Member Spotlight: Dr. Paula Gordon

Last month Minister of Health Adrian Dix announced that BC would become the first province to share breast density results with all women and their healthcare providers with their mammography screening. Dr. Paula Gordon, Medical Director of the Sadie Diamond Breast Program at BC Women’s Hospital, along with the organization Dense Breasts Canada, was instrumental in advocating for this policy change.

In honour of Breast Cancer Awareness month, we spoke to Dr. Gordon about this change and its impact on women throughout the province.

 

  1. What was your involvement in the push toward communicating breast density results in BC?

I’m a volunteer advisor to Dense Breasts Canada, a non-profit group of breast cancer survivors and medical professionals striving to educate women and physicians about the risks associated with having dense breasts.

  1. How is breast density related to breast health?

It’s normal and common to have dense breasts. But having dense breast tissue puts a woman at increased risk for getting breast cancer. Having the highest category of breast density is a greater risk factor than having a mother or sister with breast cancer. And when a woman’s breast tissue is dense, it makes it harder to see a cancer on a mammogram. Cancers and normal dense tissue both appear white on a mammogram, so looking for a cancer “is like looking for a snow ball in a snowstorm.” Women with fatty breasts are at lower risk AND it’s easier to see cancer in a fatty breast.

  1. Why is it important that women are informed about their breast density?

Mammograms miss 50% of cancers in women with dense tissue. So, women with dense breasts need to know that they can’t have the same trust in the accuracy of their mammogram, than women can if they have fatty breasts. They should still have mammograms, but should also do breast self-examination, and should discuss the option of additional screening with ultrasound, with their family doctor. BC Cancer will initiate a program to educate physicians about dense breasts in 2019.

  1. How will this decision impact women in BC?

Hopefully, women who learn that they have dense breasts will be in a position to make informed decisions about their health. ALL women would ideally improve their lifestyle to reduce their risk of getting breast cancer.

Changes include:

  • Maintaining a healthy body weight, especially after menopause
  • Doing regular, moderately-intense exercise
  • Reducing the use of hormone therapy after menopause (use the lowest possible dose for the shortest possible time, avoiding oral estrogen, and balancing the risks with the benefits to their quality of life
  • Minimizing their alcohol consumption: there’s a linear relationship between alcohol use and breast cancer risk. So enjoy, but in moderation
  • Have routine screening mammography.

Women with dense breasts should discuss the option for supplemental screening with their family physician. Currently, there is evidence to show that ultrasound finds an additional 3-4 cancers per thousand women. But like any screening test (like mammograms and pap smears) ultrasound can create false alarms, which can necessitate additional testing to determine whether cancer is present, or not. But when ultrasound finds these cancers, they are usually small, and not yet spread to lymph nodes. So these women are good candidates for less aggressive surgery and often do not require chemotherapy. When not found early, women are more likely to need mastectomies and chemotherapy.


Read more about the announcement here.

Meet the Researcher: Dr. Cheryl Krasnick Warsh

Dr. Cheryl Krasnick Warsh, FRSC is a historian at Vancouver Island University, who also served as Executive Director of the Western Association of Women’s Historians, and Editor-in-Chief of the Canadian Bulletin of Medical History. She presently is co-editor of the international journal Gender and History. Her work focuses on the history of healthcare and health research, and within those fields, the inequalities women have faced in accessing care and inclusion within the healthcare system.

Dr. Warsh started her career as a historian of healthcare nearly 35 years ago.  Studying this history, she explains, adds greater dimension and context to our current healthcare concerns and advances in medicine. The history of gender inequalities in the healthcare system is rich with examples of women’s concerns being treated as psychological, related purely to their reproductive systems, or simply ignored.

“It goes right back to Greek medicine and the first physicians, Galen and Hippocrates,” says Dr. Warsh. “Galen postulated that the centre of a woman’s life was the womb, and the woman was built up around it. Women’s reproductive organs really guided everything about her health from puberty to menopause and beyond.”

She describes that when doctors had no clear cut answer for the cause of a woman’s ailment, they defaulted to the ‘theory of the wandering womb’. If a woman was suffering from a migraine, for instance, they might put sweet smelling herbs near her pelvis and garlic and other bad smelling things near her head to “entice her womb from her head and put it back where it belongs.”

This association between a woman’s wellbeing and her reproductive organs carried on well into the 20th century. Dr. Warsh’s first research was on the London Psychiatric Hospital  during the last decades of the 19th century, where asylum superintendent Richard Maurice Bucke had a theory that “much of a woman’s mental illness related to her ovaries. If she couldn’t be treated, then maybe they needed to be taken out.”

