Dr. Joseph Ragaz

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

Academic Research Activities

Last update: July, 2022

Dr. Ragaz initiated his clinical research activities in the late 1970s at the British Columbia Cancer Agency (BCCA), University of British Columbia, Vancouver, BC. These continued between his 2003-2008 tenure at McGill University, Montreal, PQ, and currently (2022) as Clinical Professor, through the School of Population and Public Health [SPPH], University of British Columbia, Vancouver, BC, Canada.

Summary of recent and past activities

2010 - 2022 [present] Breast Cancer [BrCa] Outcome Projects - CANADA. Long-term [BrCa] Incidence & Mortality trends in the Canadian Provinces, correlating outcomes with the organization of cancer care (collaboration: Public Health Agency of Canada, Canadian Cancer Registry, and Statistics Canada).

2010 - 2022 [present]. Breast Cancer Outcome Projects - CHINA. Comparative analyses of Breast Cancer Incidence and Mortality trends between urban and rural China (Collaboration: Cancer Registries in Shanghai & Qidong).

1990s - 2022. HRT reviews. Since the 1990s, Dr. Ragaz and his team have been monitoring, and at times providing additional analyses of HRT data to clarify new HRT paradigms (i.e., Estrogen Breast Cancer DUALITY; mechanisms & estimates of estrogen-associated Br Ca mortality reduction). Provided also is evidence for strengths and shortcomings of existing HRT trials, to identify issues responsible for the lack of clarity of HRT data.

These include the recent HRT analyses by Dr. Ragaz and his team [AACR, 2019], highlighting the association of estrogen-based HRT with substantial and statistically significant [BrCa] mortality reduction in the PREVENTION setting versus no BrCa mortality reduction with Tamoxifen; and estimates of Number of avoided deaths due to estrogen-based HRT, as based on recent results of randomized trials - (see below, HRT references).

2000s - 2022. Issues of Breast Cancer Prevention:

interaction of diet and exercise
aspirin-associated cancer benefits
interaction of Cox2 suppression with Aromatase Inhibition.
Impact of Estrogen-based HRT

2000 - 2004. BCCA Molecular Biology project with Tissue Microarrays. Start and completion of the first phase of the BCCA Tissue Microarray project, in collaboration with the UBC Pathology Group [GPEC] and several groups of international collaborators (Drs. M. Lippman, G. Sledge, K. Miller, S. Badwe, A. Brodie, A. Harris, D.Hayes, et al.) This project correlated, in 930 patients participating in British Columbia Breast Cancer trials, the 20-year breast cancer survival outcome according to the expression of novel molecular markers: Her2/Neu, VEGF, Cox2, uPA, Aromatase, EMSY, etc.

1990 - 2000. Breast Cancer Outcome unit. In the late 1980s, Dr. Ragaz and his team conceptualized and obtained funding for the British Columbia Breast Cancer Outcome Unit - soon afterwards becoming one of the largest and most active Clinical Breast Cancer Outcome units in North America.

1997 - 2005. Post-Mastectomy Radiation therapy. This seminal British Columbia randomized trial [of Post-Mastectomy Radiation therapy versus not] coordinated by Dr. Ragaz and his team (New England Journal of Medicine, 1997; Journal of National Cancer Institute, 2005) helped to change in the late 1990s, along with a similarly designed Danish trial, the post-mastectomy radiation therapy guidelines for stage I-II breast cancer.

1977 - 1985. Neoadjuvant Therapy Program for early Breast cancer was piloted since the late 1970s by Dr. Ragaz's team in British Columbia, and eventually led to the guideline-acceptance of Neo-Adjuvant therapy for Breast Cancer in North America and Europe. In the process, Dr. Ragaz and his team conceptualized Neoadjuvant setting as an ideal one to test new agents for cancer efficacy, substantially reducing the time required in testing and activating new agents into guidelines.

1978 - 1980. Aromatase Inhibitors with Medical Adrenalectomy (Aminoglutethimide) in British Columbia and Canada. One of the first international projects of Aromatase Inhibitors for breast cancer therapy.

Selected Peer-Review Publications &

Presentations

Hormone Replacement Therapy (HRT)

Ragaz J, Spinelli JJ, Qian H, Wong H, Shakeraneh S, Fox J, Wilson SK: Estrogen and breast cancer benefits: Emerging hormone replacement therapy breast cancer paradigms. Cancer Research 82(4); February 2022

Ragaz J; Shakeraneh S; Qian H; Wong H, Spinelli JJ, Wilson K: Estrogen-based hormone replacement therapy [E-HRT] reduces all-cause, breast cancer, and Alzheimer's dementia mortality. Cancer Research, 2021; 81: 4.

