Meet Dr Ophira Ginsburg, Elsa Atkin Distinguished Fellow

Dr Ophira Ginsburg is a medical oncologist and global women’s health researcher with technical and policy expertise in cancer prevention and control.

The Elsa Atkin Distinguished Fellowship recognises the significant contribution of female leaders to advance women’s health equity. The role is named in honour of Ms Elsa Atkin AM, a past board director at the Institute, and acknowledges Ms Atkin’s passion and dedication to this cause.

Tell us a bit about yourself

I am a medical oncologist with expertise in cancer genetics, prevention and screening, but since 2005 my professional work would be best described as global public health, with a focus on women’s health equity.

Formerly based at Queen’s University and the University of Toronto in Canada, I was a Medical Officer at the World Health Organization (2015-2016) and continue to serve as an ad hoc consultant to several UN agencies. I am member of the Steering Committee for the International Cancer Control Partnership, that is hosted by the US NCI Center for Global Health with the Union for International Cancer Control (Geneva).

Since 2017, I have served as the Director of the High-Risk Cancer Genetics Program at the Perlmutter Cancer Center, NYU Langone Health, where I hold a faculty position as Associate Professor in the Section for Global Health, Department of Population Health at New York University Grossman School of Medicine.

I was born and raised in Canada, where I did my undergraduate degree at Queen’s University (BScHon ’89) and graduate school at McGill University (MSc Human Genetics ’92), after which I spent a couple of years working as a cancer genetic counselor, which included recruiting participants for research in hereditary breast/ovarian and colorectal cancer syndromes.

In 1994, I went back to Queen’s for medical school (MD ’98), followed by postgraduate education at the University of Toronto, becoming a Fellow of the Royal College of Physicians and Surgeons of Canada in Internal Medicine and Medical Oncology (2003/4).

Your primary focus is women’s health equity and global cancer control. What led to this decision?

As I was making my way through the myriad challenges of post-graduate medical training in the late 90’s/early 00’s, I began to reflect on the social activism work I had been involved with, really since childhood. I found myself questioning whether a traditional academic oncology career in Canada would give me the more wholistic sense of purpose and meaning that I was seeking.

It’s not easy to articulate this without sounding incredibly pompous, but I simply wanted to be of service, to make a contribution in a way that might be commensurate with the incredibly good fortune I had had in life. So I actively looked for a path that would ultimately combine my passions: for the science of oncology, for patient care, and for social justice.

I have been involved in social activism since I can remember. At age 12 I did my first media engagement (via radio), speaking about children’s rights, and volunteered with Amnesty International throughout my teens and early 20’s. Inspired by the unimaginably dire stories of the “prisoners of conscience”, I was especially in awe of the women who faced particular injustices, but who somehow had the courage and the indomitable spirit to stand up to tyranny. I believe this is why I gravitated towards women’s health in my global oncology work.

What do you see as the most pressing goals in this area?

Several contenders come to mind but first, I believe we need significantly more research funding for global cancer prevention. This should include research to elucidate causal factors for cancers about which we still know surprisingly little, and to support the effective implementation of primary and secondary cancer prevention efforts, particularly in resource constrained settings.

Pandemic or not, this is still essential research that tends to be woefully underfunded, I mean on a logarithmic scale – when compared with research into targeted, “precision medicines” to treat cancer. I don’t mean to deny the remarkable advances in cancer therapeutics, particularly in immunotherapy, and treating advanced melanoma in an increasingly cancer “agnostic” manner, such that a treatment can be effective against any cancer, so long as the molecular features of the tumor include an appropriately “druggable target”.

However, as a public health-oriented cancer researcher, the funding imbalance is a tough pill to swallow in the face of the hundreds of thousands of lives that could be saved each year by directing even a miniscule fraction of these resources towards the implementation of what we already know works. One of my colleagues, Dr. Bishal Gyawali, originally from Nepal and now based at my alma mater, Queen’s University, calls this the “cancer groundshot”.