Over the past hundred years or so, the fate of women’s healthcare and health research largely shifted toward the assumption that their care is interchangeable with men’s. She explains that medical science primarily experimented on men, and women’s unique concerns have been downplayed.

“Women were expected from a young age to take care of reproductive health in ways that may not be healthy,” she says. “When the first birth control pill was tested through the FDA in the late 1950s the FDA didn’t yet have scientists there. They had a woman employee whom they sent to get a Master’s degree in science so that she would be ‘qualified’ to test the birth control pill. The early pill had severe side effects.”

These are only a few examples of the long history of inequalities in healthcare, and understanding where we came from can be helpful for understanding where our system stands today.

“When you do a little bit of history on anything, you find out a lot more than you expected,” says Dr. Warsh.


Read more about Dr. Warsh here.

Meet the Researcher: Catriona Hippman

In honour of World Mental Health Day we talked to Catriona Hippman, a WHRI researcher, genetic counselor, and Clinical Assistant Professor in the Department of Psychiatry at the University of British Columbia. Check out this Q&A to learn more about psychiatric genetic counselling, and her research on reproductive mental health!

Catriona Hippman headshotWhat is psychiatric genetic counselling, and what does a counsellor in this field do?

Genetic counselling is a growing field, and is defined as “the process of helping people understand and adapt to the medical, psychological and familial implications of genetic contributions to disease.” Psychiatric genetic counselling entails helping people make personal meaning of the research that has been conducted in the area of psychiatric illness. People might see a psychiatric genetic counsellor if they have a family member with a mental illness (such as a child or parent), and they want to understand more about how they can help to protect their child’s – and their own – mental health. Someone who has a mental illness themselves might see a genetic counsellor to discuss what’s known about the causes of mental illness and what has contributed to their experience of mental illness. Psychiatric genetic counsellors can also talk to women and their partners about how to protect their mental health during and after pregnancy, discuss options in terms of how to manage mental health during pregnancy and the postpartum period, and answer questions about chances for their child to develop a mental illness. An important part of a psychiatric genetic counsellor’s role – regardless of the reason for an appointment – is to address feelings of guilt or shame that often impact families affected by mental illness.

How do genetics play a role in mental health?

While we know that genetic factors play a part in developing a mental illness, we also know that genetic factors alone do not cause mental illness. Anyone who would like to understand more about the causes of mental illness and the role genetics plays in mental health can contact the psychiatric genetic counselling specialty clinic at BC Women’s Hospital – the Adapt clinic: http://www.bcmhsus.ca/our-services/genetic-counselling-(the-adapt-clinic).

What drew you to focus your research on reproductive mental health?

Like many, I was drawn to work in an area that is very personally relevant. Mental illness has ravaged the lives of many of my closest friends. I have seen repeatedly how much suffering is caused by mental illness, and – fortunately – how much people can thrive when they receive support for their mental health. As a feminist, I am particularly passionate about supporting women to care for their mental health at a time when they are most vulnerable – during and after pregnancy.

What impact do you hope to make with your research?

My vision is for all women to feel empowered to care for their mental health, and my mission is to improve women’s reproductive mental health through translational research.

What is the coolest thing about the work you do?

I cherish the connections that I make with women who participate in my research, and I deeply value hearing their stories and working with them to make meaning of their experiences. It is a privilege that women tell me about some of the most personal and private aspects of their lives, and I see it as my responsibility to promote change on a large scale, in whatever way I can, through my research.


Learn more about World Mental Health Day 2018 here.

Researcher spotlight: Meet Dr. Sarah Munro

Dr. Munro is a WHRI researcher and implementation scientist doing work on access to contraception and informed, shared decision-making. She holds a joint post-doctoral position between the Contraception and Abortion Research Team (CART) and the Dartmouth Institute for Health Policy and Clinical Practice (TDI).

Dr. Sarah Munro headshotChoosing the right form of contraception is not always an easy task. Misinformation, high costs, or familiarity with a particular method are all reasons a patient may not consider different options for contraception. This gap is what led Dr. Munro, principal investigator Dr. Rachel Thompson, and the team at Dartmouth to develop and evaluate a set of tools called Right For Me, which supports patients to make informed, shared decisions for contraceptive methods. The tools are comprised of a collection of decision aid handouts, a video and prompt card outlining three key questions to ask during clinic visits, and training for healthcare providers. The tools aim to aid patients in selecting the form of contraception that best matches their values and needs.

