baby,” she says. “At this moment, I feel very fortunate that my treatment is helping me and allowing me to do a lot in my life.”

Breast cancer survivor involved in �鶹��Ƶ 'prehab' study shares her story in Washington, D.C.

davidlee1 — Wed, 16 Oct 2019 04:00:00 +0000

Breast cancer survivor involved in �鶹��Ƶ 'prehab' study shares her story in Washington, D.C.

davidlee1 Wed, 10/16/2019 - 00:00

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Christine Cosby took her story about the benefits of doing prehab and rehab following her cancer diagnosis all the way to Washington, D.C. (photo provided by Christine Cosby)

Jelena Damjanovic

Topic

Global Lens

Breast Cancer

Faculty of Kinesiology & Physical Education

Global

Graduate Students

Research & Innovation

While most people understand the benefits of rehabilitation after an injury, the concept of prehabilitation might be less familiar. A form of resilience building, prehab aims to prevent or minimize the impact of injuries before they occur – in sport, for example, or surgery.

Priya Brahmbhatt, a master’s student of kinesiology at the University of Toronto, compares it to training for a marathon.

“It’s the process of preparing yourself for an upcoming course of treatment or event that you know will cause some sort of impairment to your physical or mental health and well-being,” she says.

Brahmbhatt has been working with Assistant Professor Daniel Santa Mina of the Faculty of Kinesiology & Physical Education on a prehab study involving 25 women preparing for breast cancer surgery with exercise. The participants were recruited from the Princess Margaret Cancer Centre and provided with a home-based exercise program.

The study was the first to examine whether a structured exercise intervention was feasible in the prehab window – the period between the time of diagnosis and the breast cancer surgery.

“We were trying to understand if patients would be willing to participate in prehab, if we would be able to retain them over the course of the study and if they would adhere to their exercise prescriptions,” says Brahmbhatt.

Christine Cosby signed up to be a participant in the study following her diagnosis of stage 3 breast cancer in 2018.

“I was absolutely happy to do it,” she says. “Even though I was extremely stressed, I could see the benefit. Exercise never hurt anyone and it was something I could control when everything else was spinning out of control.”

Two weeks before surgery, Brahmbhatt tested Cosby for her cardio fitness and grip strength and tailored a set of exercises for her.

“I did five exercises with a resistance band, which I could do at home to build my upper body strength,” says Cosby. “I ran up the steps at my neighborhood park for 10 or 20 minutes a day to improve my cardio fitness.”

Right before the surgery, she came in for a follow-up. Brahmbhatt repeated the grip strength and cardio fitness measurements, which showed both had improved.

“I got the measurements and I thought, ‘Wow, I made a lot of progress in that short time period,’” says Cosby. “They also tested my body composition, which was neat because I could see that I actually built muscles in that short time. I could see how continued little efforts made a big difference.”

That’s something Brahmbhatt heard a lot in the interviews she conducted with the study participants, many of whom hadn’t experienced structured exercise prior to prehab.

“Some of the common themes that emerged were that exercise helped them regain the feeling of control, set a positive tone for recovery right from the beginning, acted as a positive distraction from the otherwise extremely stressful pre-operative period and helped them be an active participant in their care,” she says.

Following her surgery, Santa Mina put Cosby in touch with the American Association of Cancer Research (AACR), which invited her to contribute to its progress report by relating her prehab and rehab experience. She also participated in the Rally on the Hill for Medical Research organized by AACR in Washington, D.C., to lobby politicians for the funding of medical research.

“I shared the story of my experience with prehab and rehab in Canada because everyone benefits from research no matter where in the world it takes place,” says Cosby. “It was emotionally difficult to revisit the past one and a half years of cancer diagnosis and treatment, but knowing that my story could help others, I was happy to share it.”

For her part, Brahmbhatt hopes prehabilitation will move the needle from a more reactive, impairment-driven approach to a preparatory model of supportive care.

“Why are we still waiting for known impairments to occur after treatment instead of potentially preventing them, at least partially, upfront?” she says.

