What is cervical cancer?

The cervix connects the uterus (womb) to the vagina. Cervical cancer is almost always caused by human papillomavirus (HPV), which is passed from one person to another through sexual contact. There are over 100 strains of HPV, but only some can cause damage to the cervix that may lead to cancer.

Getting an HPV infection is very common. For most people, it will go away on its own without causing any harm. In some cases, however, a cancer-causing HPV virus can stay around for several years and cause more serious damage. This is why cervical cancer is very rare under the age of 25.

HPV vaccination is important because it can prevent many cases of cancer-causing HPV infections from developing. HPV vaccination does not prevent all cases, which is why screening is still important.

What will be changing around cervical cancer screening?

Ontario recently moved away from Pap tests as the first line of cervical cancer screening, to instead testing for the most common types of HPV viruses that can cause cervical cancer. HPV testing is better because it can identify those people who have a higher chance of already having or developing a cervical pre-cancer or cancer.

How is HPV testing done?

At this time, the most accurate way to detect an HPV infection with abnormal cervical cell changes is to take a sample directly from the cervix. Patients will still need to have a speculum exam at their doctor’s office, so the physical experience will feel the same as having a Pap. Patients will receive a copy of their results by mail. If positive for HPV, they will be advised of the necessary next steps. If negative, they will be told when they are next due for cervical screening.

A negative HPV test has been shown to be very good at correctly identifying people who do not have a cervical pre-cancer or cancer, and who will not develop a cervical cancer in the next five years.

If the presence of HPV is found, it doesn’t necessarily mean the patient will develop cervical cancer. Further tests will be done on positive HPV samples to look for pre-cancerous cells. Based on the HPV result and presence or type of pre-cancerous cells found, additional procedures such as colposcopy may be needed to look at the cervix more closely. For others, more frequent testing to make sure the HPV clears, or no new pre-cancer cells develop, may be all that is needed.

What is colposcopy?

Colposcopy is a procedure that closely examines the vagina, vulva and cervix using a special microscope. Sunnybrook is home to the largest colposcopy clinic in Ontario based on the number of patients seen. The multi-disciplinary team has specific training in detecting and managing genital cancers and pre-cancers.

At what age and how often should screening be done?

The other big change is around timing: screening will start at age 25. It’s recommended screening be done every five years because HPV infections need to be present for a long time before possibly developing into cancer. This change is based on science and people should feel safe. People who have a hard time fighting viruses due to a weakened immune system should be screened every three years.

Most people can stop screening between ages 65 to 69 if they have undergone regular cervical cancer screening during their lifetime. Your health-care provider can let you know what’s best for you.

Does it matter if I’ve ever been sexually active?

The HPV virus is spread through sexual contact with the genitals, which can include contact with the hands, mouth or genitals. This is why screening for HPV isn’t necessary unless a person has ever been sexually active.

Who specifically should be screened?

According to Ontario Health, get screened if you:

• are at least 25 years old
• are a woman, Two-Spirit person, transmasculine person or nonbinary person with a cervix
• have ever had sexual contact with another person
• do not have symptoms, like different bleeding or discharge (clear or yellow fluid) from the vagina

Ontario Health adds that you should still get screened if you:

• have had the HPV vaccine
• feel healthy
• have been through menopause
• have not had any family members with cervical cancer
• have had sexual contact with only one person
• have had the same sexual partner for a long time
• have not had sexual contact in a long time
• are in a same-sex relationship

How can I book screening?

There are a few ways. You can call your family doctor, nurse practitioner or midwife to book screening, or call Health811 to find a nearby screening clinic. Ontario Health also has a live chat option.

Where can I get more information?

To learn more about lowering your risk of cervical cancer, visit www.mycanceriq.ca.

Click here to read more about these new screening guidelines.

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What Exactly Is HAIP?

HAIP is a special form of treatment for individuals where colon or rectal cancer (colorectal cancer) has spread to the liver. It is used when there are too many spots of cancer within the liver to allow a surgeon to safely remove them all. HAIP offers a chance of cure to these patients by delivering targeted doses of chemotherapy, directly to the liver, through an implanted pump. The goal is to make the disease in the liver small enough that a surgeon can go in and remove what is left.

