Expert insight: Breast cancer under the microscope
Scientist Dr Dharmica Mistry explains how her work is pushing the boundaries of breast cancer diagnosis and treatment.
Health Agenda magazine
The brutal face of breast cancer is that one in eight women will develop the disease at some stage in her life. That’s about three of your daughter’s classmates, a couple of women in each train carriage, and someone in every other coffee queue.
Whether a newly diagnosed woman survives the next five years often depends on the maturity and aggressiveness of the tumour. While 90 per cent of patients achieve this, thanks to better detection, awareness and treatment, for those whose breast cancer has spread to other organs the odds of survival drop to one in four.
Early detection is key
Mammograms are still the gold standard in breast cancer detection, but with limited efficacy in those under 50 years old – denser breast tissue being the key limitation – some researchers are looking for a better way. BCAL (Breast Cancer Associated Lipids) Resources chief scientist Dr Dharmica Mistry is one such visionary.
“Blood testing is the Holy Grail. It’s not subjective and means no x-rays.” Dr Mistry explains. “It’s also easy. You don’t want a test where someone has to go out of their way to get it, not to mention squashing your breast in a clamp. Mammography has its limitations, especially for younger women in whom the cancer is even more aggressive. Many women with a strong family history or genetic mutation, are just sitting there, worrying.”
Your hair and diagnosis
In 2008, fresh from an undergraduate degree at Sydney University and eager to get to work, Dr Mistry started working at a small start-up looking at the association between breast cancer and hair. “I was offered a job at a really big company as a lab technician, close to home, good money,” she recalls. “But this smaller start-up offered me a role which, while not well paid, was really exciting.”
The turning point during her research came when Dr Mistry used her own hair as a negative control. “We x-rayed the hair and this feature popped up – the same one we’d been seeing on hair from women with breast cancer. Suddenly I thought, ‘I need to go get a breast check!’”
Happily, Dr Mistry was given the all clear and then identified the anomalous feature: every few months she moisturised her hair with olive oil. “The next day I brought in a jar of olive oil, coated the hair in it, x-rayed again, and ran a few experiments. What we realised is that it was a lipid – a fat – that caused the feature. And if it could be seen in hair, it is likely it could be found in blood.
“It changes everything,” she says. “It isn’t just one test: a blood test now becomes a test that can evaluate surgery and treatment requirements, as well as a monitoring test for patients with double mastectomies where mammograms aren’t possible. Predisposition, screening, diagnostic, treatment and monitoring – it does it all.”
The big breakthrough
It was late one night, at the Australian Nuclear Science and Technology Organisation’s mega x-ray machine, the Australian Synchrotron, that Dr Mistry and Dr French tested their hypothesis successfully. The first 100 samples showed an incredible 90 per cent accuracy rate for detecting breast cancer – while mammograms net only 60 to 70 per cent. The ‘eureka’ moment led to the founding of BCAL.
Later Dr Mistry learnt researchers from the University of Kentucky in the US were investigating the same theory. In many ways this validated her work and, most importantly, offered a potential ally in the fight against breast cancer. Thus, a collaboration was born, one Dr Mistry hopes will help commercialise the science. “That’s the wonderful thing in science,” she says. “More brains joining the think tank.”
The breakthrough earned Dr Mistry the 2015 Young Scientist of the Year and then the 2016 NSW Young Woman of the Year awards. “It’s incredible,” she says. “I was so excited just to be nominated.
Every now and then in life you are lucky enough to receive humbling pats on the back. It keeps you motivated and encouraged to do more. Mum and Dad didn’t get the opportunity to go to university so they’re very proud.”
Finding your calling
Born in England to Indian parents, Dr Mistry’s family moved to Australia when she was six. In stark contrast to the UK, they settled in the Sutherland Shire, NSW. In high school Dr Mistry realised science was her future. “It made you think, ask questions and then carry out experiments to confirm.”
Dr Mistry thought she would be a dietician, treating patients via nutrition, but things took a different course. “I fell in love with microbiology. Microbes are fascinating, so tiny, but involved in so many things – inside us and outside in the environment,” she explains.
Creating a breast cancer start-up
BCAL Diagnostics in Sydney’s CBD is where Dr Mistry’s work continues today, in a company essentially created for her – an investment by her sponsors that has clearly paid off. Although that’s not to say there weren’t hurdles.
“We banded together, overcoming an initial lack of resources while looking to other people to collaborate with,” she says. “We kept the company really lean. The only paid full-time employee is me. The board members are doing it as a social contribution because they believe in it and are passionate about it.”
One such member who has supported Dr Mistry over the years is cell and molecular biologist, and BCAL co-founder and director, Dr Peter French. Dr French interviewed Dr Mistry, a then new honours science graduate, for a role at the original research company.
“It was clear she was likely to become bored with the mundane technical role she was undertaking,” Dr French recalls. “In order to keep her and the other young scientists interested, I instituted a series of scientific meetings around the biology of breast cancer. She stood out as being able to make intelligent contributions to the discussion, and obviously had a bright future in science.”
BCAL Diagnostics is now completing a 100-patient blind study, reaffirming its previous results. Surgeons at Royal Prince Alfred Hospital and the Sydney Breast Clinic have helped collect samples over the last few years, in itself a big accomplishment. The laboratory work, however, will be conducted by the University of Kentucky.
“Of course, I’d love to have the tech here in Australia,” Dr Mistry says. “It is frustrating being so far away. Science by its very nature can change any minute so there are many variables that can come into play. Things happen when you’re experimenting. You can’t control science. That’s also what makes it fascinating.”
It’ll take a year to complete the blind tests then, pending regulatory approval, Dr Mistry hopes the BCAL blood test can enter the market and start saving lives.