The Right for Me study was conducted with funding from the Patient Centered Outcomes Research Institute (PCORI), which focuses on research that directly involves and benefits patients. Patient partners from diverse backgrounds collaborated throughout the research process – from identifying which outcomes to measure, to creating a video summary of the study protocol. Dr. Munro recently completed the qualitative evaluation of the implementation of Right for Me. Stay posted for her publication in the coming months!

Moving forward Dr. Munro will be adapting the Right For Me tools for a Canadian audience. She will continue working with Dr. Wendy Norman and other researchers at WHRI and across the province to implement these successful tools to support shared decision-making for patients and providers involved in maternal, sexual, and reproductive healthcare.

Learn more about RightForMe.org.

Meet the researcher: Dr. Gillian Hanley

Dr. Hanley headshotWHRI member Dr. Gillian Hanley is a health services and health economics researcher with OVCARE.

Recently her work has involved evaluating a knowledge translation initiative which asked gynaecologists across British Columbia to consider changing their practice to include opportunistic salpingectomy to help prevent ovarian cancer.


What is your role at OVCARE, and what led you to ovarian cancer research?

I’m an Assistant Professor in Obstetrics & Gyencology and a PI with OVCARE. I became interested in ovarian cancer research after hearing about the opportunistic salpingectomy (OS) campaign that OVCARE ran and the possibilities for preventing ovarian cancer, which is a terrible disease with a very low survival rate. As it is not possible to screen for ovarian cancer, and we have made little progress in the way of treatment, prevention is our best hope!

Briefly, what is opportunistic salpingectomy and who is it for?

Opportunistic salpingectomy refers to the removal of both fallopian tubes at the time of hysterectomy or instead of tubal ligation in women seeking permanent irreversible contraception. It should be discussed with any woman who is already undergoing one of those surgeries, and involves simply removing the entirety of her fallopian tubes (the tissue or origin for most ovarian cancers).

What was the biggest challenge in evaluating a knowledge translation initiative?

The biggest challenge with evaluation has been that we really need to study this on a population-level, as ovarian cancer is a very rare disease (thankfully). Luckily we have excellent data resources in BC, but they do not always contain data on all the things we would like to know about women who have undergone OS, so we have had to find some creative solutions.

Was there anything that surprised you during the initiative or evaluation?

The incredible success of the educational campaign that Dianne Miller, Sarah Finlayson and others at OVCARE ran in 2010 was remarkable. It usually takes 17 years for a recommendation to significantly change practice. In BC, rates of OS with hysterectomy went from 8% to 75% in and rates of OS for sterilization went from 0.5% to 50% less than 5 years following the campaign. That is really remarkable.

How may these findings impact patient care?

We hope that we will soon be able to show that by implementing OS in British Columbia, we have dramatically decreased the incidence of ovarian cancer in the province. If we have successfully decreased new cases of ovarian cancer, then we know we will have saved lives.

If there was one thing you wish everyone knew about ovarian cancer, what would it be?

That we think we can prevent it.

Meet the students!

Meet Aya, Chadni, Nicole, and Ryan, four students working on WHRI-affiliated projects over the summer.

Aya Zakaria

What do you study?
I am currently a 4th year student in the Honours in Biotechnology program. It is a joint program between UBC and BCIT in which students spend two years in BCIT to undergo rigorous laboratory training, and the final two years in UBC to enhance their theoretical knowledge and research skills.

Who is supervising your project?
Dr. Hélène Côté and Anthony Hsieh. Anthony is a PhD student in the Côté Lab and is also an alumnus of the Honours in Biotechnology program.

In one or two sentences, describe the project you’re working on:
My research investigates the mitochondrial toxicity of various combination antiretroviral therapy regimens on primary human blood cells. These drugs are used to treat HIV and have been previously linked with mitochondrial damage. The focus will be centered on examining signs of mitochondrial damage such as changes in mitochondrial DNA content, membrane potential and reactive oxygen species.

What’s your role in the project?
Under the guidance of my supervisor, I am performing all the experiments and data analyses. I also play a primary role in designing each protocol.

What’s been the most memorable/favourite thing you’ve done on the project so far?
My favorite thing about this project is the independence I am given while designing, performing and analyzing my experiments and results. Being so heavily involved with each step has exposed me to the underlying principles of academic research. It also gave me the opportunity to strengthen my networking skills while interacting with the scientific communities that the Côté lab is part of, such as the Centre for Blood Research.


Chadni Khondokerchadni khondoker headshot

What do you study?
I am a fourth year Integrated Science Student integrating human physiology and motor function in the Faculty of Science at UBC Vancouver.

Who is supervising your project?
Dr. Melanie Murray is supervising the project.