Who Is a Good Candidate?

This treatment is best for fit, motivated patients who want to adopt an aggressive treatment philosophy. Patients need to have no or very limited cancer outside the liver, and be well enough to undergo an operation. Special testing is done to ensure that the blood flow to the liver is appropriate to allow the treatment to be safely offered.

If a patient is a good fit, they’ll undergo surgery to have the pump implanted into the abdomen and a small catheter fed directly into the liver. This procedure usually takes about one to two hours, sometimes longer if the original cancer in the colon or rectum needs to be taken out at the same time.

Following that, a special nuclear medicine scan is done. Dye is injected into the body to make sure it’s reaching both lobes of the liver, and not going anywhere else in the body. That’s how we know it’s safe to start using the treatment pump. We start filling the HAIP with chemotherapy about two weeks after surgery.

What Is So Special About HAIP Therapy?

The liver is the most common site of spread for colorectal cancer. For patients with cancer spread that is limited to the liver, intensifying therapy directly to the liver makes a lot of sense.

The liver has several special properties that make HAIP therapy a very good option. First, it has two sources of blood supply (the portal vein and the hepatic artery). Studies have shown that healthy liver tissue preferentially gets it blood supply and nutrients from the portal vein, whereas growing cancer cells preferentially steal their blood supply and nutrients from the hepatic artery. That means we can preferentially treat cancer cells while sparing healthy liver by directly infusing chemotherapy into the hepatic artery.

The liver is also a unique organ; it’s where many drugs are first broken down by the body. This is called the “first-pass effect.” That means we can give very high doses of medicine directly to the liver, allow them to kill cancer cells, and know that very little chemotherapy ever gets to the rest of the body to cause side effects.

We use a very special type of chemotherapy called FUDR. It’s brought into Canada specifically for the HAIP program, and not used anywhere else. About 99 per cent of the drug is broken down in the liver itself, so we can give really high doses without the risks of side effects that are typically associated with chemotherapy, like nausea. Studies have shown we can give 400 times the dose because it’s going directly into the liver.

How Many Patients Have Had HAIP?

About 105 patients have had the pump implanted at Sunnybrook since HAIP’s inception eight years ago. I work closely with Dr. Paul Karanicolas, the surgeon who implants the pump, and many others. HAIP is such a special program that involves a coordinated, multidisciplinary team approach to care, with close collaboration across surgical oncology, medical oncology (chemotherapy), interventional radiology, nuclear medicine and oncology nursing. A patient’s first point of contact is Christina Kim, the nurse practitioner who oversees the program and helps every patient navigate the HAIP journey.

How Effective Is HAIP?

We’re seeing some really dramatic improvements in our patients. About 25 per cent who have HAIP can go on to have surgery to remove the cancer from their liver. These were patients who didn’t have that option before. Of the 105 patients that we’ve treated, about four have had their cancer completely disappear on imaging. Four others have had a good enough response to go on to other potentially curative therapies, such as a liver transplant.

It’s amazing because in many areas of oncology that I treat, there isn’t a realistic chance of cure. Through HAIP, Sunnybrook’s Odette Cancer Program is able to offer something that no one else can: a source of hope.

Has the Program Evolved?

While some patients with small spots on the liver can have surgery to remove it, they still face about at least a 50 per cent chance of the cancer coming back. In the United States, some centres are using HAIP to prevent this recurrence.

The other area where HAIP has shown evidence of success across the world is in treating bile duct cancers. At Sunnybrook, we are hoping to expand the use of HAIP in the future to apply to different types of patients and cancers.

How Can People Learn More?

Because we are the only program of its kind in Canada, we get referrals from all over the country. We can only treat patients residing in Ontario, however, because of our funding structure. More details are available on Sunnybrook’s HAIP webpage.

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What does “good nutrition” mean?

