Dr. Joseph Ragaz - Medical Oncologist & Clinical Professor

Dr. Joseph Ragaz

Medical Oncologist & Clinical Professor
Faculty of Medicine
School of Population & Public Health
The University of British Columbia, Vancouver, BC, Canada

Clinical, Academic and Research Activities

Dr. Ragaz is a Medical Oncologist, Breast Cancer Specialist and Clinical Professor at the School of Population and Public Health (SPPH), University of British Columbia (UBC), Vancouver, B.C., Canada.

CLINICAL ACTIVITIES, 1977-2022

During his 1977-2003 tenure at the British Columbia Cancer Agency [BCCA], Vancouver, BC, Dr. Ragaz subspecialized in Breast Cancer, developing multiple Clinical Research Initiatives, some of those helping with changes of National and International Breast Cancer practice guidelines.

From 2003 to 2008, Dr. Ragaz was the Director of the Oncology Program, McGill University Health Centre [MUHC], McGill University, Montreal, Quebec, Canada, where he helped to expand and modernize the MUHC Oncology activities.

2009-2022 (present): In 2009, Dr. Ragaz opened the Vancouver-based Oncology Counselling, Research and Prevention Clinic, dedicated to in-depth counselling of patients with established Cancer and for Breast Cancer Prevention. Problematic issues are frequently discussed with current local, national and international opinion leaders. In addition to the counseling activities, and if required, an informed second opinion is provided.

In February 2018, he started consulting for Inspire Health (https://www.inspirehealth.ca/), a Provincial Cancer facility aimed at offering comprehensive cancer support care for recently-diagnosed cancer patients. At Inspire Health, he expanded the Oncology counselling sessions and coordinated the academic and physician educational activities.

ACADEMIC RESEARCH & UNIVERSITY TEACHING

Since 1977, Dr. Ragaz and his team have initiated and completed a number of national and international breast cancer studies, paving the way to concepts eventually accepted by the international community. These initiatives include projects such as:

Neoadjuvant Chemotherapy (1978 - 1985)
Role of Aromatase Inhibitors replacing surgical adrenalectomy (1978 - 1983)
Post-Mastectomy Radiation for early breast cancer (1983 - 2005)
Role of tissue microarrays identifying new genetic markers (2000 - 2003)
Impact of Hormone Replacement Therapy [HRT] on multiple health outcomes

2003-2010:, Dr. Ragaz started a chain of breast cancer epidemiology outcome projects, such as:

Uniformity of and adherence to cancer guidelines as part of the organization of cancer, significantly improved long-term Breast Cancer Incidence and Mortality outcomes
Impact of HRT on long-term multiple-cause outcomes, including articulation of new HRT paradigms:
1. estrogen DUALITY vis-à-vis BrCa: exogenous [HRT] estrogen is breast cancer protective, while endogenous estrogen remains BrCa carcinogenic;
2. Guideline Recommendations of estrogen-based HRT will result in avoidance of tens of thousands of deaths per year just in the USA;
3. estrogen is associated with more significant BrCa mortality reduction, even more substantial than what is seen with tamoxifen;
Association of adverse effects of "Westernization" versus benefits of "Western therapies" on rates of Breast Cancer Incidence & Mortality in China: Comparative analyses of BrCa outcomes between Rural and Urban China versus Canada. [Collaboration, SPPH & UBC with the Fudan University, Shanghai, China]
Association of Increased rates of DCIS and BrCa mortality reduction: evidence for BrCa survival benefit of Screening Mammography, with earlier and more substantial BrCa mortality reduction in British Columbia compared to other Provinces of Canada.

2009-2022: Dr. Ragaz is currently active at the School of Population and Public Health [SPPH], University of British Columbia, Vancouver, BC, Canada, working with teams of local and international academic collaborators on a variety of Cancer Epidemiology and Outcome projects.

Some of them, such as the Public Health Impact of the modern generation HRT, or a proposal since 2012 for Oncotype DX to be routinely used to identify Breast Cancer Chemotherapy resistance, will likely impact the present management guidelines. Most of these projects were already presented between 2007 and 2021 at international forums such as ASCO & SABCS (see below "Ongoing Clinical Projects"), and are now reaching maturity and completion.

Between 2010 and 2015, Dr. Ragaz led, at UBC's SPPH, a Postgraduate course (SPPH 524, Introduction to Medicine - the Public Health Perspective), for SPPH Masters and PhD students.

PATIENT ADVOCACY

2005-2017: Board Member, Director, Cancer Advocacy Coalition of Canada (http://www.canceradvocacy.ca). Dr. Ragaz has been an active champion of patient's rights to access the best cancer care, as seen from his many activities and publications with the Cancer Advocacy Coalition of Canada.

ONGOING CLINICAL PROJECTS, 2010-2022

i. HRT

Emerging paradigms of Estrogen-based HRT: Review of pivotal HRT studies [WHI, Oxford-based Observational studies] evaluating Breast Cancer, and other health outcomes. A Critical Review with guideline implications.

Estrogen Duality and Breast Cancer: Endogenous Estrogen Stimulates, Exogenous Estrogen Protects. Further Investigation of Estrogen Chemoprevention Is Warranted.

Estrogen-based HRT versus Tamoxifen, and Breast Cancer Prevention: Estrogen-based hormone replacement [HRT] therapy is substantially more effective than tamoxifen in reducing breast cancer mortality and breast cancer case fatality ratio.

Estrogen-alone based hormone replacement therapy (HRT) reduces breast cancer (BrCa) incidence and mortality, whereas estrogen plus progestin Provera-based HRT increases both BrCa incidence and BrCa mortality: A comparative analysis of Women's Health Initiative trials 1 and 2.

ii. ORGANIZATION OF CANCER CARE

Long-term breast cancer outcomes in Canada with special analyses of cancer care access and mortality reduction.

Comparative Analysis of Breast Cancer (BrCa) Incidence and Mortality Rates among Regions of Canada between 1950 and 2004: Impact of Systemic and Diagnostic Guidelines after 1977.

Population rates of In-Situ breast cancer [DCIS] are associated with breast cancer (BrCa) Incidence and Mortality rates. A case for screening mammography.

iii. IMPACT of "WESTERNIZATION" on BREAST CANCER OUTCOMES (e.g., Urban versus Rural China)

Breast Cancer Outcomes in Urban and Rural China: Adverse Effects of Western Lifestyle, versus Benefits of Western Interventions. A Comparative Analysis with Canada.

Significantly increased rates of breast cancer incidence among young women of urban China (Shanghai) and in Canada: Implications for prevention.

MOLECULAR-BIOLOGY ASPECTS OF BREAST CANCER

Molecular Classification with 21 Gene Assay (Oncotype DX) in ER Positive Breast Cancer Patients: Definition of Chemoresistance with guideline implications.

Cox-2 expression and impact of Cox-2 expression on Breast Cancer survival according to Aromatase and ER status: Implications to or for Breast Cancer therapy with Aromatase and Cox2 Inhibitors.