Entrepreneurship Week 2019: Ten �鶹��Ƶ startups to watch

Christopher.Sorensen — Mon, 18 Mar 2019 17:10:48 +0000

Entrepreneurship Week 2019: Ten �鶹��Ƶ startups to watch

Christopher.Sorensen Mon, 03/18/2019 - 13:10

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Leila Keshavjee of Happy Pops, which makes all-natural ice pops (photo by Chris Sorensen)

Topic

Artificial Intelligence

Breast Cancer

Computer Science

Faculty of Applied Science & Engineering

Health

Innovation & Entrepreneurship

ONRamp

Startups

Sustainabilty

Ted Rogers Centre for Heart Research

ThisIsThePlace

�鶹��Ƶ Mississauga

�鶹��Ƶ Scarborough

Supported by nine different incubator and accelerator hubs spread across three campuses, University of Toronto startups and the entrepreneurs behind them are pushing the boundaries in industries ranging from foodstuffs to health care.

Over the past decade, �鶹��Ƶ has helped launch or grow more than 500 research-based companies that have generated a collective $1-billion investment. Those companies, in turn, are helping to create the jobs and industries of tomorrow.

With Entrepreneurship Week now underway, here are 10 innovative �鶹��Ƶ startups to keep your eye on in 2019:

Happy Pops

Leila Keshavjee originally planned to study medicine, but took a detour in 2016 when she spotted a local ice pops business for sale. Having done a bachelor’s degree in kinesiology, Keshavjee believed there would be a market for an all-natural, fruit-flavoured treat.

So she took the plunge.

“I think the days of red, white and blue popsicles are done,” Keshavjee told �鶹��Ƶ News last year. “All those artificial ingredients we’re feeding kids has to stop – and I’m on a mission to change that.”

The progress has been quick. Keshavjee “hustled hard” to get the word out, believing that if customers tried her bold, natural flavours they would be instant converts.

Her big break came last fall when she appeared on the season premiere of Dragons' Den, walking away with a deal with Arlene Dickinson. Fast-forward to today, she’s preparing to relaunch the brand and prove that ice pops can be more than a summertime treat.

BioRender

(photo by Chris Sorensen)

Shiz Aoki (above) and her team, which includes �鶹��Ƶ computer science alumna Katya Stein and Ryan Marien, have built an Adobe Illustrator-like tool to help researchers in the life sciences sector visually depict their work.

Aoki, a trained medical illustrator and a former lead illustrator for National Geographic, got the idea for BioRender after her Toronto studio was inundated with requests from local scientists who struggled to create quality graphics to accompany their presentations and journal submissions.

“Some of these are Nobel-winning scientists who are making the front page of really prestigious science journals, but when you open it up and read the articles, the images that are supposed to capture that science are completely unstandardized, which is obviously an issue for educational purposes,” she told �鶹��Ƶ News earlier this year.

“The quality is pretty crappy, too.”

BioRender, which received support by ONRamp, is not only improving the look of researchers’ diagrams, but is helping to create a visual language to represent protein structures and chemical pathways. That could ultimately make it easier for researchers to communicate their work to the public and to each other, speeding up the pace of innovation and discovery.

Just Vertical

(photo by Chris Sorensen)

Conner Tidd (above) and Kevin Jakiela have a lofty goal: to get city dwellers growing their own fresh food, helping to save the planet in the process.

The co-founders of Just Vertical, who both studied sustainability management at �鶹��Ƶ Mississauga, sell an upright hydroponic growing system that can be parked in the corner of a kitchen and used to grow everything from leafy kale to fresh strawberries.

Their latest model, the Aeva, retails for $999 and looks like a cross between a piece of art and high-end furniture. Tidd told �鶹��Ƶ News last year that the units are meant to be used “in your home, restaurant or wherever you want something that looks good.”

The Aeva can grow over 70 plants and produce nearly five kilograms of fresh, pesticide-free food per month.

Fian Technologies

(photo by Erin Howe)

For all the high-tech advances in medicine, sometimes it’s the simplest problems that prove hardest to solve – like getting health workers to wash their hands properly.

That’s where the Fian Bar comes in. The device is mounted next to washroom sinks in hospitals and guides users through the various stages of handwashing using three different icons – water, soap and scrub. It also uses sensors to track which stage the user is in, illuminating the proper icon.

“If the user washes their hands insufficiently, the entire device flashes and beeps,” co-founder Luke Kyne told �鶹��Ƶ News earlier this year.