In one or two sentences, describe the project you’re working on:
This study will use existing prospective data from the CARMA (Children and Women, AntiRetroviral and Markers of Aging) study to examine the contraceptive choices and associated factors of women living with HIV (WLWH) and their HIV-negative peers. WLWH less frequently choose hormonally based contraceptive methods when compared with their HIV-negative peers; we aim to determine associated factors such as drug interactions with antiretroviral therapy or other medical contraindications that may influence contraceptive prescribing practices.

What’s your role in the project? 
My role in the project is to conduct a literature review on the topic of contraceptive choice among women living with HIV, to determine the appropriate covariates for analysis, download and clean data from redcap for statistical analysis, as well as begin the preparation of a manuscript. I have the pleasure of attending educational talks delivered by inspiring professionals in the health care field that aid in the progression and development of this project.

What’s been the most memorable/favourite thing you’ve done on the project so far?
My favorite part off this project so far has been to be able to work along side and be mentored by a dynamic group of strong, inspiring female professionals. I am constantly left in awe by their passion, vision, and dedication to advancing health care and commitment to engaging marginalized populations. They go above and beyond for their patients as well as their students and role model ways to approach situations both objectively and with empathy. I feel very grateful for the opportunity to work at Oak Tree Clinic and l look forward to what lies ahead.

Connect with Chadni on LinkedIn


Nicole Ng

What do you study?
I am a medical student at UBC going into my second year!

Who is supervising your project?
Dr. Paul Yong

In one or two sentences, describe the project you’re working on:
Right now, I am working on a project looking at factors associated with negative impressions of the medical profession in women with endometriosis.

What’s your role in the project?
My role in the project is to analyze the data collected from the Endometriosis Pelvic Pain Interdisciplinary Cohort Data Registry at the BC Women’s Centre for Pelvic Pain and Endometriosis and to present my findings at different opportunities such as the BC Children’s Hospital Research Institute Summer Student Research Program poster day.

What’s been the most memorable/favourite thing you’ve done on the project so far?
The most memorable thing I’ve done so far on the project is learning more about how chronic pelvic pain and endometriosis can have big impacts on different aspects of a woman’s quality of life and current approaches to address these problems.


Ryan Yanryan yan selfie

What do you study?
I am currently working on an audit of the Evaluating Maternal and fetal Markers for Adverse placental outcomes (EMMA) clinic here at BCWH.

Who is supervising your project?
Drs. Chantal Mayer and Julie Robertson

In one or two sentences, describe the project you’re working on:
Pregnant women across BC and Yukon are referred for assessment by their prenatal care providers (obstetricians, family doctors, midwives, etc.) if they are at high risk for developing placental disease, including pre-eclampsia and intrauterine growth restriction. We are investigating if the current referral criteria and in-clinic assessment appropriately selects the population at highest risk and what the maternal, fetal and neonatal outcomes are.

What’s your role in the project?
Currently I am collecting data from various sources about the referral, EMMA assessment, and pregnancy outcomes, which will then be analyzed and ultimately used to inform better care.

What’s been the most memorable/favourite thing you’ve done on the project so far?
In June, I gave a short presentation of my work to other participants of the BCCHR Summer Student Research Program.

Meet the students!

This summer there are four students working on projects with Dr. Gina Ogilvie’s team! Sandy Zhang, Catherine Sanders, and Kara Plotnikoff are SFU Master of Public Health students completing their practicums over the summer, and Christine Lukac is an epidemiologist and UBC Medical student researching the impact of the school-based HPV immunization program.

Sandy ZhangSandy zhang

Sandy is currently working on CervixCheck, a web-based application which utilizes HPV self-collection kits to improve cervical cancer screening in BC. Sandy is involved with community engagement to help guide and inform CervixCheck’s online platform. Her role focuses on engaging with patients and clinicians in four family practices through administering a cross-sectional survey to assess the feasibility and acceptability of the program. Her work will provide knowledge and insight into the acceptability of CervixCheck in preparation for its launch.

Sandy’s favorite part of her practicum thus far has been the opportunity to connect with women in the community and work with frontline health care teams to better understand and address the existing barriers to cervical screening through a unique program like CervixCheck.

Connect with Sandy: LinkedIn

Catherine Sanders

Catherine is excited to be completing her practicum with the Advances in Screening and Prevention in Reproductive Cancers (ASPIRE) project. The most recent ASPIRE initiative is a pragmatic, randomized control trial in rural Uganda which compares 3 different approaches to cervical cancer screening.  Her role has been to assist with the design and implementation of the study, primarily through the development of standard operating procedures, training materials, and data collection forms. The most valuable aspect of her practicum has been gaining knowledge and experience in Implementation Science as an ideal approach to conducting research and improving health care and health service delivery in low- and middle-income countries.