Cao J; Ouyang Q; Wang S; Ragaz J; Hu Z, et al.: Mirtazapine, a dopamine receptor inhibitor, as a secondary prophylactic for delayed nausea and vomiting following highly emetogenic chemotherapy: an open label, randomized, multicenter phase III trial. Investigational New Drugs 38(4); April 2020

Ragaz J., Shakeraneh, S., Qian, H., Wilson,K.S., Wong H., Spinelli, J.J: Estrogen-based hormone replacement [HRT] therapy is substantially more effective than tamoxifen in reducing breast cancer mortality and breast cancer case fatality ratio. Emergence of a New Paradigm. Cancer Research, 2019; Volume 79.

Ragaz J., Shakeraneh, S., Qian, H., Wilson,K.S., Wong H., Spinelli, J.J: 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. Cancer Research, 2019; Volume 79.

Ragaz, J., K. Wilson, S. Shakeraneh, S. Budlovsky, and H. Wong: Estrogen and Avoidance of Invasive Breast Cancer, Coronary Heart Disease and All-cause Mortality. Public Health Impact of Estrogen Guidelines for Women entering Menopause. Cancer Res, 2012. 72.

Ragaz J., Wilson K., Muraca G., Budlovsky J., Frohlich J.: Dual Estrogen Effects on Breast Cancer: Endogenous Estrogen Stimulates, Exogenous Estrogen Protects. Further Investigation of Estrogen Chemoprevention Is Warranted. Cancer Res, 2010; 70.

Ragaz, J., Coldman, A. : Age-matched all cause-mortality impact of hormone replacement therapy (HRT): Applicability to breast cancer survivors. Breast Ca Res Treat. 1999, 57-58 A23.

Cancer Epidemiology: Organization of cancer care

Ragaz J, Shakeraneh S, Fox J, Wilson KS, Qian H, Wong H: Interaction of 1970–2010 breast cancer in-situ (brca, DCIS) rates with invasive breast cancer and mortality: Comparative analysis of two regions [of Canada] with different screening mammography and therapy guidelines. Cancer Journal of Clinical Oncology 34; May 2016

Ragaz, J., H. Qian, S. Shakeraneh, J. Fox, K. Wilson, J. Simpson, J.-Y. Yoon, and H. Wong: Increasing population rates of in-situ breast cancer [DCIS] are associated with reduced breast cancer (BrCa) mortality. A case for screening mammography and "overdiagnosis" linked to outcome benefits. Cancer Res, 2016. 76 (4 Supplement).

Ragaz J., Coldman A., Wilson K.S., Fox J., Shakeraneh S., Wong H., Qian H., Spinelli J.J.: Long-Term Breast Cancer Outcomes in Canada with special analyses of cancer care access and mortality reduction. Journal of Clinical Oncology; 2014; Volume 32, Issue 15_supp.

Ragaz, J.: Randomized adjuvant trials in Oncology: A necessity or time-consuming luxury? Breast Cancer Research, 2010, 12 (Suppl 4):S14.

Ragaz, J., J. Spinelli, R. Semeniciw, W. Hryniuk, J. Budlovsky, and E. Franco: Breast cancer mortality reduction in the western world: therapeutic versus diagnostic interventions. Implications for cancer care organization processes. Cancer Res, 2009. 69 (2 Supplement): p. 6083

Ragaz, J., H. Wong, and H. Qian, Comparative Analysis of Breast Cancer (BrCa) Mortality Reduction among Regions of Canada between 1950 and 2004: Impact of Systemic and Diagnostic Guidelines after 1977, with Model Definition of Number of Potentially Avoided Annual Deaths (N-PAAD). Cancer Res, 2009. 69 (24 Supplement): p. 2063-2063.

Ragaz, J. and Spinelli, J.J.: Outcomes of breast cancer therapies in stage IV metastatic breast cancer compared to adjuvant setting: how much do they differ? Critical comments towards the present process of randomized trials as a pre-requisite for adjuvant therapy guidelines. Breast Cancer Res Treat, 2007. 106 (Suppl 1): p. pS6.

Ragaz J., Spinelli J.J., Villeneuve G., Ellison L., Coldman A.: Mortality reduction of breast cancer in Canada: Beneficial impact of cancer care infrastructure. Journal Clin Oncol, 2005; Vol 23:16S, 649.