“Hand hygiene data is also uploaded to our servers, which can be viewed and analyzed in real time by hospital administrators and researchers.”

Kyne said he and his fellow co-founders – Marawan Gamal, Parham Chinikar and Michael Wu – got the idea after learning Canada has the highest rate of health-care acquired infections of any developed country – and that about half of those infections can be traced to improper hand hygiene.

StageKeep

(photo courtesy of Axel Villamil)

As a hip hop dancer, �鶹��Ƶ Scarborough’s Axel Villamil knew first-hand how cumbersome it was for choreographers to map out their routines using conventional methods: pen, paper and sometimes the odd stool or sneaker to stand in for a performer.

He figured there must be a better way. So he teamed up with co-founder William Mak to build an app that allowed choreographers to map out their routines, with dots representing dancers, while taking into account the size and shape of the performance space – all in time to the music.

The app is already being used by the Toronto Raptors and choreographers representing other big-name performers have expressed interest.

“It was a dream of mine to do something with the NBA and I was too short to do basketball, so this should suffice,” Villamil told �鶹��Ƶ News last year.

Polumiros

(photo by Laura Pedersen)

As a researcher, Soror Sharifpoor was focused on heart-related technologies – and then a surgical oncologist came calling.

The surgeon was looking for a material to immediately reconstruct the damaged tissue of his breast cancer patients during lumpectomy procedures. And, as luck would have it, Sharifpoor and her colleague Kyle Battiston had been working with a unique polymer in the lab of �鶹��Ƶ Professor Paul Santerre that, with a few tweaks, fit the bill.

The two ended up co-founding Polumiros, which is working toward getting the material approved through clinical trials.

“The patients don’t have to go under the knife a second time,” said Sharifpoor, who completed her PhD at �鶹��Ƶ in biomaterials and biomedical engineering and is now the research program manager at the Ted Rogers Centre for Heart Research's translational biology and engineering program.

“They never have to live with a defect.”

Braze Mobility

(photo by Chris Sorensen)

Pooja Viswanathan’s mission to improve the lives of wheelchair users began when she was an undergraduate student.

That was when she visited a long-term care facility and was struck by the number of “slumped over” residents who had been stripped of their mobility and independence. She blamed a lack of wheelchair innovation over the past half century.

So she set to work making an array of sensors that could be attached to any motorized wheelchair – not unlike the collision-avoidance sensors that now come standard on many automobiles.

“You end up with a smart wheelchair that can detect obstacles,” Viswanathan, who did her post-doctoral research at �鶹��Ƶ, said during a pitch competition last year.

Viswanathan’s startup, Braze Mobility, says its sensor arrays are especially useful for wheelchair users who suffer from vision or hearing impairment, or who have upper body mobility issues.

Structura Biotechnology

(photo by Chris Sorensen)

Run by a brother-sister team, Structura Biotechnology is based on a simple premise, even if the technology underpinning is far from straightforward: It’s much easier to discover new, life-saving drugs if you can see what you’re doing.

The �鶹��Ƶ startup uses artificial intelligence to create accurate 3D representations of the protein structures with which potential drug molecules must interact.

"Proteins make every process in your body happen, and drugs are these small molecules that have to bind to proteins,” Ali Punjani, the startup’s co-founder and CEO, told �鶹��Ƶ News earlier this year.

“But if you can't see the protein, then drug discovery is like solving a puzzle with a blindfold on.”

Structura’s software is designed to make sense of the noisy, cluttered images captured through Cryo-EM, a type of electron microscopy that won a Nobel Prize in chemistry two years ago.

The startup already counts several multinational pharmaceutical companies as customers despite the fact that it hasn’t begun to actively market its software.

LegUp Computing

(photo by Chris Sorensen)

Field-programmable gate arrays, or FPGAs, are complicated pieces of hardware traditionally used to implement specialized functions like network switches, but are increasingly being deployed by cloud service providers.

However, the challenges associated with designing hardware threaten to limit wider adoption – which is where LegUp Computing comes in.

