Dalla Lana School of Public Health

Faculty Member

Steven Narod MD, FRCPC, FRSC

Research Interests

Dr. Steven Narod is a Tier I Canada Research Chair in Breast Cancer, a full professor in the Dalla Lana School of Public Health and the Department of Medicine at the University of Toronto, and a senior scientist at Women’s College Research Institute, where he leads the Familial Breast Cancer Research Unit. Dr. Narod is renowned for his resesarch on the BRCA1 and BRCA2 genes, that when mutated, substantially increase a woman’s lifetime risk of breast or ovarian cancer. He also studies various aspects of cancer prevention and screening. With more than 550 peer-reviewed publications and an h-index of 85, he is the most-cited researcher in the world in the field of breast cancer. In 2012, Dr. Narod was elected a Fellow of the Royal Society of Canada.

Dr. Narod has studied hereditary breast cancer since 1987 at the International Agency in Research in Cancer in Lyon France with Dr Gilbert Lenoir. He reactivated his career in Canada in 1995 at McGill University under Dr David Rosenblatt working with Dr Patricia Tonin and Dr William Foulkes. He is a co-discoverer of the BRCA1 and BRCA2 genes, and since their discoveries in 1994 and 1995, he has studied the distribution of mutations worldwide. His team have identified founder mutations in the Ashkenazi-Jewish, French-Canadian, and Bahamian populations. His recent research has revealed that one per cent of Jewish women in Ontario carry a BRCA1/2 mutation, that half of these women are not eligible for provincially-funded genetic testing. Most recently, Dr. Narod’s collaborative research showed that women in Poland with BRCA1mutations have a 46 per cent lower risk of breast cancer than women in North America with the same mutation. Dr. Narod’s seminal discoveries have stemmed from both his laboratory and his database – the largest of its kind – of over13,000 women. He has advanced cancer genetics around the world through collaboration with experts in over 30 countries in North America, Asia, Europe, the Caribbean, and Latin America. His research has been instrumental in understanding the role of hereditary factors in breast and ovarian cancer, and he continues to translate the emerging knowledge into more effective strategies for cancer prevention, detection and management. Dr Narod’s influence during the last 15 years has profoundly shaped current knowledge of how to assess breast and ovarian cancer risk and reduce its mortality amongst carriers of BRCA1/2 mutations.

Education & Training History

Undergraduate University of British Columbia	Mathematics	B.Sc.	1975
Medical Doctorate University of British Columbia	Medicine	M.D.	1979
Internship McGill University – Jewish General Hospital			1980
Residency University of Ottawa	Community Medicine	FRCP(C)	1983-1987
Fellowship Hospital for Sick Children, Toronto, ON	Medical Genetics		1987-1988
Programme on Viral & Hereditary Factors in Carcinogenesis Unit of Mechanisms of Carcinogenesis International Agency for Research on Cancer, Lyon, France	IARC Fellow/Cancer Epidemiology		1988-1990

Other Affiliations

Member, Program Committee, American Society Human Genetics	1997 – 2000
Member, Scientific Council, International Agency on Cancer Research (IARC)	2001 – 2005
President, Scientific Council, International Hereditary Cancer Center of Pomeranian Academy of Medicine, Poland	2003 – present

Primary Teaching Responsibilities

Professional Summary & Appointments

McGill University
Assistant Professor,	Dept. of Medicine Dept. of Oncology Dept. of Human Genetics	1990-1995 1990-1995 1993-1995
Quebec Cancer Genetics Network
Director		1994-1995
FRSQ Cancer Networks
Coordinator		1994-1995
Univerisity of Toronto
Chair, Breast Cancer Research,	Canadian Breast Cancer Foundation (Ontario Chapter)	1995 – 2003
Director	Interdepartmental Division of Preventive Oncology	1996 – 2002
Associate Professor	Departments of Public Health Sciences, Medicine, Surgery	1995 – 2000
Member	Graduate Department of Community Health	1996 – present
Member	Institute of Medical Science	1998 – present
Professor	Departments of Public Health Sciences, Medicine, Surgery	2000 – present
Professor	Department of Obstetrics & Gynecology	2001 – present
Canada Research Chair	Breast Cancer	2003 – present
Professor	Dalla Lana School of Public Health	2008 – present
Women’s College Research Institute
Senior Scientist		1995 – present
Director	Familial Breast Cancer Research	1995 – present

Honours & Awards

Member, Canadian Genetic Diseases Network	1993
Member, American Society of Clinical Investigation (ASCI)	1996
UBC Medical Alumni Association—Class of 1979 Silver Anniversary Award	2004
World’s Most Cited Researcher in Breast Cancer	2005
Honorary PhD, Pomeranian University of Medicine, Poland	2011
Fellow, Royal Society of Canada	2012
Fellow, Canadian Academy of Health Science	2012
FORCE – Spirit of Empowerment Award	2012
Queen Elizabeth II Diamond Jubilee Medal	2013
Canadian Gene Cure Foundation – Champion of Genetics	2013
Canadian Cancer Society- O. Harold Warwick award	2013

Current Research Projects

• Steven Narod as Principal Investigator:Natural Sciences and Engineering Research Council of Canada (NSERC) – Steven Narod (PI), 2012 – 2015

  The physiological impact of postmenopausal oophorectomy on hormone levels in women with a BRCA1 mutation