Simply, it means making sure a patient gets enough calories and protein to maintain their weight and keep their body strong. For patients who are losing weight or struggling with low appetite, I advise them to choose high-calorie, high-protein foods so they get the most nutrition in every bite. Examples are nuts, seeds, full-fat milk products, eggs, smoothies and shakes. They may find it easier to eat small meals or snacks every two to three hours instead of three larger meals. They can opt for any food that looks appealing. Eating breakfast for dinner is totally fine!

Is protein needed at every meal or snack?

Yes. People with cancer usually need more protein. Protein helps to build muscle and repair healthy cells that are damaged during chemotherapy, radiation and surgery. They can include a protein food, like meat, poultry, fish, legumes (dried beans, peas and lentils), tofu, eggs, dairy products, nuts or seeds at meals and snacks. Protein powder or skim milk powder can also be added to low-protein foods, like oatmeal and congee, to turn them into high-protein foods.

What about hydration?

All liquids provide hydration. If a patient’s weight is stable, water is the drink of choice. If they are losing weight, liquids that contain calories and protein are key; cow’s milk, soy milk, hot chocolate, smoothies, milkshakes and lassi. Soups made with cream, beans or meat contain calories and protein and can help meet nutritional needs.

Are oral nutrition supplements recommended?

Oral nutrition supplement drinks provide extra calories and protein, and can help patients meet their nutritional needs when food is not enough. Patients who are losing weight should pick the “plus calories” versions to get the most nutrition. If they have a medical condition like diabetes or kidney disease, it’s advised they ask a dietitian if a specialized nutrition supplement would be beneficial.

What role does exercise play?

Up to half of newly diagnosed cancer patients have low muscle mass, also called sarcopenia. Low muscle mass can make it harder for patients to do their daily activities and deal with side effects of treatment. Eating enough calories, protein and staying active during treatment helps to maintain and build muscle. Patients should try to be active for 30 minutes every day. Inactive patients can start with 5 minutes of physical activity a day and increase the duration over time.

What are the benefits of good nutrition for patients undergoing cancer treatment?

Good nutrition can help patients maintain their strength, energy, weight and muscle mass. It also means a lower chance of getting an infection or being admitted to hospital during treatment. Robust patients who have good nutrition and exercise regularly usually deal better with the side effects of treatment, stick to their treatment plan, heal and get better faster.

Talk to your health-care team if you have any questions about nutrition or exercise. The Odette Cancer Centre also has nutrition resources for additional support.

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In 2017, undergraduate student Dr. Julia Hamer and I reviewed the literature to determine what evidence-based lifestyle changes women could make to improve their overall health and reduce their risk of dying of recurrent breast cancer. Our review of 67 published scholarly papers was published in the Canadian Medical Association Journal. Here is a summary of our findings then, what’s been learned since and some helpful resources that are available now.

Exercise

Aside from following their recommended treatment plan, exercise is the single most important thing women with breast cancer can do. That means starting or continuing exercise right from the moment of diagnosis, through active treatment (chemotherapy, radiation, surgery) and beyond. We found that even a small amount is beneficial; 30 minutes per day, five days per week of moderate exercise, may boost survival rates by about 40 per cent. More hours per day (but not more vigorous exercise) may be even more beneficial. It appears that a mix of aerobic exercise and muscle strength training is ideal. Importantly, exercise is also linked to a reduction in treatment side effects like nausea, fatigue, anxiety and depression.

A more recent study, looking at women at high-risk for recurrence, supported the benefits of exercise. It found women who met the above minimum exercise guidelines before their diagnosis, as well as two years after treatment, had a 55 per cent lower risk of recurrence and a 68 per cent reduced risk of death from any cause. Women who did not meet the guidelines prior to their diagnosis, but did at the two-year follow-up, had almost a 50 per cent lower risk of breast cancer recurrence and a 43 per cent lower risk of death from any cause.

Weight gain

Weight gain of more than 10 per cent of one’s initial body weight has been shown to increase the risk of breast cancer recurrence and death. Exercise, as well as guidance from a registered dietitian, can be helpful in maintaining a healthy weight.

Diet

No specific type of diet has been shown to reduce the risk of breast cancer recurrence. Evidence shows that patients do not need to avoid soy, and it may actually help with weight management if used to replace higher-calorie meat proteins. Women should aim for a diet high in fruits, vegetables, lean protein and fibre, and low in saturated fats, simple sugars and alcohol. A high-calcium diet is helpful for maintaining bone health, and is preferable to supplements.