LegUp is developing a cloud-based platform that allows software developers to easily scale and manage FPGA devices. The startup was co-founded in 2015 by Andrew Canis, Jongsok Choi and Ruolong Lian, as well as Professor Jason Anderson in the Faculty of Applied Science & Engineering,

“LegUp allows software developers to leverage FPGA capabilities and eliminates the need for hardware-design skills,” Canis, LegUp’s CEO, explained to �鶹��Ƶ Engineering last year.

“Traditional servers are overwhelmed by real-time requirements of applications like fraud detection, bidding for advertisements and video analytics – these requirements can easily be met by FPGAs, so we are making them more accessible.”

LegUp closed a seed round of funding last year that was led by Intel Capital.

Chopin

(photo by Chris Sorensen)

Awash in patient data, the health-care sector is poised to be transformed by AI technologies like machine learning – but there’s just one problem: Much of that data is walled off in silos, making it difficult to analyze effectively.

Fortunately, Carolina Gomes and Daniel Zhang have a solution.

Their startup, called Chopin, weaves together data from different silos using something called a knowledge web, while making it more accessible to front-end users.

“We’re interested in hospitals that haven’t centralized their data or for which centralized data isn’t working – specifically mid-sized hospitals that don’t have a large budget,” Gomes told �鶹��Ƶ News last year.

Chopin, which got its name for the way the tool “orchestrates” data behind the scenes, is already field testing its tool at several local health-care institutions.

Increasing physical activity linked to better immunity in breast cancer patients, �鶹��Ƶ study finds

noreen.rasbach — Thu, 24 May 2018 15:46:57 +0000

Increasing physical activity linked to better immunity in breast cancer patients, �鶹��Ƶ study finds

noreen.rasbach Thu, 05/24/2018 - 11:46

Cutline

(photo by iStock)

Jelena Damjanovic

Topic

Our Community

Breast Cancer

Faculty of Kinesiology & Physical Education

Research & Innovation

A new study from the University of Toronto’s Faculty of Kinesiology & Physical Education has found that moderate to vigorous physical activity may help regulate the levels of C-reactive protein – an important biomarker whose levels rise in response to inflammation or infection present in the body.

High concentrations of C-reactive protein (CRP) are associated with a higher incidence of disease and mortality in women diagnosed with breast cancer, so strategies to decrease their levels are important to improve prognosis and health outcomes, says Professor Catherine Sabiston, a Canada Research Chair in Physical Activity and Mental Health and lead author of the study.

Increasing physical activity levels may be a cost-effective, non-pharmaceutical treatment that can mitigate CRP concentrations after a cancer diagnosis, she says.

“In this study, we found that physical activity is consistently related to better immunity in the early survivorship period post-treatment, when inflammation could relate to other illness or disease and when the women are focused on getting past treatments and overcoming the lingering side-effects of breast cancer diagnosis,” says Sabiston.

Although previous studies have found that moderate to vigorous physical activity decrease the levels of CRP, most of the evidence regarding the benefits of exercise for breast cancer patients was based on controlled and supervised laboratory-based interventions that fall short of describing naturally occurring developmental trends in physical activity and CRP over time, says Sabiston.

This study followed 138 women over the first year after being treated for breast cancer, comparing each woman's physical activity trends over time to her own levels of CRP, as well as comparing each woman against the larger group of survivors. The researchers made five data collections over the year, during which the women filled out questionnaires, wore accelerometers for seven consecutive days to measure their physical activity and provided blood samples to measure their CRP concentrations.

Read the research

“We found that when women exercise more than their own personal average, they have better immune function,” says Sabiston. “We also found that women in our sample who were generally more physically active have better CRP outcomes compared to women in the sample who were less physically active.”

The implication here is that it is never too late to start exercising, says Sabiston, and when you do exercise any more than usual, it is beneficial.

Sabiston hopes the results of the study will lead to health professionals encouraging women to engage in moderate to vigorous physical activity early after a breast cancer diagnosis and treatment to improve immune function and general health and well-being.

“A specific understanding of the association between moderate to vigorous physical activity and inflammation during the first year [of] post-treatment for breast cancer helps to inform behaviour modification strategies and improve health and disease outcomes,” she says.

The study, published in the Annals of Behavioral Medicine journal, was co-authored by Carsten Wrosch and Andrée L. Castonguay from the department of psychology at Concordia University, and Benjamin Sylvester, a post-doctoral researcher in �鶹��Ƶ’s Faculty of Kinesiology & Physical Education.

