For the last four years, Dr. Vincent Biron, a head and neck oncologic surgeon and researcher from the University of Alberta, has been focused on improving the experiences of head and neck cancer patients in the province. And that is a good thing — over the last 20 years, the incidences of these kinds of cancers have been growing exponentially in developed countries.
For Biron, the work is intensely gratifying, and he sees it as a realization of a goal he’s had since he was an undergrad in university: to work in science, where he could be both an explorer and a trailblazer.
“I have found my career sweet spot,” says the 40-year-old, who grew up on an acreage near Bonnyville, Alberta. “In this field, I can do complicated surgeries, reconstruction procedures and innovative research — all to influence real change.”
One of Biron’s main research projects involves adapting a diagnostic tool to identify head and neck cancers — which are caused from a subset of the human papillomavirus (HPV) — in early stages.
This tool, called a droplet digital polymerase chain reaction (ddPCR), was originally developed to detect DNA sequences, particularly from samples with little genetic material. Biron took advantage of the technology to screen head and neck cancer patients for a specific gene related to HPV. Since 2015, he and his team have obtained saliva samples from 300 patients in whom the HPV virus had already been detected and confirmed via biopsy. The team then used the ddPCR tool to see if the HPV could also be detected via those simple saliva swabs. They were able to clinically validate the tool’s efficacy by identifying the virus with 97 per cent accuracy.
This is a significant development, because 80 per cent of new tonsil and tongue cancers in Alberta are now associated with HPV, rather than with smoking and drinking. Tissues of the tongue and throat are similar to those of the cervix and are therefore preferentially infected by the virus. Also, HPV can be transmitted by oral sex.
Like all cancers, if HPV-related head and neck varieties are caught early, they can be treated less invasively (radiation or minor surgery, for example) and more effectively, reducing mortality rates and increasing quality of life factors.
In light of progress being made with HPV-related cancer detection and intervention, the National Comprehensive Cancer Network (NCCN) has even changed staging criteria — in some cases, advanced-stage cancers are now being re-staged as early stage ones. With Biron’s tool being relatively inexpensive (original set-up cost for the ddPCR is $40,000-plus, but it’s only $20 a pop per patient for the saliva swipes) and easy to use, screening compliance rates should also go up. In addition, instead of expensive imaging tools, like PET scans and biopsies, the tool can be used to look for cancer recurrence.
Because of such promising preliminary results, Biron has been approved to move into phase two of the project, thanks to a $550,000 research grant from the Alberta Cancer Foundation. This phase involves rolling out the screening tool and encouraging its use in clinical practices across Alberta and the rest of Canada.
Down the road, he’d love to see it used as a screening tool in the general population, the way pap smears have evolved to detect cervical cancer. He’d also like to get dentists more involved as potential screening agents — they are often the first to witness suspicious lesions of the throat and mouth and would be ideal co-conspirators in the stand against cancer.
“He is an exceptional clinician, has excellent surgical skills and a highly analytical mind. He’s a natural at research.” — Dr. R. Hadi Seikaly
A related project that Biron is working on began in 2017 and is taking place in Kenya. A colleague, Dr. Andre Isaac, convinced Biron to initiate a cervical cancer screening initiative in the country, using the ddPCR. Kenya is in great need of this kind of help. It has one of the highest rates of HPV-related cancer in the world, but is a “low resource” environment when it comes to cancer care. Few women are aware of the link between the virus and cervical cancer or have timely access to screening. By the time symptoms present, the disease is frequently in advanced and life-threatening stages.
“The tool could be perfect there — a game changer,” says Biron. “We can screen large numbers and get results quickly.”
Biron’s team is planning to collect 200 saliva samples from Kenyan women in Nairobi and surrounding areas who have been diagnosed with cervical cancer, and ship them to Alberta for analysis. If the tool continues to detect HPV with premium accuracy, the end goal will be to help the local community establish its own lab with equipment and personnel.
To Biron, all this promising research means very little unless it is absorbed into practice. He sees cancer patients every day who motivate him to do just that — provide clarity about their diagnosis, effective treatment and prognosis, and hope for their future. He is also paying it forward by sharing his knowledge about clinical work, surgery and anatomy with medical residents at the Faculty of Medicine & Dentistry at the University of Alberta.
It is not always easy doing research. Getting clinicians on board takes coordinated efforts and judicious communication, and there is always “healthy scepticism” with anything new on the landscape. But the dedicated professionals Biron works with provide practical and emotional support, which is critical to his resilience.
Some of his colleagues are also fervent fans. “Vince possesses a rare combination of skills that ensure his success,” says Dr. Hadi Seikaly, a fellow oncologic surgeon, researcher and professor in Edmonton. “He is an exceptional clinician, has excellent surgical skills and a highly analytical mind. He’s a natural at research.”
After a long day at the office, Biron recharges by heading home to his wife and two children. He might go to karate with his 10-year-old son or to a swimming event with his 13-year-old daughter. It’s the ability to enjoy simple yet life-enriching moments such as these that inspire him to keep moving forward in improving and advancing medical care for Albertans.
“It keeps you focused on what’s important,” he says.
8 Questions with Dr. Biron
1. Describe what you do in 10 words or less.
I surgically treat and research head and neck cancers.
2. What’s the biggest misperception about what you do?
That I am an “ear, nose and throat doctor.” This gives patients a skewed perception of what I actually do as a head and neck cancer surgeon. The title itself sounds a bit like I’m an expert in treating the common cold.
3. Where do you get your best ideas?
I get my best ideas while going on long runs.
4. If you weren’t a surgeon/researcher, what would you be?
A farmer. I grew up in a rural community and helped out with farming as a teenager. I liked the variety of work, taking care of animals and being outdoors.
5. What’s the hardest lesson you’ve learned?
Learning to go with the flow and deal with the unexpected, particularly in the operating room.
6. What motivates you?
In my job, seeing patients who have struggled and ultimately lost their lives to head and neck cancer motivates me to improve the management of this disease.
7. What do you do to recharge?
I enjoy going on vacation with my family and doing martial arts with my son.
8. Why does your research matter?
Because it addresses a significant gap in our ability to manage head and neck cancer. This research looks at ways to improve the accuracy of diagnosis for HPV-related head and neck cancer, which is essential to provide the most appropriate treatment for patients. It also aims to provide a new and inexpensive tool to detect these cancers earlier, ultimately enabling earlier and less invasive treatment.