Vitamin supplements

Moderate consumption of vitamin C may be helpful, but more evidence is needed. Because chemotherapy and hormonal treatment can reduce bone density, vitamin D supplements should be taken by all women to maintain adequate levels for bone strength. As vitamin D requires fat to be absorbed properly, be sure to take it with a meal if choosing the pill form.

Smoking

Simply put, stop smoking. While it’s unclear if quitting after a breast cancer diagnosis affects recurrence, the risk of death from smoking-related health issues is a strong reason to butt out.

Alcohol intake

Limiting alcohol intake doesn’t affect the risk of recurrence but will reduce the risk of developing a new breast cancer. Aim to hydrate with water. All women, especially those on chemotherapy, should try to drink two litres of water daily. Having water available during and after exercise is particularly important.

Final thoughts

As powerful as lifestyle changes can be, they are never a substitute for the standard treatments your health-care team has prescribed. The breast cancer patients who benefitted from lifestyle changes in the reviewed studies were also receiving conventional anticancer therapy.

Most importantly, I want this to be clear: no woman should ever be made to feel guilty that her breast cancer has come back and spread because she didn’t make enough positive lifestyle changes. Some breast cancers have aggressive biology and will recur despite the most meticulous lifestyle behaviors.

I hope that this review and its key findings will help point women in the direction of lifestyle changes that could have a positive impact on overall health and on reducing breast cancer recurrence.

Helpful resources:

Exercise

• Toronto Rehab’s Health, Exercise, Active Living and Therapeutic Lifestyle (HEALTh) program
• Wellspring
• Moving Through Cancer

Smoking Cessation

• Sunnybrook Health Sciences Centre

Alcohol and Drugs

• Sunnybrook Rapid Access Addiction Medicine (RAAM) Clinic

The post Lifestyle changes that impact breast cancer risk appeared first on Your Health Matters.

Does sugar feed cancer?

No. Sugar is a carbohydrate and all cells in the body use carbohydrates for energy. If you avoid carbohydrates, that could actually lead to undesired weight loss which is associated with worse outcomes. While it’s always a good idea to focus on eating a variety of nutritious foods, there is no dietary change that can “starve” cancer cells.

Is it ok to eat soy (isoflavones)?

Yes, even for people with hormone-sensitive cancers like breast and prostate cancer. Furthermore, studies suggest that up to three servings of soy foods – like one cup of soy milk or one-third cup of tofu – per day may be protective against colorectal, prostate and breast cancer. It is not recommended to take soy supplements, since they have much higher levels of isoflavones.

Should I avoid eating red meat?

No, but remember moderation. Red meats like beef, pork and lamb provide protein and important vitamins and minerals that are part of a balanced diet. If you choose to eat red meat, limit it to three servings a week; higher amounts are linked to an increased risk of colorectal cancer. When it comes to processed meats like bacon and deli meats, try to avoid them or only eat small amounts.

Is it safe to eat dairy?

Yes. Dairy provides calories, protein, calcium and vitamin D, which are all important for a healthy diet. Canadian farmers are not allowed to use growth hormones in dairy cows, and all milk is tested to make sure it’s free of antibiotics.

Are there any benefits to opting for organic produce?

Eating fruits, vegetables and other plant-based foods, whether they are farmed organically or traditionally, is the best way to reduce your risk of cancer through food. It’s recommended that patients choose produce they enjoy the taste of and that fits their budget. That can include choosing fruits and vegetables that are canned, fresh or frozen.

Should I be taking vitamin/mineral supplements?

No, unless your health-care team recommends you to do so. The body uses vitamins and minerals best when a variety of vegetables, fruits, whole grains and protein foods are included in the diet.

Should all patients undergoing cancer treatment change their diet?

