Photo by HSIMS (L-R) Drs. Pat Parfrey and Ban Younghusband and nurse coordinator Elizabeth Dicks.

By Sharon Gray
The Colorectal Cancer Interdisciplinary Research Team has been up and running for over two years, and all studies are on target as the project reaches its halfway point.

The project is studying colorectal cancer in Newfoundland and Labrador and Ontario. Team members in both provinces work together on six projects examining the relative contribution of genetic and non-genetic factors in this type of cancer: The causes of colorectal cancer, clinical outcomes, frequency and associated illnesses, psychological impact, barriers to prevention, and how genetic risk information is communicated and used.

The project is funded by a Canadian Institutes of Health Research grant of $5 million over five years. All components of the project have received ethics approval and are underway or will begin shortly. The team currently includes 33 faculty members, who in addition to their research are involved in training graduate students and health professionals in a wide range of disciplines.

The key to the Newfoundland research is a registry of people in the province with colorectal cancer. About 750 people are eligible to participate, and so far about 650 have been contacted through their physicians. Fewer than 20 per cent declined to participate and of the rest, 315 family histories have been completed. “We have a group of people who have completed the whole thing, and at the end we send them a thank-you card,” said Elizabeth Dicks, nurse-coordinator of the project. “We also send out sympathy cards if we find out one of our participants has died. We’ve had a very positive response to these cards, it puts a personal spin on research.”

At Memorial, the principal investigators for the Colorectal Cancer Study are Dr. Pat Parfrey, clinical epidemiologist and nephrologist, and Dr. Ban Younghusband, molecular geneticist. “This project is working so well because we function as a team,” said Dr. Parfrey. “We are all trying to find out what particular genes are causing this disease in the community and then use that information to take the high risk families in a screening program to prevent cancer developing in the future. It’s a combination of molecular genetics at the basic level and health care delivery.”

Photo by HSIMS Dr. Michael Woods

On behalf of the team, Dr. Steve Gallinger, University of Toronto, along with Dr. Younghusband and Dr. Roger Green of Memorial, have additional funding of $100,000US from the National Institutes of Health to research patients who have been referred to the Genetics Clinic for colorectal cancer known to be familial. “We’re trying to enroll all those patients and extend their family trees in the same way the main study does,” explained Dr. Younghusband.

A major bonus of this project will be the purchase of equipment for a rapid ascertainment system for the Newfoundland Cancer Treatment and Research Foundation. This will enable to NCTRF to get data from cancers in all pathology labs in the province almost instantaneously, avoiding what is now delays of up to 18 months. “Unfortunately our study will be over before this system is fully operational, but it will be a lasting benefit for the people of the province,” said Dr. Younghusband.

Another lasting benefit from the CIHR-funded project is a new molecular-genetic laboratory focusing on colorectal cancer. As part of the initiative to develop interdisciplinary research between the two provinces, Dr. Michael Woods was recruited as a post-doctoral fellow to train at Mount Sinai Hospital’s Samuel Lunenfeld Research Institute. He has recently returned to Newfoundland to develop the new facility in co-operation with Dr. Younghusband and Dr. Des Robb, Pathology, which will be able to carry out the full range of molecular tests required for a cancer genetics program.

While at the Samuel Lunenfeld Research Institute, Dr. Woods began screening previously known high-risk hereditary non-polyposis colorectal cancer Newfoundland families for specific mutations. Using the latest techniques he has begun to create a “molecular picture” of these families. “The information will aid in screening these and other high-risk family members and may be valuable in the understanding of the cause of colorectal cancer,” he said.