How Dr. Kelly Metcalfe has been breaking new ground in breast cancer research for twenty years

An Adjunct Scientist at the Familial Breast Cancer Research Institute at the Women’s College Research Institute, Dr. Kelly Metcalfe has dedicated her career to the study of cancer prevention and treatment, specifically focusing on individuals at high risk of developing the disease. She shares her journey of two decades in research, from her unexpected beginning to her current goals.

When Dr. Kelly Metcalfe began her undergraduate nursing degree at the University of Western Ontario, she was looking ahead to becoming a clinician, with a specialization in oncology. It would have been the start of a career as one of the many dedicated nurses working with cancer patients in Canadian healthcare — if not for three discoveries that would lead her down a different path.

The first two discoveries had an impact on a global scale: in 1994 and 1995 respectively, scientists identified the BRCA1 (BReast CAncer one) and BRCA2 genes, which carry with them a greatly increased risk of breast, ovarian and prostate cancer when mutations are present. Dr. Metcalfe was partway through her nursing degree when she became intrigued by this new and exciting area of cancer research.

“Tests to detect the BRCA1 and BRCA2 mutations were just being developed, but the impact of this type of genetic testing hadn’t really been explored,” she explains. “What did it mean for the patient? What did it mean for her family members? How could we prevent cancers in women who we identified as being at high risk? We still, in the mid-nineties, didn’t know that much about it, so I was very interested in looking at that.”

This led to the third discovery, which was far more personal: Dr. Metcalfe found she had a love of research. After graduating with a nursing degree in 1996, she decided to pursue this newfound interest with a PhD in Medical Science at the University of Toronto, from which she graduated in 2002. During that time, she became involved with the research group at Women’s College Hospital (WCH) that was dedicated to this new area, and was given the opportunity to explore the questions that were of specific interest to her.

Dr. Metcalfe is now an adjunct scientist with the hereditary cancers research team at Women’s College Research Institute, one of the only hospital-based research centres in the world focused on advancing healthcare for women, as well as a professor at the Lawrence S. Bloomberg Faculty of Nursing at the University of Toronto — a role that involves both teaching and research. She has dedicated her research career to the study of cancer prevention and treatment, specifically focusing on individuals at high risk of developing breast and ovarian cancer. But she also hasn’t strayed far from her clinical roots.

“I think when someone thinks of research, their mind goes to a lab with test tubes, and that’s not what I do. My research involves patients and their families, and it is about having a name with a face,” she explains. “I want to take what happens in the lab, and translate that to the patient, so it’s ultimately the patient who benefits from these scientific discoveries.”

“I think when someone thinks of research, their mind goes to a lab with test tubes, and that’s not what I do. My research involves patients and their families, and it is about having a name with a face.”

In that regard, she’s been very successful; a lot of the research that she’s led has changed clinical practice. She’s looked at the efficacy of prevention and treatment options, showing through her research that a bilateral mastectomy (surgical removal of both breasts) can reduce the risk of dying by half for women with BRCA-related breast cancer. She’s also looked at the psychological implications of treatment and prevention in many of her studies. A bilateral mastectomy, for example, can practically eliminate the risk of developing breast cancer for BRCA carriers — but it’s a challenging choice to make. Recognizing this, Dr. Metcalfe developed a decision aid to help women with their prevention plan.

“You can imagine what it must be like for a woman who comes to see us in clinic, and all of a sudden she’s told that she has an 80% chance of developing breast cancer. What must that feel like for her? We give her options about what she can do to prevent cancer, and no one option is perfect. No one decision is right for every woman.”

The important thing, she says, is that the woman makes a decision and feels supported in the choice she has made. “Ultimately, by doing genetic testing, we’re identifying these high risk women, but if we don’t give them the tools they need to decide what to do with this information, we’re not going fully realize the benefit of being able to prevent cancer from happening.”

Identifying BRCA carriers is in itself a challenge, with strict criteria set out by the government limiting who is eligible for testing. But that’s a challenge Dr. Metcalfe and her team are addressing in a big way: this past spring, she and her colleagues launched The Screen Project – a major study that allows any Canadian to be tested for the BRCA1 and BRCA2 mutations for a nominal fee. Open to both women and men, The Screen Project aims to empower Canadians to know their risk and, if that risk is high, to work together with genetic counsellors at WCH to understand their options. It will also create a significant body of data that will inform ongoing breakthroughs in BRCA research. The Screen Project is the first population-based study of its kind in the world.

Talking about her research achievements, Dr. Metcalfe points out how critical it has been to be part of a supportive team. At Women’s College Hospital, she works with three other scientists dedicated to cancer genetics, including Dr. Steven Narod, who helped identify the BRCA1 and BRCA2 genes, and is one of the most-cited breast cancer researchers in the world. She had the opportunity to collaborate with him early in her career, and she credits him as being one of the reasons she chose WCH to pursue her work.

She was also drawn to the hospital’s dedication to women’s health, and specifically breast cancer, which aligned with her own areas of interest. She talks proudly of the impact she and her colleagues are having at the local level, with the women that come to clinics at WCH, as well as beyond the doors of the hospital.

“As a group, we’re highly productive. We’re making a difference in the way that cancer genetics testing is delivered around the world, we’re making a difference in how these women are treated, and in how we prevent cancers,” says Dr. Metcalfe. “Our combined efforts have had an impact in the past and will continue to have an impact — because cancer genetics is something that evolves constantly. We are discovering new genes, and trying to understand the clinical implications of those genetic discoveries is something that we’re committed to.”

Her current research is focused on one of those new genes, called PALB2. It has similar cancer risks to those associated with BRCA1 and BRCA2, but little is known about the clinical implications. Her goal is to better understand the exact risks, and determine how women with PALB2 and breast cancer should be treated to optimize their survival.

It’s a challenge she likens to being back twenty years ago, when BRCA1 and BRCA2 were newly discovered. And in all that time, her motivation hasn’t changed.

“I’m not in it for the glory. I’m not in it for the fame. I’m in it to know that I am having an impact on women and their families,” says Dr. Metcalfe. “I can seriously say, over the last twenty years, lives have been saved because of the research that we do, and that’s what keeps me going every day.”

For more than 100 years Women’s College Hospital (WCH) has been developing revolutionary advances in healthcare, and working to close the health gaps that exist in healthcare for women because their unique needs are not taken into consideration. Today, WCH is a world leader in the health of women and Canada’s leading, academic ambulatory hospital. It focuses on delivering innovative solutions that address Canada’s most pressing issues related to population health, patient experience and system costs.

For more information about how WCH is transforming patient care, visit www.womenscollegehospital.ca. To find out how you can give and get involved, visit www.wchf.ca.