The research was supported by the Canadian Institutes of Health Research.

Routine mammograms do save lives: �鶹��Ƶ expert

rasbachn — Tue, 07 Nov 2017 23:49:50 +0000

Routine mammograms do save lives: �鶹��Ƶ expert

rasbachn Tue, 11/07/2017 - 18:49

Cutline

X-ray technician Marie Kiley prepares to do a mammogram on a patient at a Scarborough clinic (photo by Richard Lautens/Toronto Star via Getty Images)

Topic

Subheadline

The Conversation with �鶹��Ƶ's Martin Yaffe and UBC's Paula Gordon

A recent article published by The Conversation Canada stated routine mammographies do not save lives – and that the harms of screening outweigh the benefits.

As researchers who have worked in the field of breast cancer detection for decades, we know that exactly the opposite is true – there’s overwhelming evidence that earlier detection of breast cancer by mammography screening, combined with modern therapy, reduces deaths from breast cancer markedly.

We believe that women should decide for themselves whether to participate in screening after they have all the facts.

Screening mammograms help save lives by detecting small breast cancers when they have not yet spread through the body (metastasized). Metastases are what make breast cancer a lethal disease. An additional benefit of earlier detection is that it often allows less toxic, gentler therapies to be used – less extensive surgery and the use of drugs that have fewer and less severe side-effects than chemotherapy.

Screening mammograms help save lives

Debates on the wisdom of, and best age to begin, routine mammography screening have raged within both the medical literature and the media for many years. It is important, then, that recommendations and guidance for women are based upon a thorough review and presentation of the best evidence available.

The study referenced in the original article was based on screening performed in the early 1980s using obsolete technology. That study was heavily criticized by multiple reviewers because of the poor quality of the images and other flaws in how the study was conducted. This was the only study that failed to show a benefit of screening.

Multiple overviews of all of the randomized trials of breast cancer screening on the other hand – including one recently performed by the International Agency for Research on Cancer, one by a research team in the United States and one produced for the American Cancer Society – show a reduction in breast cancer deaths by about 20 per cent. The way randomized trials are analyzed tends to underestimate the benefit, so the real benefit for women who do get screened is likely to be higher.

A recent Canadian study, published in 2014, reinforces these findings. Researchers compared breast cancer deaths across seven Canadian provincial screening programs and observed about 40 per cent fewer deaths in women screened, with benefits extending for screening between ages 40 and 79. For women in their 40s, the reduction in breast cancer deaths was 44 per cent.

Similar observations have been noted in British Columbia, in Norway, Florence and five regions of Italy and across Europe – women who participate in mammography screening are less likely to die of breast cancer than those who do not.

Mammograms detect possible cancers

It is important for women to know that mammography screening doesn’t diagnose cancer. The pictures from a mammogram simply allow the radiologist to detect suspicious areas in the breast where cancer could be present.

As a result, it is likely that some cancers are over-detected by mammography – in that if they weren’t found they would possibly not have caused harm. This could be the case if a cancer that is growing slowly is detected, but the patient dies of other causes before the cancer becomes lethal. For example, if the woman dies in a car accident, or from a heart attack before the cancer kills her.

Early detection of breast cancer can allow for less toxic, gentler therapies to be used, such as drugs with fewer, less severe side-effects than chemotherapy (photo by Franka Bruns, AP)

Here is an example based on real data from the British Columbia Screening Program. In every 1,000 women age 55 who go for screening, 929 (or 93 per cent) of them will have a normal result. They will be asked to return in one or two years for the next exam. The other 71 women will be asked to return for additional imaging to evaluate abnormal areas. At this point, the level of suspicion for cancer is still very low. After the imaging, 59 of these women will be told that there is no evidence of cancer (this can be considered to be a false alarm).

For 12 women (1.2 per cent of those who were screened), suspicion will remain. They will have a biopsy, with local freezing, in which a small amount of tissue is removed with a needle and examined under a microscope. This is where the actual diagnosis takes place. About four of the original 1,000 women will be found to have breast cancer and will be offered treatment. One cancer will be missed in the screening.

