Titles and Affiliations
Associate Chief, Division of Oncology
Director, Stanford Women’s Clinical Cancer Genetics Program
Co-Leader, Stanford Cancer Institute Population Sciences Program
Professor of Medicine
Professor of Epidemiology and Population Health
Research area
Using big data approaches to understand population-level aspects of breast cancer to inform treatment and improve outcomes.
Impact
Population-based research can reveal large-scale trends in myriad aspects of a disease that enable the characterization of important metrics such as common sites of disease recurrence, identifying high-risk populations, racial and ethnic disparities, assessing the financial aspect of treatment, how to undertake prevention, and more. These data can guide doctors and patients in treatment decisions to improve outcomes and quality of life. Dr. Kurian is using a “big data” approach to improve diagnosis and the management of breast cancer for optimal survival and quality of life for patients with breast cancer.
Progress Thus Far
Dr. Kurian is using a novel informatics approach to mine real-world data sources to understand and improve breast cancer treatment, survival, and other outcomes. The primary source of data is Oncoshare—an integrated breast cancer research database that Dr. Kurian’s team built by linking Surveillance, Epidemiology and End Results (SEER) cancer registry data to electronic medical records of more than 34,000 women treated for breast cancer in two California healthcare systems. The team has made several findings that represent progress in their goals of understanding how most patients are treated for breast cancer, and guiding improvements in their care and survival, including:
- Breast cancer patients who paused treatment with anti-hormonal therapy to become pregnant were less likely to resume treatment, and more likely to have a cancer recurrence.
- There are persistent gaps in referral of patients with breast cancer for genetic counseling and testing.
- A shift from in-person to telehealth genetic counseling and testing improves care access for patients living in areas of socioeconomic deprivation.
- Treatment regimens for patients with metastatic breast cancer vary substantially with how far patients must travel for care.
- Early changes in blood immune cell profiles can predict response to treatment for patients with HER2-positive breast cancer.
- Breast surgery in women diagnosed at age 85 is both effective and well tolerated even in this older population.
- Antibiotic use is associated with lower survival after a triple-negative breast cancer diagnosis.
What’s next
Building on these findings, Dr. Kurian and her team will now develop, validate, and implement an artificial intelligence (AI) approach to accelerate data retrieval from electronic health records within Oncoshare, dramatically scaling up what has historically been a slow, manual process. The team will focus this new approach on the complex, longitudinal care of patients with metastatic breast cancer, identifying treatment pathways most strongly associated with optimal breast cancer-specific survival. Building on this AI-accelerated data extraction, the team will then develop and validate treatment quality metrics that can precisely pinpoint targetable gaps in care, metrics designed to be scalable and implementable in larger, more comprehensive nationwide health record databases. Altogether, this work will leverage recent advances in AI to enable rapid, in depth and more actionable analysis of real-world breast cancer care.
Biography
Allison W. Kurian, MD, MSc is a Professor of Medicine and of Epidemiology and Population Health at Stanford University. She is Associate Chief of the Division of Oncology, Director of the Stanford Women’s Clinical Cancer Genetics Program, and Co-Leader of the Stanford Cancer Institute Population Sciences Program. Dr. Kurian graduated from Stanford University, attended Harvard Medical School followed by Internal Medicine residency at Massachusetts General Hospital, and completed Medical Oncology fellowship and a master’s degree in Epidemiology at Stanford University.
Dr. Kurian’s research focuses on the identification of women with elevated breast and gynecologic cancer risk, and on the development and evaluation of novel techniques for early cancer detection and risk reduction. As an oncologist and epidemiologist, she aims to understand cancer burden and improve cancer treatment quality at the population level. Her research employs methods from the population sciences, in collaboration with the Surveillance Epidemiology and End Results (SEER) Program and other large, real-world data resources. Dr. Kurian leads epidemiologic studies of cancer risk factors, clinical trials of novel approaches to cancer risk reduction, and decision analyses of strategies to improve cancer outcomes.
She has published more than 250 peer-reviewed articles, and her research has been supported by grants from the National Institutes of Health, California Breast Cancer Research Program, Komen for the Cure Foundation, and others. Dr. Kurian’s work has been honored by Impact Awards of the National Consortium of Breast Centers and the BRCA Foundation, and election to the American Society of Clinical Investigation.
