Allison Kurian, MD, MSc

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. Over the past year, 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.

What’s next

In the coming year, Dr. Kurian will continue to use the Oncoshare database, which integrates electronic health records and state cancer registry data for thousands of women diagnosed with breast cancer over 25 years. She and her team will complete several ongoing projects, including studies of metastatic breast cancer treatment and distance traveled for care, and changes in blood immune cell profiles as a predictor of response to treatment. They will also begin several new projects. One is a study of how commonly used weight loss medications (glucagon-like peptide 1 receptor agonists, such Ozempic®, a semaglutide) affect the side effects of breast cancer treatment and survival. Another is to study how lymphedema, a common complication of surgical treatment, affects? immune function and survival after breast cancer. A third new study will focus on breast cancer in elderly women–diagnosed at age 85 or older–and will identify patient characteristics that predict successful treatment. These new studies are designed to further our goals of understanding and improving breast cancer care.