Ragaz, J., N. Phillips, and A. Coldman, Breast cancer mortality reduction in British Columbia over the last 25 years: Impact of medical interventions including adjuvant chemoradiation, tamoxifen, and screening mammograms/education. Breast Cancer Research and Treatment, 2001. 69 (3): p. 279.

Ragaz, J., Coldman, A., Le, N., Olivotto, I., Fang,R., Hislop, T.: Incidence of 2nd cancers in patients with primary breast cancer: Analysis of British Columbia cancer registry cohorts with differing policies of adjuvant therapy between 1970-1994. in Proc Ann Amer Soc Clin Onc, 1998.

Cancer Epidemiology: Impact of Westernization in China

Ragaz, J., A. Coldman, J. Fox, K.S. Wilson, S. Shakeraneh, Y. Zheng, J.J. Spinelli, P. Bao, H. Wong, J.S. Simpson, X.-C. Hu, and J.G. Chen, Breast cancer incidence among young women of urban China (Shanghai) and in Canada: Implications for prevention. Journal of Clinical Oncology, 2014. 32 (15_suppl): p. 1576-1576.

Ragaz, J., Spinelli, J.J, Semeniciw, R., Hryniuk, W., Budlovsky, J., Franco, E.: Breast cancer mortality reduction in the western world: therapeutic versus diagnostic interventions. Implications for cancer care organization processes. Cancer Research, Vol 69; Supl; January 2009; p383s # 6083.

Ragaz, J.; Bao, P.P.; Pisani, P.; Zheng, Y.: .: Breast Cancer Mortality Trends in the West compared to the East: Lives gained, Lives lost. Cancer Research, Vol 69; January 2009; p383s

Ragaz, J., Chen, G.; Bao, P.P.; Hu, X.H.; Zheng, Y.; Wong, K.; Qian H.: Rapid Increase in Breast Cancer (BrCa) with Regional Mortality Differences in China: Adverse effects of the Westernization and benefits of the Western interventions. JCO, 2009, Suppl., ASCO, Breast, Sept. 2009.

Molecular Biology aspects of Breast Cancer &

British Columbia Tissue Miocroarray Project

Ragaz, J., K. Wilson, H. Wong, G. Muraca, W. Hryniuk, and C. Bajdik: Molecular Classification with 21 Gene Assay (Oncotype DX®) Shows in 1966,1967 ER Positive Patients High Frequency of Low Recurrence Score [LRS] in Both Node Positive (N+) and Negative (N-) Breast Cancer (BrCa) Cohorts. Definition of Chemoresistance Based on LRS with Cost and Guideline Implications. Cancer Res, 2011. 71 (24 )

Ragaz, J. : The 21-gene assay and its impact on breast cancer in Canada. Oncology Exchange, May 2010.

Ragaz J., Lippman, M., Van Rijn, M., Brodie, A., Jelovac, D., Nielsen, T., etal.: Survival Impact of HER-2/Neu, Cox-2, Urokinase Plasminogen Activator (upa), Cytokeratin 17/5,6 and other Markers with Long-Term Outcome of Early Breast Cancer. Report from the British Columbia Tissue Micro-Array Project. Breast Ca Res Treat 2003; 79, p278;

Ragaz, J., Miller K., Badve,S., Dayachko, Y., Dunn,S., Nielsen, T., Brodie, A., Huntsman, D., Bajdik,C., Sledge G: Adverse association of expressed vascular endothelial growth factor (VEGF) with long-term outcome of stage I-III breast cancer (BrCa), with co-expression data of VEGF and Her2, Cox2, uPA and ER. Results from the British Columbia Tissue Microarray Project. J Clin Oncology; Suppl. 2004 July 15; Vol. 22 p. 14S.

J. Ragaz, C. Bajdik, J.J. Spinelli, M. Hayes, D. Jelacic, A. Brodie.: Significant expression of Cox-2 according to Aromatase, independent on ER status: implications to breast cancer therapy with Aromatase and Cox-2 inhibitors. Long-term follow up of the British Columbia Tissue Microarray project. Breast Ca Res Treat, 2004; Vol.88; #109; S22.

