Michelle Rambarran
(L to R) Drs. Neil Fleshner, Shabbir Alibhai, Tulin Cil split $1 million to fund their different projects in the Health Equity Grand Challenge, the latest in the Princess Margaret Cancer Centre's Grand Challenges competition, which was launched in 2020. (Photos: UHN)

A project that looks at genetic factors predisposing Black men to more aggressive forms of prostate cancer, an investigation into inequity in aging and cancer in Canada, and a global project addressing inequities in breast cancer genetic testing in Nigeria are the latest Princess Margaret Cancer Centre's Grand Challenges to be awarded $1 million in funding.

This Health Equity Grand Challenge is supported by the generosity of donors Lindy Green and Sam Chaiton, and focuses specifically on equity in access to cancer care and disparities that impact the occurrence, frequency, death and burden of cancer in Black, Indigenous and people of colour (BIPOC).

"We are grateful to our generous and visionary donors and with their support can address equity, diversity and inclusion in cancer care," says Dr. Raymond Kim, a medical geneticist at the Princess Margaret and Medical Director Cancer Early Detection.

Adds Jacqueline Silvera, UHN's Director of Inclusion, Diversity, Equity, Accessibility and Anti-Racism: "The donor's focus on equity is invaluable to the health of the communities served by the Princess Margaret."

Dr. Neil Fleshner, Medical Director UHN BioSpecimen Services, and his team will undertake research to identify genetic factors that predispose Black men to more aggressive prostate cancer. They will disseminate their findings to at-risk individuals as well as the physicians who serve these patients, and community groups who advocate for them.

"One in four Black men develop prostate cancer, a two-fold increased risk compared to non-Black men," says Dr. Fleshner. "Our project aims to increase awareness of genetic risk factors and address discrepancies in prostate cancer outcomes for at-risk men."

Dr. Shabbir Alibhai, Senior Scientist at Toronto General Hospital, and his collaborators across the country will study the lived experience of racialized older Canadians with cancer, and examine how they are treated and enrolled in clinical trials.

"In Canada, there is no systemic collection of data on race or gender for those with cancer," Dr. Alibhai says. "Our health systems have biases including age, racism and sexism in cancer care. 

"We need to identify ways to develop a national approach for data collection and use that includes race and gender."

Grand Challenges focus on four pillars of care and discovery

Cancer predominantly affects older people and racialized old adults are less likely to be invited to participate in clinical trials or may decline to participate.

"To improve cancer treatment for this population, we need to change this," says Dr. Alibhai.

Dr. Tulin Cil, a surgeon and researcher who holds the Gattuso Chair in Breast Surgical Oncology, will expand the collaboration between the Princess Margaret Cancer Centre and the Obafemi Awolowo University Teaching Hospital (OAUTH) in Nigeria.

Her research is focused on hereditary testing among Nigerian women predisposed to have breast cancer. Nigerian women are diagnosed at a younger age and later stage of cancer compared to their North American or European counterparts, and yet have limited access to genetic testing.

This project will determine the feasibility of performing saliva-based genetic testing for BRCA 1 or BRCA 2, the genes most commonly affected in hereditary breast cancer. It will also explore perceptions of hereditary breast cancer testing and genetic counselling among doctors and patients in Nigeria, as well as develop tailored, culturally safe educational materials.

"I am excited to do this work with Dr. Funmi Wuraola at the OAUTH and partners in Nigeria," Dr. Cil says. "Our study will improve outcomes for patients, identify knowledge gaps for healthcare providers and add to the literature on breast cancer patients globally.

"I hope it will lay the foundation for breast cancer genetic testing as a standard of care in Nigeria."

The Princess Margaret Cancer Centre's Grand Challenges competition was launched in 2020 to award bold, innovative and high-impact projects, and to inspire cancer diagnostics and treatments to cure more patients and improve quality of life of those living with cancer.

It focuses on the following pillars:

  • Early Detection: detecting cancer early and intercepting it before symptoms, while still curable;
  • Beyond Chemotherapy: thinking beyond chemotherapy towards more precise, customized therapies that effectively target cancer to each individual patient, without the harsh side effects of chemotherapy;
  • Cancer Digital Intelligence: reimagining and redesigning the cancer patient experience by maximizing digital intelligence and embracing augmented human intelligence;
  • Cancer Experience: solidifying the human touch in cancer care by infusing comfort and joy into every interaction, focusing on equity and access, navigation, diversity, ambience of the centre, patient engagement, inclusivity and supportive communication.
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