These four cancers are real. Some will be highly aggressive and grow quickly while others may grow slowly, possibly not at all. The pathologist has some tools to distinguish between these two situations, and research continues to improve these tests. But this is not an exact science.

Most doctors and women opt for aggressive treatment because it is “better to be safe than sorry,” and in some cases this results in over-treatment. While unreasonably high estimates of over-detection have been made by some researchers, more careful analysis suggests that it is in the order of one to 10 per cent of cancers.

It does not make any sense to throw away the lives saved by screening – to avoid over-treating a small number of cancers. A promising way to avoid over-treatment is to follow the lead of male prostate cancer treatment while we wait for the pathology tests to improve. This involves a discussion between patient and doctor of more conservative treatment of some cancers. Clinical trials are now underway to test these ideas.

False alarms and smoke detectors

Recalls (false alarms) from screening for additional tests can cause anxiety. It is important, therefore, that women are informed of the possibility of false alarms before they choose to be screened. Women should be informed that only a small percentage of those recalled are subsequently diagnosed with cancer.

Most women will accept the risk of transient anxiety once they are aware of the potential mortality reduction by participating in screening. In one study, women who attended public education sessions about screening reported decreased anxiety. Patients and physicians should also advocate for faster diagnostic investigation to reduce the time to resolution of whether cancer is present, or not.

The false alarms from mammography are very similar to those from smoke detectors. You install a smoke detector to avoid damage and injury from a fire. For most people, there will never be a fire in the house (only about 12 per cent of women will develop breast cancer), so for those people who don’t, you could argue that the smoke detector is a waste of money.

It is also possible that a fire will start, and the detector will not go off for some reason (the sensitivity of mammography is approximately 80 per cent) or that the fire grows so quickly that the alarm does not really help you (a fraction of cancers are too aggressive for screening to be useful). Alternatively, the fire might start in the fireplace, so it does not really matter that the alarm went off because the fire would not have hurt you (some cancers are indolent; these are the over-detected cancers). The alarm might sound in the middle of the night and wake you up, but there is no fire (as when mammograms raise false alarms).

The benefits, of course, are that the alarm could wake you up just in time and save your life. It could even wake you so quickly, you can extinguish the fire before any real damage has been done to your house. The equivalents of all these situations occur with mammography screening.

Radiologists opt for mammograms

We know that large X-ray doses increase the risk of cancer. And, while there is no direct evidence, it is reasonable to be cautious and assume that the lower X-ray dose from mammograms can cause cancer. However, avoiding mammography due to fear of radiation is not a winning bet.

We have analyzed the risks and the benefits of screening every two years from ages 50 to 69. In a sample of 1,000 women the radiation from mammograms would hypothetically be responsible for 0.27 cancers and 0.04 cancer deaths. Mammograms, on the other hand, would prevent five deaths (125 times more than those lost) and save 105 years of life.

This is why breast radiologists, who are well-acquainted with the radiation dose in modern mammography, overwhelmingly have annual screening themselves and recommend the same for their families, friends and patients.

We recognize both the benefits of mammography screening as well as its limitations or risks. It is far from perfect. But screening has the potential to prevent 1,000 breast cancer deaths in Canadian women each year. Women and their health-care providers need an accurate and balanced picture of these strengths and limitations so they can make an educated decision about participation in screening.

Paula Gordon is a clinical professor in the department of radiology and medical director of the Sadie Diamond Breast Program at BC Women’s Hospital, University of British Columbia. Martin Yaffe is a professor of medical biophysics and medical imaging at the University of Toronto and senior scientist at Sunnybrook Research Institute.

This article was originally published on The Conversation. Read the original article.

�鶹��Ƶ researchers part of international group that discovered 72 genetic variants that predispose to breast cancer

rasbachn — Mon, 23 Oct 2017 16:57:12 +0000

�鶹��Ƶ researchers part of international group that discovered 72 genetic variants that predispose to breast cancer

rasbachn Mon, 10/23/2017 - 12:57

Cutline

Professor Gary Bader: “These new variants substantially expand the number of genes and pathways that are involved in breast cancer development” (photo courtesy of Canadian Foundation for Innovation)

Topic

University of Toronto researchers have helped identify 72 new genetic variants that contribute to the risk of developing breast cancer as part of a major international collaboration involving hundreds of researchers worldwide.

