David Lim, MD

Understanding the impact of social marginalization and variability in care on outcomes in patients with invasive lobular carcinoma

Impact

Invasive lobular carcinoma (ILC) originates in the lobules – glands in the breast that produce milk. The incidence of ILC is on the rise, but it is treated the same way as invasive ductal carcinoma, despite differences in cancer biology, detection, and response to treatment. Research on this subtype is limited because each treatment center only sees a small number of patients with ILC. For his Conquer Cancer Award supported by BCRF, Dr. Lim is conducting a series of studies that look at factors beyond biology—such as social and geographic disparities in care. He and his team will make use of a large administrative health care databases that captures information on patients diagnosed with ILC in Ontario, Canada between 1990 and 2020.

Progress Thus Far

Dr. Lim is gaining access to the health data from the Institute of Clinical Evaluative Sciences (ICES) and has been granted institutional ethics approval. He is finalizing a contract between the institute and ICES so that the data can be transferred, and he can begin analysis.

What’s next

He and his team will evaluate:

• The role of social marginalization in shaping survival outcomes, including the impact of education level, age and employment status, race, and housing situation.
• Variations in the care patients receive across different treatment centers and providers, including use of breast MRI, genetics referrals, surgical approaches, and use of chemotherapy and radiation.
• How characteristics of the treating center and providers influence outcomes.

While precision medicine often focuses on tailoring care based on tumor biology, their work expands that definition, highlighting where a patient lives, where they are treated, and who provides their care can also profoundly affect survival.