Titles and Affiliations
Professor of Medicine
Director, Marvelle Koffler Breast Centre
Marvelle Koffler Chair in Breast Research
Research area
Preventing recurrence in patients with early-stage, hormone-receptor positive breast cancer.
Impact
Earlier diagnosis and more effective treatments have led to better outcomes for women diagnosed with hormone receptor (HR)-positive breast cancer. In spite of this, they face a continuing risk of relapse that extends for many years. Dr. Goodwin is conducting a study of tumor- and patient-related factors that may be associated with late recurrence in women who are completing or recently completed adjuvant hormonal therapy. Successfully identifying predictors of risk of recurrence could lead to interventions that will lower this risk and improve the outcomes of women diagnosed with breast cancer.
Progress Thus Far
Dr. Goodwin’s team has reached its goal of enrolling nearly 500 women who were treated for HR-positive breast cancer. The team is analyzing blood and clinical information that will allow them to identify environmental and lifestyle factors, such as stress, physical activity, trauma, surgery, and medication use, that may be related to recurrence as well as blood-based markers, such as circulating tumor cells (CTCs), that may predict risk of recurrence. So far, they have observed 28 cancer events, half of which are distant recurrences. Recently, they found that the presence of CTCs was associated with a striking increase in the risk of metastases developing during the subsequent year. The study is also generating survivorship information about the medical, psychological, and lifestyle status of the study participants. Those studies revealed that women report strong emotional ties and stable overall health, with the majority physically active and maintaining balanced diets. Many use vitamin and calcium supplements with little use of unproven anti-cancer therapies. These results suggest the breast cancer survivors participating in their study are doing well and following healthy lifestyles.
What’s next
In the next year, Dr. Goodwin and her team will validate their findings, investigate additional blood factors (e.g., circulating tumor DNA, metabolic and inflammatory factors), and explore potential contributions of patient-related factors (such as stress, medical/surgical conditions, body size, dirt and physical activity) to the appearance of CTCs and subsequent development of metastases.
In parallel, the team will continue to document the medical, psychological, and lifestyle status of the participants. Exploring changes in these factors during follow-up will enhance our understanding of the lived experience of long-term breast cancer survivors and may lead to novel interventions to lower the risk of late recurrence in breast cancer survivors who are more than five years post-diagnosis.
Biography
Pamela Goodwin has been involved in research relating to host factors in breast cancer for over 25 years. Early in her career, she became intrigued with the possibility that patient-related factors, especially obesity, might impact outcomes of women diagnosed with breast cancer. She began a research program that has focused on the role of these factors, including obesity, nutrition, exercise and related factors. She has led studies which investigate the complex interactions between body size, nutrition, exercise and physiologic mediators such as insulin, IGF-I and vitamin D, examining their impact on risk and survival. Dr. Goodwin has expanded this work to investigate the status of long-term breast cancer survivors and the influences of hereditary factors, vitamin D and metformin on outcomes. She currently leads the international Phase III trial (NCIC MA.32) examining the impact on breast cancer outcomes of an insulin lowering drug, metformin, and has an active translational research program examining the interface between host factors and tumor biology in both early and advanced disease.
Dr. Goodwin is Professor of Medicine at the University of Toronto, with cross appointments in Health Policy, Management and Evaluation and in the School of Graduate Studies. She is a Senior Investigator at the Lunenfeld-Tanenbaum Research Institute of Mount Sinai Hospital, Director of the hospital’s Marvelle Koffler Breast Centre and holds the Marvelle Koffler Chair in Breast Research. She is an Associate Editor of the Journal of Clinical Oncology, has published over 170 research articles, and is active in the clinical management of breast cancer patients.