Ragaz J., Brodie A., Bajdik C., Jelovac D., Nielsen T., Gilks B., Cheung M., Spinelli JJ., van de Rijn M.: Expression of Cox2, aromatase, HER-2/neu and their correlation with the long-term outcome of 930 stage I-III breast cancer (BrCa) patients. Results from the British Columbia (BC) Tissue Micro-Array Project (BCTMAP. Journal of Clinical Oncology - 2003; Vol.21

Chia S., Ragaz, J., Makretsov, N., Cheung M., etc.: Carbonic anhydrase IX (CA IX) as a predictive marker for benefit from post-mastectomy adjuvant locoregional radiation (RT): Results from the British Columbia (BC) Randomized Radiation Trial. Journal of Clinical Oncology, 2005; Vol. 23, Issue 16.

Callagy, G.M., Pharoah, P.D., Pinder, S.E., Hsu, F.D., Nielsen, T.O., Ragaz, J., Ellis, I.O., Huntsman, D., Caldas, C. : Bcl-2 is a prognostic marker in breast cancer independently of the Nottingham Prognostic Index. [erratum appears in Clin Cancer Res. 2006 Aug 15;12(16):5002]. [Journal Article. Research Support, Non-U.S. Gov't] Clinical Cancer Research. 12 (8):2468-75, 2006 Apr 15.

Nielsen, T.O., Hsu, F.D., Jensen, K., Cheang, M., Karaca, G., Hu, Z., Hernandez-Boussard, T., Livasy, C., Cowan, D., Dressler, L., Akslen, L.A., Ragaz, J., Gown, A.M., Gilks, C.B., van de Rijn, M., Perou,C.M. : Immunohistochemical and clinical characterization of the basal-like subtype of invasive breast carcinoma. Clinical Cancer Research. 10 (16):5367-74, 2004 Aug 15.

Hughes-Davies, L., Huntsman, D., Ruas, M., Fuks, F., Bye, J., Chin, S.F., Milner, J., Brown, L.A., Hsu, F., Gilks, B., Nielsen, T., Schulze, M., Chia, S., Ragaz, J., et al. : EMSY links the BRCA2 pathway to sporadic breast and ovarian cancer. [see comment]. Cell, 2003 Nov 26 115 (5):523-35, .

Nielsen, T.O., Andrews, H.N., Cheang,M., Kucab, J.E., Hsu, F.D., Ragaz, J., et al. : Expression of the insulin-like growth factor I receptor and urokinase plasminogen activator in breast cancer is associated with poor surviva. Cancer Research. 64 (1):286-91, 2004 Jan 1.

Ragaz, J., Bauer,K., Nielsen T., Webster S., Huntsman, D., Bossy, B., Lippman, M.: Use of automated scanning digital microscopy for the accurate and efficient assessment of HER-2 gene amplification based on analysis of 391 human breast cancer specimens. Breast Cancer Research and Treatment, 2003. 82 : p. S11.

Breast Cancer Collaborative Projects,

Fudan University, Shanghai, CHINA

Cao J., Ouyang Q., Wang S., Ragaz J., Wang X., Teng Y., Wang B., Wang Z., Zhang J., Wang L., Wu J., Shao Z., Hu X.: Mirtazapine, a dopamine receptor inhibitor, as a secondary prophylactic for delayed nausea and vomiting following highly emetogenic chemotherapy: an open label, randomized, multicenter phase III trial. Invest New Drugs. 2020 Apr; 38 (2):507-514.

Li T., Wang B., Wang Z., Ragaz J., Zhang J., Sun S., Cao. J, Lv F., Wang L., Zhang S., Ni C., Wu Z.., Xie J., Hu MetasX.: Bevacizumab in Combination with Modified FOLFOX6 in Heavily Pretreated Patients with HER2/Neu-Negativetatic Breast Cancer: A Phase II Clinical Trial. PLoS One. 2015 Jul 17; 10 (7)

Hu X.C., Zhang J., Xu B.H., Cai L., Ragaz J., Wang Z.H., et al.: Cisplatin plus gemcitabine versus paclitaxel plus gemcitabine as first-line therapy for metastatic triple-negative breast cancer (CBCSG006): a randomised, open-label, multicentre, phase 3 trial. Lancet Oncol. 2015 Apr; 16 (4):436-46.

Zhang J., Jia Z., Ragaz J., Zhang Y.J., Zhou M., Zhang Y.P., Li G., Wang B.Y., Wang Z.H., Hu X.C. : The maximum standardized uptake value of 18 F-FDG PET scan to determine prognosis of hormone-receptor positive metastatic breast cancer. BMC Cancer. 2013 Jan 31; 13:42.