No, unless there are issues with weight loss or symptoms that make it difficult to eat. Following Canada’s Food Guide (food-guide.canada.ca) is a good starting point, and supports a balanced diet containing lots of vegetables, fruits, whole grains and adequate sources of protein. Talk to your health-care team if you have any questions. The Odette Cancer Centre also has nutrition resources for additional support. (Sunnybrook.ca/cancernutrition)

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To help unpack the change, three Sunnybrook experts provide their perspectives. They say the change is welcome – but patients in their 40s should still speak with their primary care provider about whether early mammography is right for them.

Dr. Lisa Del Giudice is a family physician and the regional primary care cancer lead for the Toronto Regional Cancer Program.

Dr. Ellen Warner is a medical oncologist at Sunnybrook’s Odette Cancer Centre who led a practice-changing study of breast cancer screening for high-risk patients.

Dr. Martin Yaffe is a senior scientist, Physical Sciences at the Odette Cancer Research Program.

How will this change current screening protocols?

LISA: Currently, only patients age 50-74 can self-refer for a screening mammogram. This means they can book their own appointment directly through the Ontario Breast Cancer Screening Program without a doctor’s referral. Patients in this age bracket also receive a recall letter every one to two years inviting them to be re-screened for breast cancer.

The change coming into effect this fall will mean patients in their 40s will also be able to self-refer for a mammogram if they wish. They can also continue to seek guidance and a referral from their primary care provider if they prefer. This will be a big shift from the status quo, where currently people age 40-49 who want a screening mammogram must discuss it with their primary care provider first, who will then refer them for the procedure.

Until now, how commonly have family doctors referred patients in their 40s for a screening mammogram if asked?

ELLEN: I think most (but not all) patients in this age group who have asked for a mammogram got a referral. Having a mammogram at this earlier age should be a nuanced discussion between a patient and a doctor.

LISA: I have heard of the rare situation where patients were told they did not qualify because they weren’t 50. Not all family doctors are aware they should discuss the pros and cons with the patient but still refer them if they want to be screened; there is definitely some confusion and room for improvement.

In the months ahead, we also expect that health authorities and regional cancer programs will be offering educational programming for family doctors to increase their understanding around screening protocols. Several new patient resources will also highlight the benefits and risks of screening people age 40-49, especially for people who do not have easy access to a primary care provider.

What are the pros and cons of screening mammograms that patients in their 40s should consider?

MARTIN: In 2023, Canadian researchers compared data from provinces which regularly screen patients in their 40s with data from those that don’t and concluded that earlier mammography screening leads to improved breast cancer survival rates.

Lowering the age at which people can self-refer gives them more control over decisions around earlier detection to prevent advanced cancer. That’s important knowing that people diagnosed with breast cancer earlier face the possibility of more years of life lost.

Also, by treating cancers found earlier, you may reduce the need for extensive surgery or other aggressive treatments, like radiation or chemotherapy.

Among the cons is the need for a screening recall, which happens when the result isn’t clear and secondary imaging is needed. Even though only a small number of these recalls will result in a diagnosis of cancer, the process can cause anxiety. If after that recall imaging there is still some suspicion, a biopsy may be done. While that’s not surgery, it involves needles which can be stressful and uncomfortable. There is also the risk of overdiagnosis. That means finding a real cancer, but one that is very slow growing and might have otherwise caused no harm because it wasn’t serious. Despite the fact it doesn’t cause risk, that patient is now a cancer patient. The challenge is that until a cancer is found and evaluated, the doctor doesn’t know if it’s slow growing or one that will be more aggressive.

One way we could reduce the anxiety associated with screening is to reduce the time it takes for a patient to be told that ‘everything is okay’ after recall imaging or a biopsy.

 LISA: For people in their 40s, there is an increased risk of ‘false positives’, or screening recalls that do not find cancer, due to factors such as having denser premenopausal breasts. As Martin noted, this process can then lead to biopsies and other tests which can be anxiety-provoking. Patients need to consider their tolerance for false positives and whether they will be okay if they have to wait to have further tests done.

It is also worth noting there is weaker evidence to support systematic breast cancer screening among people age 40-49 compared to those age 50-74. On the other hand, there are people in their 40s who may be at higher risk of developing breast cancer, such as those with a family history, certain ethnic groups, and those of late childbearing age.