In terms of women’s health equity regarding cancer, it is clear we need to do much more to implement what we already know to reduce the global burden of breast, cervical and other gynecological cancers. We also need far more resources to study the causes of certain types of breast cancer such as the “triple negative” subtype, as well as the primary causes of ovarian cancer – which aside from those cases associated with an inherited risk factor (i.e BRCA1 and BRCA2) remains largely unknown.

In the case of cervical cancer, the frustrating – I would even say infuriating – reality is that we know the cause, we understand the natural history (better than almost any other cancer), and we know how to prevent, screen and treat it with cost-effective measures; yet cervical cancer continues to take the lives of more than 350,000 women per year. Moreover, it kills far too many women in their prime and represents the epitome of cancer health disparities globally - and also nationally. Nine in ten women who will die of cervical cancer before the end of this year will be living in a low- or middle-income country (LMIC). In high income countries, including Canada, the US and even Australia (which is set to become the first country to achieve the elimination of cervical cancer), most people who die of cervical cancer are marginalised in one or more ways, including (but not limited to) individuals who live in poverty, identify as black, Indigenous or people of color, or trans and non-binary people.

All that said, I believe that the call to action for the elimination of cervical cancer as a public health concern by WHO’s Director-General Dr. Tedros in 2018 launched a wave of optimism and activism to support the hard work of implementing proven interventions such as HPV vaccination, screening, and treatment for people with pre-cancers and invasive cancer in all resource settings. So I was excited to witness the launch of the cervical cancer elimination campaign during the 2018 World Health Assembly, and what was starting to feel like a truly global movement with emerging solidarity among members of civil society, people living with cervical cancer, public health professionals, frontline health workers, as well as scientists, policymakers and even heads of state.

Since then, momentum had been growing to galvanise the public health and cancer community towards achieving something within our grasp, and after so many years of spinning our wheels, resources were finally starting to be mobilised. 

At least, that’s what it seemed like, but this was prior to the COVID-19 pandemic.

Now, I know some of the top scientists in this area say that we shouldn’t even have such elimination goals – that they are unrealistic and can distract from the focus on the day-to-day work that’s needed urgently. I do sometimes feel the same – but over time I’ve come to appreciate their value, however “aspirational”. We can look to the eradication of smallpox, the progress towards the same for polio, and the tremendous gains in maternal and child health, stemming from the Millennium Development Goals (MDGs).

Of course, this could be the topic of a whole other conversation, but I do believe that much was achieved in part because of the public discourse the MDGs fostered, and with it, the push for more transparency and accountability from all countries globally.

What recent research excites you and why?

I am excited by a lot of the cancer control research carried out by colleagues in LMIC settings. So much of our research in the relatively new discipline we’re calling “global oncology” is still being led by those in high income countries. We need to work towards the decolonisation of global oncology as with any other domain of science, and particularly in global health.

If I had to pick one recent study I’m very excited about, it would be the long-term results of a pivotal randomised controlled trial that suggests considerable efficacy of clinical breast exam as a primary screening method to prevent deaths from breast cancer in lower resource settings, led by colleagues at the Tata Memorial Cancer Center in Mumbai India.

Another study I am excited about is led by Dr. Valerie McCormack (IARC) and colleagues in a multi-country prospective cohort study “ABC-DO” for the African Breast Cancer Disparities in Outcomes Study. Among several excellent papers they’ve already published is one that quantified maternally orphaned children when the mother died of breast cancer. We hope to build upon this work in our Lancet Commission on women and cancer, for which we are taking an explicitly intersectional feminist approach. (The keyword there is the “and”).

You have a variety of challenging roles across several regions. What keeps you motivated?

I suppose it’s my lifelong enthusiasm to continually learn new things, combined with my passion to be part of the solution, to contribute even in a tiny way towards reducing unnecessary suffering and injustice. More recently it’s the opportunity to mentor young people, women especially, who are so clearly committed to social justice, as well as pursuing their careers in global oncology.

What does it mean to be a Distinguished Fellow at The George Institute?

I'm truly honored to be the inaugural Elsa Atkin Distinguished Fellow at The George Institute! I think that the work of the Institute is highly relevant to real world interests and priorities in global health. I feel I have found many kindred spirits and fellow scientists at The George who share a common sense of purpose, particularly in the domain of women’s health and health equity.