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Kala Visvanathan, MBBS, FRACP, MHS

Johns Hopkins University
Baltimore, Maryland

Titles and Affiliations

Professor of Epidemiology and Oncology
Johns Hopkins Bloomberg School of Public Health
Director, Clinical Cancer Genetics and Prevention Service
Director, Cancer Epidemiology Track
Sidney Kimmel Comprehensive Cancer Center

Research area

Examining the factors associated with racial and ethnic disparities in the mortality rates for patients with second breast cancers.


While deaths from breast cancer have decreased significantly, the number of new diagnoses made each year has not. Even if women have been successfully treated for their cancer, their cancer may return or another (breast or non-breast) primary cancer may develop, sometimes long after their initial diagnosis. According to a national SEER (Surveillance, Epidemiology, and End Results) database, the cumulative incidence of developing any second cancer among breast cancer patients is between 15-20 percent at 25 years, including a seven percent incidence of developing a new primary breast cancer. In addition, the National Cancer institute has identified second cancers as an underexplored area of research. Dr. Visvanathan has found that breast cancer survivors who have a subsequent cancer have a much higher likelihood of dying from cancer compared to women with a single cancer. Indeed, that increase in death starts within 6 months of a cancer. The risk of dying was not the same for everyone and differed by type of first breast cancer, second breast cancer characteristics, treatment, and time between the cancers. Additionally, she observed that Black Americans and Hispanic women were more likely to die after a second cancer than their white counterparts. She is leveraging her significant expertise in disparities research to focus on factors that influence mortality rates from second cancers across racial and ethnic lines. She hopes to address critical gaps in our current knowledge, inform clinical practice, and develop more targeted interventions to address disparities and reduce mortality from second breast cancers for all patients.

Progress Thus Far

In the first of its kind, large population-based study, Dr. Visvanathan examined the mortality differences in breast cancer survivors with a second primary cancer (other than breast cancer) compared to breast cancer survivors with no second cancer. Through this study, she reported that the risk of death was 82 percent higher with a second breast cancer compared to the first. Ongoing studies are investigating multiple factors including racial/ethnic differences that can explain the greater negative impact a second breast cancer has on Black and Hispanic women.

What’s next

Current survivorship guidelines with respect to second cancers are based on evidence for first cancers. The results of Dr. Visvanathan’s research revealed the need for new approaches to early detection, prevention, and possibly treatment of second cancer. In the next year, her team will determine if liquid biopsy technology could be used to detect all types of second cancers in breast cancer survivors. They hope to develop a predictive model for second cancer as well as help identify key contributors to the racial/ethnic disparities observed in second breast cancer mortality.


Kala Visvanathan is a Professor in the Department of Epidemiology at Johns Hopkins Bloomberg School of Public Health and the Department of Medical Oncology at Johns Hopkins School of Medicine. Dr. Visvanathan is Director the Clinical Cancer Genetics and Prevention Service and the Cancer Epidemiology Track at Johns Hopkins.

She received her medical degree from the University of Sydney in Australia.  She subsequently went on to complete her training in Internal Medicine and Medical Oncology at Royal Prince Alfred Hospital, an academic teaching hospital of the University of Sydney in Australia and at the Sidney Kimmel Comprehensive Cancer Center Johns Hopkins School of Mediine. Dr. Visvanathan also completed training in clinical/cancer epidemiology at the Johns Hopkins Bloomberg School of Public Health.

Her research is focused on primary and secondary prevention of breast and ovarian cancer. Trained as a medical oncologist and cancer epidemiologist, a large part of her research is transdisciplinary and focused on translating results from the laboratory to populations, to identify at risk groups, preventable targets and to evaluate agents that have the potential to impact the natural history of breast and ovarian cancer. She conducts both observational studies and clinical prevention/early detection studies Specific exposures of interest include hormonal exposures, inflammation, genetic and epigenetic changes, DNA damage/repair, obesity and oxidative damage. She has recently co-chaired the American Society of Clinical Oncology national guideline on breast cancer risk reduction.

BCRF Investigator Since