Transforming Breast Cancer Care

Dr. May Lynn Quan takes action to improve the quality and timing of care for individuals with breast cancer in Alberta.

When Dr. May Lynn Quan sees a problem, her natural impulse is to do whatever it takes to solve it. A shining light in the field of breast cancer care, Quan’s titles include professor in the departments of surgery, oncology and community health sciences at the University of Calgary, the Calgary Breast Health Program’s medical director and the scientific director of the Strategies for Precision Health in Breast Cancer (SPHERE). It’s a full plate she balances while also performing breast cancer surgery and caring for patients. As demanding as her schedule can be, Quan performs all these roles with an infectious sense of enthusiasm and good humour, finding satisfaction in not only treating individual patients, but also transforming the way care is delivered to those with breast cancer across Alberta.

Case in point: after years of seeing patients’ tumours being marked with cumbersome and uncomfortable wires protruding from their breasts, then having to travel to another medical centre to see a surgeon who would use the wire placement to find and remove the tumour, Quan took it upon herself to find a better and less painful solution. She brought a system known as Sentimag to Calgary to replace traditional “hook wires” with magnetic seed (Magseed) markers that can be placed at the site of tumours too small to feel, allowing surgeons to easily find the lesions with magnetic tools.

“Hook wires have been the standard in Calgary for decades, but the wires are problematic for a number of reasons,” Quan says. “Everyone across the province has recognized that the wires are obsolete.”

Not only is the Magseed marker more comfortable and less invasive for patients, it’s more precise because it can’t get dislodged like a hook wire can. It also allows for easier scheduling of surgery since it can be placed in the breast anytime before surgery, versus the same day for hook wires. And, Magseed contains no radioactive material. Through her tireless advocacy and the securing of funding from Calgary Health Foundation and the Alberta Cancer Foundation, Quan was able to launch Sentimag in Calgary. The three-year pilot program will replace hook wires with Magseeds for all Calgary patients, with the goal of extending the program to the rest of Alberta. She saw a problem and found both medical and funding solutions — because that’s what Quan does.

A natural pathway

Quan’s determination to solve this seemingly obvious problem is emblematic of the kind of health-care provider she’s become, though, surprisingly enough, she didn’t always dream of becoming a doctor. Her undergrad degree is in kinesiology. But medicine seemed a natural next step with her interest in human physiology and, specifically, in helping people.

“Was I one of those eight-year-olds running around with a stethoscope? No, not at all,” she says. “I tried to follow my interests, which were in people and the human body. I thought maybe I would apply for med school. If I could get in, that’d be great. I could be a doctor.”

From there, the transformation to medical changemaker started to take hold. Thinking she’d end up as a pediatrician, Quan wasn’t particularly interested in her surgical rotation. But when a supervising surgeon trusted her to make an incision on a patient, she was immediately hooked. She shifted to general surgery, then chose to specialize in breast cancer surgery. But, as much as she enjoys performing surgery, Quan’s curiosity and problem-solving nature couldn’t be confined to the operating room.

Research role model

Quan’s passion for research was sparked during a breast oncology surgery fellowship at Memorial Sloan Kettering Cancer Center in New York in the early 2000s. Research projects required to complete her program piqued her interest so much that she followed her fellowship with a Master of Science degree in epidemiology from the University of Calgary. Her next move was to a position as a surgeon-investigator at Sunnybrook Health Sciences Centre in Toronto, where she got involved in research work designed to improve the health-care system, and became deeply involved in how to improve breast cancer care, particularly for younger women with breast cancer. Personal circumstances brought her back to Calgary in 2009, and she was determined to explore similar work at the University of Calgary and the Foothills Medical Centre.

“When I was at Sunnybrook, I met a young woman who was a lawyer. She was the same age as me or maybe a little bit younger and she was diagnosed with breast cancer,” Quan recalls. “I realized the data about women that young with breast cancer was really poor. It was a turning point in my career.”

Quan’s research work eventually resulted in the creation of her SPHERE research team at the University of Calgary, a group formed to improve treatment and outcomes for individuals with breast cancer in Alberta through precision medicine, patientreported outcomes, big data and machine learning. Focusing on the unique challenges of younger women with breast cancer remains central to her work: her ongoing Reducing the Burden of Breast Cancer in Young Women (RUBY) study collects data from more than 1,500 breast cancer patients aged 40 and under across Canada. SPHERE is also overseeing the development of an app called Sapphire to help younger women with breast cancer manage unmet psychosocial needs that can come with a cancer diagnosis.

Leaning into leadership

Quan’s propensity for research and trying to answer questions that arise in her surgical practice naturally led her to take on leadership roles to help make the healthcare system run better and more efficiently. This is where projects like Sentimag come in — as the Calgary Breast Health Program’s medical director, she’s able to seek solutions for what she sees as avoidable problems impeding her patients’ well-being. In addition to the hook wire issue, Quan has made it her mission to address the patient pathway from screening to surgery to eliminate unnecessary, often timeconsuming, steps.

Through SPHERE’s work with the Cancer Strategic Clinical Network’s Provincial Breast Health Initiative, she helped to shorten the route Alberta patients take from a mass in the breast being identified as “highly suspicious” in diagnostic imaging to biopsy by referring patients directly from screening to a surgeon. Previously, a report was sent to their family doctor who would then refer them for surgery. Similarly, under Quan’s leadership, the time patients spend in hospital after breast surgery has shortened considerably, with the vast majority of breast cancer patients in Alberta now going home the same day as their operation, which is beneficial to recovery and the health-care system.

While all of these initiatives — pathway efficiencies, phasing out hook wires, recognizing that younger women with breast cancer have a unique set of needs — have a tremendous impact on cancer care, Quan doesn’t see herself as a hero. She’s just doing what makes sense in a field that happens to save people’s lives.

“I’ve been fortunate enough to find something I love,” she says. “It doesn’t seem like work. It just seems like this is what we should be doing.”