Hu X., Zhang J., Xu B., Jiang Z., Ragaz J., Tong Z., et al.: Multicenter phase II study of apatinib, a novel VEGFR inhibitor in heavily pretreated patients with metastatic triple-negative breast cancer. Int J Cancer 2014 Oct 15; 135 (8):1961-9.

Zhao X., Xu X., Guo L., Ragaz J., Guo H., Wu J., Shao Z., Zhu J., Guo X., Chen J., Zhu B., Wang Z., Hu X.: Biomarker alterations with metronomic use of low-dose zoledronic acid for breast cancer patients with bone metastases and potential clinical significance. Breast Cancer Res Treat. 2010 Dec; 124 (3):733-43. doi: 10.1007/s10549-010-1183-6. Epub 2010 Sep 30.

Breast Cancer: Systemic Therapy

Coleman, R; Powles, T; Paterson, A; Gnant, M; Anderson, S, Diel, I; Ragaz J, et al.: Adjuvant bisphosphonate treatment in early breast cancer: meta-analyses of individual patient data from randomised trials. The Lancet, 386(10001); October 2015

Li T, Wang B, Wang Z, Ragaz J, Hu X, et al.: Bevacizumab in Combination with Modified FOLFOX6 in Heavily Pretreated Patients with HER2/Neu-Negative Metastatic Breast Cancer: A Phase II Clinical Trial. PLoS ONE 10(7); July 2015.

Ragaz J, Shakeraneh S: Book Review: Therapeutic Revolution: The History of Medical Oncology From Early Days to the Creation of the Subspecialty. Current Oncology 22(3):222; March 2015

Mackey J., McLeod D., Ragaz J., Gelmon K., Verma S., Pritchard K., Laing K., Provencher L., Charbonneau L.F.: Adjuvant targeted therapy in early breast cancer. Cancer. 2009 ; 115 (6):1154-68. doi: 10.1002/cncr.24114.PMID: 19165856 Free article. Review.

Ragaz, J., Spinelli, J.J : Cost-benefit estimates of Adjuvant (Adj) Trastuzumab (Herceptin, H) for early Breast Cancer (BrCa). Breast Ca Res & Treat, 2005; 94: S 93.

Ragaz, J., Can we cure breast cancer with adjuvant trastuzumab? Evaluating the costs and benefits. Oncology Exchange, 2005. 4 (4): p. 8-10.

Hryniuk W., Ragaz J., Peters W.J.: Dose density by any other name. Journal of Clin Oncol., 2004 Feb 15; 22 (4):750-1; author reply 751-3. doi: 10.1200/JCO.2004.99.130.PMID: 14966105 No abstract available.

Ragaz, J., Comments on kinetics and biology of the residual cancer, and on relevant therapeutic strategies based on these phenomena. Prog Clin Biol Res, 1990. 354B: p. 117-39. ed. J. Ragaz. L. Simposon-Herren. M.Lippman, B.Fisher, New York: Wiley-Liss.

Ragaz, J., Ng, V., Spinelli, J.J.: Correlation of survival with suppression of granulocytes - an expression of biological effectiveness of the delivered dose intensity of adjuvant chemotherapy: analysis of British Columbia adjuvant breast Cancer trial. in Proc Am Soc Clin Oncol., 1989.

Radiotherapy in Early Breast Cancer

Ragaz, J., Jackson, S.M., Le, N., Plenderleith, I.H., Spinelli, J.J., et al.: Adjuvant radiotherapy and chemotherapy in node-positive premenopausal women with breast cancer. [see comment]. [Clinical Trial. Journal Article. Randomized Controlled Trial] New England Journal of Medicine. 337 (14):956-62, 1997 Oct 2. UI: 9309100

Ragaz, J., Olivotto, I.A., Spinelli, J.J., et al.: Locoregional radiation therapy in patients with high-risk breast cancer receiving adjuvant chemotherapy: 20-year results of the British Columbia randomized trial. Journal of the National Cancer Institute [JNCI]. 97 (2):116-26, 2005 Jan 19.

Ragaz, J.: Radiation impact in breast cancer. Breast Cancer Res., 2009; 11 Suppl 3:S14. Epub 2009 Dec 18. Review, pp 1-5.

Truong P.T., Woodward W.A., Thames H.D., Ragaz J., Olivotto I.A., Buchholz T.A. The ratio of positive to excised nodes identifies high-risk subsets and reduces inter-institutional differences in locoregional recurrence risk estimates in breast cancer patients with 1-3 positive nodes: an analysis of prospective data from British Columbia and the M. D. Anderson Cancer Center. Int J Radiat Oncol Biol Phys., 2007 May 1; 68 (1):59-65.