When family doctors are discussing screening mammography with patients, they need to help them weigh out all their individual risks and benefits.

What do you think of the change to Ontario’s breast cancer screening protocols?

ELLEN: Patients who want a mammogram should be able to get one. But it shouldn’t be misinterpreted as an endorsement for every single patient in their 40s to get screening mammography.

LISA: Cancer screening has many potential benefits and people have wanted this for some time. But I have also seen a lot of anxiety that can come from a false positive; it happens to more patients than you might think. In a perfect world, primary care providers will have the time to thoroughly discuss the pros and cons with individual patients.

 MARTIN: Primary care doctors are busy and some may not fully understand the issues around screening, so better educational tools will help them. It’s worth noting that having a screening mammogram is not mandatory at any age. Providing clear and accurate information will help patients make the decision that is best for them.

As I referred to above, researchers have found that earlier screening leads to improved survival rates. Overall, this is something I’ve been pushing towards for over 20 years, so I think it’s great news. And it brings Ontario in line with several other provinces where patients can self-refer for a mammogram starting at age 40.

Any other thoughts regarding breast cancer screening?

MARTIN: There are other groups, including Black patients and other ethnic and racial minorities, who are at a higher risk for breast cancer in their 40s. Right now, we don’t have any special considerations in place around reducing barriers to care and providing more equitable health care for these individuals. Moving screening to age 40 will help some of these patients.

ELLEN: Screening everyone the same way based on their age and sex isn’t a terribly efficient way to do things. It would be nice to approach this in a more nuanced way. That means screening patients with a family history and those with a first pregnancy after age 35. There are a lot of models that look at risk and can help predict those patients who are most likely to get breast cancer, and therefore benefit from earlier screening. Continuing to research these risk-prediction models would be helpful.

LISA: It’s important to note that screening mammograms are for people who do not have any symptoms. Anyone who feels a lump or notices changes in their breast(s) should be assessed by a doctor or nurse practitioner and get a diagnostic mammogram and possibly an ultrasound. A diagnostic mammogram provides more detailed views of the breast and does require a referral.

The post What to know about screening mammograms in your 40s appeared first on Your Health Matters.

Breast cancer is one of the most common types of cancer affecting women in Canada. About 1 in 8 women develop breast cancer in their lifetime. Starting in the cells of the breast, tumours can infiltrate nearby tissue or spread to other parts of the body. Breast cancer can be treated with surgery, drug therapy, and radiation therapy, but not all breast cancers are the same. Since every patient will respond to these treatments differently, predicting a tumour’s response to therapy can improve patient outcomes.

Dr. William Tran, radiotherapist and senior scientist in the Odette Cancer Program, has teamed up with Dr. Fang-I Lu, a breast pathologist at Sunnybrook and associate professor at the University of Toronto and together, they are developing AI technology to improve radiation therapy treatment for breast cancer patients.

The team is mapping the tumour immune microenvironment, the complex ecosystem of cells surrounding the breast’s tumour. Since the immune system plays a role in clearing tumour cells, the team aims to measure the probability of a tumour’s response to high-dose radiation treatment in women with high-risk breast cancer. The project involves taking thousands of tumour images and complex computational methods to recognize biomarkers associated with the tumour-killing effects of radiation treatment.

Dr. Fang-I Lu and Dr. William Tran analyze an annotated pathology sample.

“Our work will allow doctors to determine which patients will benefit most from radiation therapy,” explains Dr. Lu. “The ability to predict a tumour’s response to certain types of therapy has the potential to support more personalized and effective treatment plans for patients with advanced breast cancer.”

Radiation therapy is a common type of treatment for many cancers. The treatment uses high-energy beams to destroy the genetic material in cancerous cells that control how the cells grow and spread. Radiation therapy can also damage healthy cells in the body, which can cause short-term and long-term side effects like hair loss and fatigue. “Personalizing the treatment plan using AI can help optimize treatment outcomes while minimizing the side effects,” adds Dr. Tran, who is also an associate professor at the University of Toronto. “Our AI-based prediction model will help spare patients who are unlikely to benefit from radiation treatment from the short and long-term side effects associated with exposure to that type of therapy.”