  Surgical removal of the ovaries (i.e., preventive oophorectomy) among women with a BRCA1 or BRCA2 mutation is associated with significant reductions in the risks of breast and ovarian cancer 1. We have recently shown that among BRCA mutation carriers, the reduction in risk associated with surgical menopause is much stronger than that associated with natural menopause. It is not clear whether this risk reduction is due to the direct effects of postmenopausal sex hormones (i.e., androgens) on breast cell proliferation or their indirect effects since androgens serve as precursors for biotransformation to estrogen. Clarification of the mechanism would help to develop recommendations regarding chemoprevention. To establish the endocrine basis for this observation, we propose to compare serum and breast hormone levels before and after oophorectomy in 20 BRCA1 carriers who reached menopause prior to the oophorectomy. As controls, we will include 20 premenopausal BRCA1 carriers and 20 postmenopausal non-carriers undergoing oophorectomy. We will evaluate a new technology that uses a miniaturized, integrated method for hormone analysis that relies on digital microfluidics (DMF) and only requires a small amount of tissue. We can then measure the impact of oophorectomy on the tissue levels of these hormones. These findings will help justify the use of aromatase inhibitors in addition to oophorectomy in this high-risk population for breast cancer prevention. Further, this tool will have clinical relevance for the general population and will be used as a risk assessment tool to develop personalized prevention strategies. Thus, this work fits squarely into the mission of the Collaborative Health Research Projects (CHRP) program, which is to support work ”involving any field of the natural sciences or engineering and the health sciences” that can ”lead to health benefits for Canadians.” In addition, the project satisfies all of the key CHRP criteria, including knowledge translation, interdisciplinary research, collaboration, and training of highly qualified personnel (HQP).

• Canadian Breast Cancer Foundation (CBCF) – Steven Narod (PI), 2011- 2014The impact of pregnancy on survival after breast cancer in carriers of BRCA1 and BRCA2 mutations

  Women with BRCA mutations are more likely to present with early onset breast cancer, bilateral breast cancer, triple hormone receptor-negative, high histological grade, and P53 mutations than non-hereditary breast cancers. We aim to study whether or not pregnancy increases the risk of breast cancer recurrence and survival in this high-risk population. As a consequence of the fact that its impact is uncertain, many women have decided not to take the risk, whereas if they would be well informed, her decisions regarding a future child-bearing would probably change. The degree to which this population should be clinically assessed, and the way in which that information is delivered is crucial in order for these women to make assertive decisions.

  Canadian Institutes of Health Research (CIHR) – Steven Narod (PI), 2010- 2013

  Clinical Course of BRCA2-associated prostate cancer

  We will perform genetic testing for BRCA2 mutations on 5,000 men with screen- detected prostate cancer, diagnosed at Sunnybrook Health Sciences Center or the Princess Margaret Hospital, between 1997 and 2012. We expect to identify from 40 to 100 cases of BRCA2-associated prostate cancer. We will select three non-carrier controls for each carrier case, and we will compare these for clinical features at presentation, and rates of distant recurrence and prostate cancer-specific death at five and ten years. This study will help decide on policy for screening for prostate cancer among men with BRCA2 mutations and will open directions for future research. If men with screen-detected prostate cancer and a BRCA2 mutation have poor survival we intend to develop clinical trials specific for this subgroup.

  Canadian Cancer Society Research Institute – Steven Narod (PI), 2009- 2014

  Risk factor analysis of hereditary breast and ovarian cancer

  The major goal of this proposal is to identify and to follow a cohort of 3,000 female carriers of mutations in the BRCA1 or BRCA2 genes and to establish the impact of oral contraceptive use and of hormone replacement therapy on breast cancer risk. We aim to expand our cohort of BRCA1 and BRCA2 carriers from 2856 to 4000 by January 1, 2008.

  Canadian Institutes of Health Research (CIHR) – Steven Narod (PI), 2009-2012

  Genetic Susceptibility to Esophageal Cancer

  Our goal is to perform a genome-wide association study in esophageal cancer in order to identify one or more genes which are associated with a relative risk of esophageal cancer of four or greater in the Turkmen population of Iran. Our ultimate aim is to implement public health strategies which can be used to identify high-risk individuals and to prevent cancer.

• Steven Narod as Co-Investigator:National Institute of Health – Thomas Sellers (PI), 2007-2012

  Haplotype-Based Genome Screen for Ovarian Cancer Loci

  Ovarian cancer is poorly understood but continues to cause more deaths each year amongst women in North America than any other gynecologic cancer. BRCA1 and BRCA2 gene mutations are rare in the general population and account for only 12-15% of ovarian cancer cases. By conducting a genome-wide analysis, we hope to identify other cancer susceptibility genes.

  Role: Co-Investigator

  Canadian Breast Cancer Foundation – Joanne Kotsopoulos (PI), 2011-2013

  Risk Factor Analysis for Familial Breast Cancer

  The goal of this study is to develop a cohort of 1,000 high-risk women with a significant family history of breast cancer, but who do not carry a BRCA1/2 mutation. Through data collected from biennial questionnaires, biological samples and medical records, we will be in a position to identify risk factors for this disease and to develop the clinical guidelines for the prevention, management and treatment of this unique group of high-risk women. Currently, there exists no scientific evidence for the management and care of these women.

  Role: Co-Investigator