Ragaz, J., Phillips, N., Manji, M.: Long-term results of the British Columbia randomized trial of locoregional radiation in early breast cancer, with comparative analyses of the N1-3 versus N4+ cohorts. Breast Cancer Research and Treatment, 2003. 82: p. S181-S182.

Ragaz, J., Phillips N., and Spinelli J.J.: Extensive nodal involvement or extracapsular spread in predicting the survival impact of loco-regional radiation for stage II breast cancer patients: Long-term observations from the British Columbia randomized trial. in Proc Am Soc Clin Oncol., 2001

Ragaz, J., Spinelli, J.J., Coldman, A.J.: Breast cancer survival advantage with radiotherapy. Lancet. 356 (9237):1270-71, 2000 Oct 7. UI: 11072966

Ragaz, J., Spinelli, J.J.: Wide-field radiation as adjunct to adjuvant chemotherapy in high-risk cases with early breast cancer: do it or not? [comment]. [Journal Article] International Journal of Cancer, 2000. 87 (3):423-6.

Ragaz, J., Jackson, S.M.: Significance of axillary lymph node extranodal soft tissue extension and indications for postmastectomy irradiation. Cancer, 2000. 89 (1):223-5.

Ragaz, J., Spinelli, J.J.: Large breast cancer tumors and radiotherapy: biology vs. chronology. [Comment. Editorial] Radiotherapy & Oncology, 1999; 52 (3):203-5.

Ragaz, J., Jackson, S., Plenderleith, I., Wilson, K., Basco, V., Knowling, M., Worth, A., Spinelli,J.J., and Ng, V.: Can adjuvant radiotherapy improve the overall survival of breast cancer patients in the presence of adjuvant chemotherapy? 10 year analysis of the British Columbia randomized trial. in Proc Am Soc Clin Oncol., 1993.

Preoperative (NEOADJUVANT) Therapy of Early Breast Cancer

Stages I - II

Oxford Overview Meta-Analysis Group: Long-term outcomes for neoadjuvant versus adjuvant chemotherapy in early breast cancer: Meta-analysis of individual patient data from ten randomised trials. The Lancet Oncology 19(1); December 2017.

Ragaz, J., Baird, R., Rebbeck, P.: Organization of randomized preoperative (neoadjuvant) trial in stage I and II breast cancer-early results. in Proc 2nd Intl Congress on Neo-adjuvant Chemotherapy, Paris. 1988.

Ragaz, J. : Preoperative (neoadjuvant) chemotherapy for breast cancer: outline of the British Columbia Trial. [Clinical Trial. Comparative Study. Journal Article] Recent Results in Cancer , J. Ragaz, P.R. Band, J. Goldie, eds., 1986. 103 :85-94.

Ragaz, J. : Emerging modalities for adjuvant therapy of breast cancer: neoadjuvant chemotherapy. [Clinical Trial. Journal Article. Randomized Controlled Trial] NCI Monographs. (1):145-52, 1986.

Ragaz, J., R. Baird, P. Rebbeck, A. Coldman, and J. Goldie: Neoadjuvant-preoperative-chemotherapy for breast cancer - preliminary report of the Vancouver trial. Prog Clin Biol Res, 1985. 201: p. 77-87.

Ragaz, J., Goldie, J.H., Baird, R., Rebbeck, P., Basco, V., Coldman, A. : Experimental basis and clinical reality of preoperative (neoadjuvant) chemotherapy in breast cancer. [Journal Article] Recent Results in Cancer Research, 1989; 115 :28-35

Ragaz, J., Baird, R., Rebbeck, P., Goldie, J., Coldman, A., Spinelli, J. : Neoadjuvant (preoperative) chemotherapy for breast cancer. [Journal Article] Cancer. 56 (4):719-24, 1985.

Ragaz, J., Goldie J., Coldman A.: Preoperative adjuvant chemotherapy for cancer of the breast. In: Proc Am Soc Clin Oncol., 1982.

Preoperative (NEOADJUVANT) Therapy,

Stage III Locally-Advanced Breast Cancer.

Ragaz, J., Manji, M., Plenderleith, I.: Impact of residual disease in stage III breast cancer patients treated with preoperative (neoadjuvant) chemotherapy, radiotherapy and mastectomy: The 10-year analysis of the British Columbia study. In: Proc Am Soc Clin Oncol, 1994.

