An edited transcript from an interview with Dr David Huntsman, Director of OVCARE, Vancouver General Hospital, BC Cancer Agency and UBC.
Dr David Huntsman
My name is David Huntsman, and through my training, I'm a pathologist and what's called a clinical molecular geneticist. So I do DNA work in the lab, but my research is focused on ovarian, and rare cancers. And for the past 20 years, I've had the profound privilege of leading the ovarian cancer research team in British Columbia.
Golda Arthur
If you were sitting next to someone on an airplane, how would you describe to them the work that you do?
Dr David Huntsman
I spend about half of my time with my own team driving my own research, and the other half of the time, increasing the impact in trying to ensure the success of the other team members who are working on other parts of the puzzle, because there are so many things we need to solve and fix. And research is the key. And no single research team is going to be able to do all that. So we take a broad multidisciplinary approach. So team science, and I lead in some things and I'm extremely pleased to be able to play a supporting role. Sometimes, it's a direct supporting role, where we provide the laboratory space and the technologists, for my clinical colleagues who are very busy surgeons who want to engage in research. Sometimes it's slightly further removed, where I help with grants or some other mascot and cheerleader, but our team mission is to decrease death and suffering from ‘gyne’ cancers by 50%. And we can only do that if we're working in a coordinated fashion across many fronts.
Golda Arthur
I think when I hear you say that, even as a lay person, you want to decrease it by 50%, that sounds like a really big goal, a very ambitious goal. Can you say more about that, why is that the mission statement?
Dr David Huntsman
So it obviously is a challenging goal. But when you look at the different ways you can have impact, so you start prevention, through to diagnosis and treatment. And then the other piece, which has been really missing is survivorship. So this is decreasing death and suffering. So we think a lot of the pieces are starting to come into play. There's all sorts of missing parts. So prevention, we believe that opportunistic salpingectomy, when combined with population-based screening for high risk individuals will have a huge impact. That's for the most common type of ovarian cancer. For diagnosis and management, we now have a very much a subtype driven approach to care. We have some solutions. Obviously PARP inhibitors have been a tremendous advance. We don't fully know how to use them and how to combine them with other treatments and how to sequence them. But now we have to focus in on the women whose cancers don't have BRCA mutations, we need solutions for them. We also need to start looking to see what we can do to decrease the morbidity of treatment. Can we improve impact and decrease morbidity? So the current treatments are effective, but not in a lasting way. They're not good enough in any way. They're very toxic too. And so can we move beyond that? And then this mostly brings us naturally into survivorship. So obviously, we want to cure the cancer. So we want to treat the cancers but we don't want to treat cancers in a way that the patient's lives are really damaged afterwards. And so there's a lot of work to be done. I mean, this is a goal, which is motivating. If it was easy, it wouldn't be motivating. It forces us to change how we operate in some really interesting ways. Since our goal is to reduce death and suffering from gynecologic cancers, we have to have individuals in the team focused on each of those cancers and across the continuum of activities from prevention through to survivorship. And in some cancers, ovarian cancer is kind of a little ahead of the pack. But endometrial cancer is leaping forward in terms of progress and the use of a molecular classification, cancer of the vulva is further behind. And we can bring all of these forward, and one program can learn from the other. And another thing it does is, if you say something like you're going to decrease death and suffering by 50%, this isn't an elitist statement where it can only work in your hospital. This has to be for an entire population, or it has no relevance. And so we have to build programs to make sure no one's left behind, which, as a largely laboratory focused individual, I find this is fantastic. I ended up working with social scientists and others who I wouldn't otherwise interact with, because there's a whole bunch of work which needs to be done to make sure we don't create new economic, cultural and geographic inequities in care, which would preclude success for us. It's not just we want to have, it's we need to have. And so for instance, our survivorship clinics have a big reach-out component and the southeast Asian and Chinese population and we're looking to work with the First Nations community as well, because it's absolutely critical that the benefits of our research, and also the inspiration for research comes from across the whole population.
Golda Arthur
The first thread I want to pull from what you said is, with that kind of mission statement, it forces you to change how you operate. Can you tell, what's the change?
