The House of Commons’ Standing Committee on Health is currently looking to address issues in women’s health in Canada. To gain insight on various matters in this area of health, the House of Commons’ Standing Committee on Health invited the Gynecologic Cancer Initiative’s very own Dr. Gillian Hanley and Dr. Jessica McAlpine to appear in front of the House as witnesses. Dr. Hanley and Dr. McAlpine shed light on some of the incredible BC-led research at the Gynecologic Cancer Initiative while calling for federal support and funding to help reduce the burden of gynecologic cancers on Canadians.

Currently, gynecologic cancers account for 10% of all cancer deaths. It is also estimated that a total of 12,000 Canadian women, transgender men, and non-binary people will be diagnosed with gynecologic cancers this year alone. Yet, there is a significant disparity in funding of gynecologic cancer research. 

“Both national focus and dedicated investment are needed in this important area,” Dr. Hanley says about gynecologic cancer research.

Through a multidisciplinary and multi-institutional model of research and care, Gynecologic Cancer Initiative researchers have made groundbreaking discoveries which have led to innovative screening and prevention programs, and precision medicine approaches for the diagnosis and treatment of gynecologic cancers. While many of these practice-changing and evidence-based interventions have been implemented into national and international clinical care guidelines, there are still profound disparities in their adoption across Canada. This means that a woman affected by gynecologic cancer may receive dramatically different care in Alberta, Ontario or Newfoundland. Dr. Hanley and Dr. McAlpine highlight the need for funding and partnership with the federal government to ensure programs are effectively communicated and accessible to all Canadians. 

Ovarian Cancer Prevention

With no existing screening method for ovarian cancer, Dr. Hanley a Tier 2 Canada Research Chair, emphasized the importance of opportunistic salpingectomy for ovarian cancer prevention. Opportunistic salpingectomy is an intervention in which the fallopian tubes are removed during other gynecologic and pelvic surgeries, while leaving the uterus and ovaries behind, to reduce ovarian cancer risk. This intervention was developed based on the finding that the most lethal ovarian cancers start in the fallopian tubes. Dr. Hanley’s research has shown that this is a safe procedure with no additional risk of complications. After childbearing, there is no known use for the fallopian tubes. 

“Recognizing that approximately 80% of ovarian cancer occurs in people who have no genetically increased risk, this intervention is not based on genetic risk for ovarian cancer, but rather on opportunity. Hence, we called it ‘opportunistic salpingectomy.’ We are taking the opportunity provided by another surgery to also conduct this important ovarian cancer prevention surgery,” Dr. Hanley says.

 Data published by Dr. Hanley’s team last year demonstrates the effectiveness of opportunistic salpingectomy as a prevention strategy for reducing the risk of ovarian cancer. Opportunistic salpingectomy is now recommended in nine countries world-wide, including Canada. However, the adoption of opportunistic salpingectomy varies tremendously across Canada. Thus, Dr. Hanley calls for additional federal support in promoting uniform uptake of opportunistic salpingectomy to ensure all individuals have equitable access to this life-saving cancer prevention procedure.

Precision Medicine for Uterine Cancer

Dr. Jessica McAlpine is a GCI surgeon-scientist, Tier 1 Canada Research Chair and Chew Wei Chair at the University of British Columbia studying precision medicine for uterine cancers. Uterine, or endometrial, cancers are the most common gynecologic cancer and are on track to becoming the second most common cancer among women, trans and non-binary individuals.

To address the shortcomings and inconsistencies of the previous endometrial cancer diagnostic system, Dr. McAlpine and her team developed a molecular classifier for endometrial cancers, which provides a consistent system for stratifying a patient’s risk and identifying which treatments work the best. The molecular classifier, ProMisE, uses lab techniques easily performed in most Canadian hospitals.

Dr. McAlpine’s molecular classification system has since been recognized by the World Health Organization and adopted by international treatment guidelines as the standard of care for endometrial care. However, research advancements such as these face an additional barrier– implementation and accessibility.

“What is immensely frustrating is that despite this global recognition, molecular classification is not uniformly accessible to patients across Canada. Even in British Columbia, where we developed this tool, it took two years to ensure free testing for all endometrial cancer patients. In Canada, we have centres where they [patients] may have to wait 8 to 10 weeks to get their results, may have to send their tissue out-of-province to get molecular testing, or clinicians not even get to discuss molecular testing with their patients,” Dr. McAlpine explains.

Thus, implementation science and funding are a necessity to ensure these incredible interventions available bring forth meaningful change in patient care and outcomes.

A Call to Action to Support Gynecologic Cancer Research and Implementation

On behalf of the Gynecologic Cancer Initiative, Dr. Hanley and Dr. McAlpine presented the following recommendations to the House of Commons’ Standing Committee:

1. Increase funding for gynecologic cancer research to accurately reflect the burden of these cancers on Canadians.
2. Target funding to clinical research and multidisciplinary teams and working across cancer disease sites and institutions to make the fastest and most meaningful progress.
3. Work to ensure that scientifically proven interventions in the screening, prevention, diagnosis, and treatment of gynecologic cancers are accessible to all Canadians.
4. Invest in implementation sciences and partner with the Gynecologic Cancer Initiative and other Canadian researchers in nation-wide communication campaigns to ensure uptake of effective medical interventions by all Canadians. 

Through galvanizing the academic and clinical communities and patient partners, we believe we can truly bring positive change and impact as we work towards our goal of reducing the incidence, death and suffering from gynecologic cancers by 50% by 2034. The Gynecologic Cancer Initiative looks forward to what we can achieve with greater support for gynecologic cancer research and the implementation of scientifically proven innovations.