Ragaz, J., I. Olivotto, S. O'Reilly, U. Kuusk, I. Plenderleith, V. Ng, and V. Basco. The significance of mastectomy in patients with locally advanced breast cancer treated with preoperative (neoadjuvant) therapy: is there a need for randomization. in Proc Am Soc Clin Oncol., 1991. 989.

Ragaz, J.: Biologic aspects, classification, surgery, and radiotherapy of stage III breast cancer. Current Opinion in Oncology, 1990. 2 (6): p. 1053-1067.

Ragaz, J., R. Baird, J. Goldie, A. Coldman, and P. Rebbeck. Role of preoperative (neo-adjuvant) therapy for breast cancer in stage I - III disease. in Colloque INSERM., 1988.

M. Manji, J. Ragaz, A. Worth, I. Plenderleith, J. Harman, M. Knowling, I. Olivotto, and V. Basco. Is mastectomy indicated in patients with stage III breast cancer treated with preoperative (neoadjuvant) therapy? In Proc Am Soc Clin Oncol, 1988.

Ragaz, J., Manji, M., Olivotto, I., Basco, V., Worth, A., Knowling, M., Plenderleith, I., Spinelli, J.J.: Role of Mastectomy in preoperative (neoadjuvant) combined modality therapy of locally advanced breast cancer. in Proc Am Soc Clin Oncol, 1987.

Ragaz, J., Knowling, M., Jones G., Manji, M., Plenderleith, I., Olivotto, I., Spinelli, JJ., Basco, V., Worth, A.: Comparability of preoperative (NEOADJUVANT) and postoperative therapy for locally advanced breast cancer (LABC). in Proc.Amer.Assoc. Ca Res. 1987. Philadelphia, PA 19106-4404 USA.

Oxford Overview Meta-analyses of Early Breast Cancer trials

Long-term outcomes for neoadjuvant versus adjuvant chemotherapy in early breast cancer: meta-analysis of individual patient data from ten randomised trials. Early Breast Cancer Trialists' Collaborative Group (EBCTCG).Lancet Oncol, 2018 Jan; 19 (1):27-39. 2017 Dec 11.PMID: 29242041. Review.

Early Breast Cancer Trialists' Collaborative Group (EBCTCG): Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomized trials. Lancet; 2005; Vol 366, Issue 9503.

Early Breast Cancer Trialists' Collaborative Group (EBCTCG): Polychemotherapy for early breast cancer: An overview of the randomized trials. Lancet; 1998, Vol. 352 Issue 9132.

Tamoxifen in prevention of human Breast Cancer

Ragaz, J., Spinelli, J.J.; Coldman, A. ; Mihalciou, C.: Is Tamoxifen prevention of Breast Cancer (BrCa) underutilized in younger women? Analysis of competing cause mortality. Journal Clin Oncol, Suppl., 2006; Vol. 24; p 39.

Ragaz, J. : Interaction of tamoxifen's impact on overall net mortality and quality of life. Oncology, 1997 Feb.; 1 (2 Suppl 1):45-8

Ragaz, J., Coldman, A. : Survival impact of adjuvant tamoxifen on competing causes of mortality in breast cancer survivors, with analysis of mortality from contralateral breast cancer, cardiovascular events, endometrial cancer, and thromboembolic episodes. Journal of Clinical Oncology. 16 (6):2018-24, 1998.

Breast Cancer Outcomes (BCCA Breast Cancer Outcome Unit)

Woodward, W.A, Truong, P.T, Yu, T.K, Tereffe, W., Oh, J., Perkins, G., Strom, E., Meric-Bernstam, F., Gonzalez-Angulo, A.M, Speers, C., Ragaz J., Buchholz, T.A: Among women who experience a recurrence after postmastectomy radiation therapy irradiation is not associated with more aggressive local recurrence or reduced survival. Breast Cancer Res Treat. 2010 Sep; 123 (2):597-605.

Truong, P.T., Woodward, W.A., Thames, H., Ragaz, J., et al.: The ratio of positive to excised nodes identifies high-risk subsets. [Comparative Study. Journal Article. Multicenter Study. Randomized Controlled Trial] International Journal of Radiation Oncology, Biology, Physics, 2007 May 1. 68 (1):59-65,

Chua, B., Olivotto, I., Weir, L., Kwan,W., Truong, P., Ragaz, J.: Increased use of adjuvant regional radiotherapy for node-positive breast cancer in British Columbia. [Journal Article. Research Support, Non-U.S. Gov't] Breast Journal. 10 (1):38-44, 2004 Jan-Feb.