The studies, reported today in the journals Nature and Nature Genetics, identified 72 common variants that predispose to breast cancer. Among these genetic regions, some are specifically associated with either estrogen receptor-positive (ER+) or estrogen receptor-negative (ER-) breast cancer – the subset of cases that do not respond to hormonal therapies, such as the drug tamoxifen.

The findings are the result of work by the OncoArray Consortium, a huge endeavour involving 550 researchers from about 300 different institutions in six continents. In total, they analyzed genetic data from 275,000 women, of whom 146,000 had been diagnosed with breast cancer.

“These new variants substantially expand the number of genes and pathways that are involved in breast cancer development, and these represent multiple new avenues of research to learn how to treat breast cancer,” says Gary Bader, a professor at the Donnelly Centre for Cellular and Biomolecular Research and the department of molecular genetics, whose research group was among five �鶹��Ƶ teams involved in the study.

Bader’s group was instrumental in identifying new pathways involved in breast cancer and making the discovery that ER+ and ER- breast cancers are linked to different pathways, supporting the idea that these cancers are genetically distinct diseases and therefore need to be thought of differently by researchers.

Breast cancer is caused by complex interactions between a large number of genetic variants and the environment. The inherited component of breast cancer risk is due to a combination of rare variants in genes such as BRCA1 and BRCA2 that confer a high risk of the disease, and many more common genetic variants that each confers only a small risk. The newly identified risk regions nearly double the numbers that are already known, thereby bringing the number of known common variants associated with breast cancer to around 180.

The risk variants identified in the two studies are common: While some are carried by one woman in 100, others are carried by more than half of all women. Individually, the risks conferred by each variant are modest. But because they are common and their effects multiply together, the combined effect is considerable. These findings will help improve risk prediction. The researchers believe these differences may be sufficient to change practice, such as in how women at different risks are screened.

Read the studies in Nature and Nature Genetics

“Using data from genomic studies, combined with information on other known risk factors, will allow better breast cancer risk assessment, therefore helping to identify a small but meaningful proportion of women at high risk of breast cancer,” says Professor Jacques Simard from the Genomic Centre of the CHU de Québec-Université Laval Research Centre in Québec City, who was one of the co-leading investigators on the project.

“These women may benefit from more intensive screening, starting at a younger age, or can be offered screening by magnetic resonance imaging (MRI), which is more sensitive, allowing early detection and prevention of the disease. At the same time, this personalized information will also be useful to adapt screening modalities for women at substantially lower risk,” says Simard.

The major advance of the study was that a large amount of genomic information was used to better link genetic variants to the genes they act on. Identified as single misspellings in the DNA code, variants are scattered across the genome and often fall outside the gene-coding regions. To find a gene that is affected by any given variant, researchers would typically home in on a gene that is located closest to the variant – a difficult task when there are many genes to choose from, as is often the case.

But here, data about transcription factor binding – proteins that bind the DNA at specific sites to switch genes on and off – as well as epigenetics data that tell researchers how accessible DNA is to transcription factors, were taken into account to better predict which gene should be linked to which breast cancer-associated variant.

Despite this leap in our understanding of the genetic risks of breast cancer, Bader says that the data still can’t explain most of breast cancer cases and are not yet widely useful for population screening. The current study looked at common variants and to explain more of breast cancer risk, researchers will need to consider rare mutations as well as how different genes interact to influence each other’s effect on disease.

The research was funded by Genome Canada, Genome Quebec, Canadian Institutes of Health Research, Quebec Breast Cancer Foundation, Cancer Research UK, National Cancer Institute USA and the European Union Horizon 2020 program.

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StageKeep

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Read more about entrepreneurship at �鶹��Ƶ

Increasing physical activity linked to better immunity in breast cancer patients, �鶹��Ƶ study finds

Read the research

Routine mammograms do save lives: �鶹��Ƶ expert

Screening mammograms help save lives

Mammograms detect possible cancers

False alarms and smoke detectors

Radiologists opt for mammograms

�鶹��Ƶ researchers part of international group that discovered 72 genetic variants that predispose to breast cancer

Read the studies in Nature and Nature Genetics