Dr David Huntsman
So there's so many questions, and so many things which need solving, you'd have to be almost strategically foolish to be tripping over each other in a place like Vancouver. Everybody can be a driver, and everyone is a supporter. And that I think the big change is to think about things in terms of how they could be implemented across a population. Now, I'm not a fundamental scientist, I know the biggest changes in medicine come from fundamental science. But I start very much at the coalface and work backwards. And then when people talk about translational research, often they think effective translational research is taking things from a lab and bringing them into the clinic. But the problem is, if you do it that way, often the things which get presented to the clinic are so at the wrong shape and size and they’re million dollar solutions to $10 problems sometimes and it doesn't work so well. You have to really start with the problem. So we spend a lot of time talking with our clinical colleagues, the ones who are invested in seeing patients everyday, to make sure we understand what their challenges are and what the population's challenges are before we start working on them because we have to convert those into questions. So for instance, part of my lab works on identifying and developing new targets for treatment for clear cell carcinoma because that is a type of ovarian cancer where a standard treatment has little to no impact and we are really desperately needing treatments for higher stage clear cell cancers. There wouldn't be a point doing that for cancer, which was more benign or where there are solutions in play already.
Golda Arthur
Well, that's great to hear. I want to just ask you two more questions. The first is a personal one, and I hope you'll be open to answering it. But I'm just curious why you do what you do. But also why the focus on ovarian cancer for you?
Dr David Huntsman
So after medical school, I went to Labrador, where I worked for a couple of years as a rural family doctor, and I learned a couple of things. One is that, I had an amazing time, but to be continually successful, you have to keep learning a little bit about everything. And I'm not really programmed for that. I like to know a lot about things. But also, we just didn't know what we were doing. No one knew what they were doing, the knowledge base for medicine was not serving patients. And so I wanted to learn more about disease. And so I went into a pathology program, and there I realized again, but you know, it was stuck at an 1850s style kind of microscopic approach to diagnosis. And we had to go further, which drew me into research. And then when I started talking with Dr. Diane Miller, I had done a little bit of ovarian cancer research, but it was really doing hereditary cancer research and some breast cancer research. And I just realized that the things I could bring to the table and my particular skill set where I could combine pathology, genomics, and kind of an ability to coalesce teams and push things forward, I could have an impact and make a difference. And in ovarian cancer, and there was a desperate need for progress. When I was doing breast cancer research, I had a kind of bad feeling that if I didn't exist, anything I was going to do, someone else would do within a year. And that, for me, wasn't motivation enough to proceed because it wasn't about competition, it was about impact. And so in ovarian cancer, I thought we could have a lasting and profound impact if we work together as a team. And, you know, unravel the subtypes from ovarian cancer, use genomics to figure out what was going on with them and then start trying to develop solutions across prevention, diagnosis, treatment, survivorship for these different diseases. And I just thought it was an inspiring problem to address with people I wanted to work with and to serve a community I wanted to help, and in life there are a few absolute no brainers but this was one.
Golda Arthur
My last question for you is, so I'm going to ask for a yes/ no answer, and then a why you think yes or no. Is the needle actually moving in ovarian cancer?
Dr David Huntsman
Yes, and with absolute certainty. I think on prevention, we're going to prevent more cancers in ways that will be women who never knew they're at risk. And they will become advocates for the disease because they never knew they were at risk and they just completely dodge this through opportunistic salpingectomy and other approaches. Population-based genetic testing should at some point be able to identify most of the high risk individuals in the community as well. The subtype driven care has led to the use of PARP inhibitors, and now other really interesting avenues for treatment are starting to be developed as well. And so we just now have to keep focusing on the subtypes, we need solutions for all of them, we need to work around the model systems to develop the solutions, we need to work as a community to develop them. And then in the survivorship space, I think we have to, you know, lay out pathways for post treatment life, which are going to be as unperturbed as possible. And so I think things have really moved forward. And it's a complex, it wasn't one problem, it was a complex myriad of little problems, which were all kind of mixed up 20 years ago. And now they've been kind of laid out, there's a trajectory across them all, there are real issues which needs solving, or there are things which are happening in the clinic right now, which are making improvements. So yeah, I'm absolutely optimistic.