Connect with Catherine: LinkedIn | Twitter

Kara Plotnikoff

Kara shares her time between the BC Centre for Disease Control and the Women’s Health Research Institute. Kara has been involved in the development, implementation, and analysis of a survey for BCCDC STI clinic clients exploring their perceptions about STI vaccines as an emerging form of prevention and treatment. Kara is also working with STRIVE-BC to plan a pre-conference symposium dedicated to the research and development of STI vaccines at a global scale, to be held preceding the STI & HIV World Congress in July 2019. Kara enjoys her time at the WHRI because of the ample opportunities to learn about the important and ground-breaking work in the field of women’s health research while being immersed in a dynamic and forward-thinking environment. She can often be found attending rounds or listening to webinars and live-streams trying to learn as much as she can about research and research methods.

Connect with Kara: LinkedIn | Twitter

Christine Lukac, MPH

As part of Dr. Ogilvie’s team, I am studying the impact of the school based Human papillomavirus (HPV) immunization program on the rates of genital warts (GW) in BC. HPV is a common sexually transmitted infection, and GARDASIL®4 is a highly efficacious vaccine that protects against four HPV serotypes, including 6 and 11 which are associated with 90% of GWs. In 2008, the first cohorts of girls were immunized in grades 6 and 9, and by 2017 they reached the age of sexual maturity. Among the first immunized cohort, some women are now sexually active and may have been exposed to HPV. This work is timely and the results are highly anticipated by public health stakeholders in BC to monitor attainment of population health targets and optimize the HPV immunization program.

This project has afforded an opportunity to practice research skills during all stages of the study: literature review, project planning, data access, data management and analysis, communicating results, writing a manuscript, and submission for publication. I am grateful to be working with Dr. Ogilvie as she creates learning opportunities, promotes the strengths of her team members, and builds collaboration between her networks. For example, Dr. Ogilvie connected me with Dr. Robine Donken, a postdoctoral research fellow at the Vaccine Evaluation Center and Women’s Health Research Institute. One of my favourite and enjoyable parts of working on this project has been meeting with Dr. Donken on a weekly basis to discuss progress and next steps in data management and analysis.

Connect with Christine: LinkedIn

Dr. Jennifer Love: Fighting the gender pay-gap at UBC

This year WHRI was excited to present Dr. Jennifer Love as a keynote speaker on the topic of Women in Academia. Dr. Jennifer Love was recently reappointed for the 2018-2020 term as Senior Advisor to the Provost on Women Faculty at the University of British Columbia, a role which she has filled since July 1, 2016.

In her position she led the creation of a “Faculty Data Dashboard” – a tool which compiles faculty data to compare salary, parental leave, tenure track, and other factors by gender to help understand discrepancies between male and female faculty members.  The dashboard is the result of collaboration between Dr. Love and Human Resources and Planning and Institutional Research (PAIR) at UBC, and will be instrumental in identifying areas to promote greater equality.

In addition to the dashboard, Dr. Love will be tackling the issue of the gender pay-gap at UBC as chair of the pay equity committee. She will also be working alongside the Faculty Association to develop programming to mentor and sponsor women faculty.

Meet the researcher: Dr. Nichole Fairbrother

Dr. Nichole Fairbrother holding a koala bear

What is your role?

I am an assistant professor in the UBC Department of Psychiatry, located in Victoria BC with the UBC Island Medical Program.

What led you to a career in research?

The year after high school I took a career interests test and my strongest (by far) score was for research psychologist. I find the idea of learning something completely new for the world, no matter how small, very thrilling. Following the birth of my first child, I developed a passion for healthy reproduction and early parenting. I am very grateful to be working in the field of maternal mental health.

Can you summarize your research in one sentence?

I study anxiety disorders in women during pregnancy and the first year postpartum.

Why is your research important?

As many as 20% of all pregnant women and new mothers report symptoms meeting criteria for one or more anxiety disorders. When I began in this area, very little research had been conducted, despite the fact that anxiety disorders can be very distressing and impairing for the women who experience them, and can have negative consequences for the developing fetus and for infants.

Who or what inspires you?

I am inspired by caring and compassion. My primary motivator in life is the alleviation of emotional distress in others.

What’s the most important lesson you’ve learned in your career so far?

Research does not happen quickly.

What is the coolest about the work you do?

I study new mothers’ unwanted, intrusive thoughts of infant-related harm. This is a really cool topic.

When you’re not working you can be found  _____.

Riding my bike, playing with my children, doing aerial hoop.