Since 2018, the team has been researching the use of AI and digital pathology to map breast tissue samples and measure their resistance to neoadjuvant chemotherapy treatments. With this newest model currently undergoing planning for early-phase clinical trial testing, Dr. Tran hopes to continue improving personalized cancer treatment planning in the radiation oncology clinic.

The post AI in Action: Supporting precision radiation oncology appeared first on Your Health Matters.

A good summer skin care routine is essential to counteract the effects of factors like sweating and pollution. It is recommended to wash your face twice a day to remove dirt and excess oil. Immediately after washing, use a lightweight, oil-free moisturizer to keep your skin hydrated without clogging pores, and avoid heavy products that can cause breakouts.

Sun protection is crucial for everyone all year long. Use sunscreen with an SPF of 30 or higher regularly and reapply every two to three hours. Harmful ultraviolet (UV) rays can get through windows, even if you are indoors or inside a car, so wearing sunscreen daily is recommended. Additionally, wear a hat, sunglasses and sun-protective (UPF) clothing to further shield your skin from potential damage.

To prevent the appearance of sun-spots, use tinted sunscreens. Recent studies reveal that visible light, from sources like the sun, indoor lighting and screens, contributes to skin pigmentation. Most sunscreens protect against UV light, which can increase the risk of sunburns and skin cancer, but not against visible light. Tinted sunscreens resemble foundation and contain both UV filters and iron oxides, which block visible light.

If you do happen to get a sunburn this summer, get inside as soon as possible to a cool, air-conditioned space. To help soothe your skin, take cool baths, showers or apply cool compresses. Afterward, gently pat your skin dry and apply a thin layer of a lightweight moisturizer to ease dryness. Using a soothing moisturizer that contains aloe vera or soy can provide additional relief with a cooling effect. If your sunburn is very red and uncomfortable, you can apply an over-the-counter mild hydrocortisone cream two to three times a day. For more severe cases, you may need to see a doctor for a stronger cream. To avoid further irritation wear lightweight, loose clothing and steer clear of irritating skin care products like exfoliating creams. When you go outside again, protect your skin by seeking shade and using sun protection.

During this season and all year long, it’s important to monitor your skin and moles. The Canadian Skin Cancer Foundation has helpful resources to guide you. Be sure to see a doctor if you notice any changes.

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Sunnybrook Health Sciences Centre is home to the Odette Cancer Centre, the second largest cancer centre in Canada. The centre is leading the way in innovative cancer care that is designed to meet the unique needs of individual patients living with cancer.

At the latest Sunnybrook Speaker Series, experts from the centre shared their insights about personalized cancer care and how it is evolving.

Dr. Calvin Law, chief of the centre, described the transformative future of personalized cancer care as the health-care system moves away from a “one-size-fits-all approach” and instead focuses on each individual’s experience and treatment needs in order to achieve the best possible outcomes.

“At the end of the day, it is the individual patient who we are serving,” said Dr. Law. “The personalized care we provide needs to get better every day.”

How do Genes Play a Role in Personalized Cancer Care?

Tracy Graham, genetic counsellor and manager with the Odette Cancer Centre Genetics Program, shared her insights on how a person’s genes can play a role in the personalized cancer care they receive – something many patients might not be aware of.

“All cancer is genetic because there has to be genetic mutations occurring within the cells of our body for cancer to occur,” explained Graham. “But only five to ten percent of cancer is hereditary.”

Genetic testing can be done for both hereditary cancers (germline mutations) and those which are acquired throughout a person’s lifetime (somatic mutations) to help determine the most effective treatment options.

Often conducted with a simple blood or saliva test, genetic testing can also provide patients with a sense of closure by answering the question, Why was I diagnosed with cancer?, said Graham.

“For example, for a patient who is diagnosed with colorectal cancer in their 20s – which is a young age – finding out there is a hereditary genetic reason behind it sometimes gives them that explanation they are looking for.”

Genetic testing and counselling can also help guide screening and early detection for other types of cancer a person could be at risk of developing, as well as for their family members.

The Future of Precision Oncology

Dr. Eileen Rakovitch, program research director with the Odette Cancer Centre, explained that experts are trying to better understand why standardized cancer treatments are more effective for some patients than others.

A key goal for the future of cancer care is to shift towards personalized treatment for each individual, as opposed to the same approach being used for all patients with the same type of cancer.

Thanks to breakthrough scientific technologies, cancer researchers can now pinpoint the molecular profile of cancers in order to recommend optimal personalized treatment plans.

“With molecular profiling, we now can see this individual with breast cancer, for example, has a different molecular profile than others,” explained Dr. Rakovitch. “Once you do that, you can match and individualize the best drug or radiation treatment for that specific individual.”

Added Dr. Rakovitch: “This is going to enable us to direct better and more effective treatments to patients and help them avoid side effects of treatments that are ultimately not going to be effective. This is the future of cancer treatment.”

Targeting Cancer with Personalized Radiotherapy

Dr. Deepak Dinakaran, a radiation oncologist with the Odette Cancer Centre and scientist with the Sunnybrook Research Institute, discussed how advances in radiation treatment are also contributing to personalized cancer care.

Radiation therapy, also called radiotherapy, uses high energy X-rays targeted at the cancer site to damage cancer cells in the hopes of stopping the future growth and spread of the disease.

“Thanks to technological advances over the past 10 to 20 years, radiation oncology has evolved to better target the site of cancer and significantly reduce how much radiation is going to the rest of the body,” said Dr. Dinakaran. “This precision radiotherapy has allowed us to evolve what we can do clinically to help patients.”

The next frontier of radiation treatment, he said, is adaptive radiotherapy. This aims to adjust a patient’s treatment plan on any given day based on sudden changes within the body. In simple terms: If the tumour or cancer site requiring treatment has suddenly moved, instead of directing radiation where it may no longer be needed, a more accurate site of the body can be focused on.

“Currently it is very hard to adapt to those kinds of internal shifts, but that is what adaptive radiotherapy aims to do by leveraging leading-edge equipment and artificial intelligence for image analysis,” explained Dr. Dinakaran.

“All of this happens within minutes while the patient is still on the bed. It is still new and evolving, but it will really open up new opportunities in how to use radiotherapy.”

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Following treatment with chemotherapy and radiation, as well as participation in an immunotherapy trial, Vera says she is now living an active and fulfilling life. Acknowledging the many difficult days she’s experienced since her diagnosis, she says she’s also grateful for all the positives cancer has given her.

“My family had immigrated from Russia to Canada about four years before my diagnosis, so I was working like crazy. There was no time to pay attention to my wellness, or the balance between my work and being a wife and mother.” Vera says having cancer made her stop and reconnect with herself. “It was a gift wrapped in barbed wire.”

Vera identifies as a cancer warrior whose family inspired her to fight for herself. “To do that, I had to completely reconsider my values and what was authentic to me.” Coming from parents who were an architect and an artist, Vera now explores her talents as a painter, writer and visual performer. “Once you’ve been given a cancer diagnosis, there’s nothing else in this world that can scare you. I’m more encouraged to now participate in things that prior to cancer, I wouldn’t dare to do.”

As a recent immigrant, Vera says it was her health care team and those helping her through many difficult moments that gave her a sense of community again. “That made me feel like the universe was supporting me. It wasn’t just me against cancer; it was us dealing with that together.”

During one recent visit to Sunnybrook, she recalls seeing a recruitment poster for the Odette Patient and Family Advisory Council (PFAC). This group includes patient and family members who work to improve the experiences of people with cancer. “It was my birthday when I saw the poster, so joining the PFAC was my gift to myself. Now having 10 years of lived experience, it was a natural way to give back to the community.”

When she talks to other patients, Vera advises them to become their own personal Wikipedia. “Educate yourself around your diagnosis and treatment. You are an important member of the health care team.”

For Vera, many people who were on her team seem more like family now. She still has friendships and connections with many of them, and is known as the “Timbit girl” when she visits the Odette Cancer Centre. “Life can be hard, so a little sugar never hurts!”

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