Bryce, C., Kennecke, H., Chia,S., Ragaz, J. : Benefit of Paclitaxel in estrogen receptor-negative versus estrogen receptor-positive early breast cancer. Journal of Clinical Oncology. 21 (23):4465- 66, 2003 Dec 1.

Olivotto,I.A., Chua, B., Allan, S.J., Speers, C.H., Chia, S., Ragaz, J. : Long-term survival of patients with supraclavicular metastases at diagnosis of breast cancer. [Journal Article] Journal of Clinical Oncology. 21 (5):851-4, 2003.

Aromatase Inhibitors & Oophorectomy in Breast Cancer

Long, B.J., Jelovac D., Handratta V., Thiantanawat A., MacPherson N., Ragaz J., Goloubeva O.G., Brodie A.M. : Therapeutic strategies using the aromatase inhibitor letrozole and tamoxifen in a breast cancer model. J Natl Cancer Inst., 2004 Mar 17; 96 (6):456-65. doi:

Ragaz, J.: Adjuvant trials of aromatase inhibitors: determining the future landscape of adjuvant endocrine therapy. J Steroid Biochem Mol Biol, 2001. 79 (1-5): p. 133-141.

Ragaz, J. : Status of aromatase inhibitors in relation to other breast cancer treatment modalities. [Review] [145 refs] [Journal Article. Review] Endocrine-Related Cancer. 6 (2):277-91, 1999 Jun.

Ragaz, J., Jackson, S., Le, N., Plenderleith, I., Wilson, K., Knowling, M., Olivotto, I., Basco, V., Spinelli, JJ., Coldman A.: Can ovarian ablation improve outcome of stage I-II premenopausal breast cancer patients with estrogen receptor positive tumors treated with adjuvant chemotherapy? Long-term analysis of British Columbia randomized trial. Proc of Amer Soc Clin Oncol (16), S. 142a, 1997. 501.

Ragaz, J., Buskard, N., Manji, M. : Thrombocytopenia after combination therapy with aminoglutethimide and tamoxifen: which drug is to blame?. [Case Reports. Journal Article] Cancer Treatment Reports. 68 (7-8):1015-6, 1984 Jul-Aug.

Ragaz, J., E. Ibrahim, M. Leahy, and A. Willan. Some observations on the hormonal therapy of metastatic breast cancer (MBC) - aminoglutethimide (AG) with or without tamoxifen (T). In Proc.Amer.Assoc.Ca Res, 1981.

Ragaz, J., Combination of hormones for metastatic carcinoma of the breast: aminoglutethimide plus tamoxifen in combination versus aminoglutethimide alone versus tamoxifen alone. Cancer, 1981 (Suppl. a): p. 547-562.

BOOKS

Ragaz, J., Simpson-Herren, L., Lippman, M., Fisher, B. eds. : Effects of Therapy on the Biology and Kinetics of the Surviving Cancer. Part A. Preclinical Aspects. Willey-Liss, New York, 1990.

Ragaz, J., Simpson-Herren, L., Lippman, M., Fisher, B. eds. : Effects of Therapy on the Biology and Kinetics of the Surviving Cancer. Part B. Clinical Aspects. Willey-Liss, New York, 1990.

Ragaz, J., Ariel, I., eds.: High Risk Breast Cancer, Part 1: Diagnosis. Springer-Verlag, Heidelberg, 1989.

Ragaz, J., Ariel, I., eds.: High Risk Breast Cancer, Part 2: Therapy. Springer-Verlag, Heidelberg, 1991.

Ragaz, J., Band, P., Goldie, J.H., eds. : Preoperative (Neoadjuvant) Therapy of Cancer. Springer-Verlag, Heidelberg, 1986.

CHAPTERS

Ragaz, J., Shakeraneh S.: Estrogen and Breast Cancer in Postmenopausal Women. A Critical Review. Part 1 of the Hormone Replacement Therapy [HRT]. In: Management of Breast Diseases, 2nd Ed., I.Jatoi, A.Rody Ed, Springer International Publishing, Switzerland, 2016. p. 483-490.

Ragaz, J, S. Shakeraneh, Estrogen and Cardiac Events with all-cause Mortality. A Critical Review, Part 2 of the Hormone Replacement Therapy [HRT]. In: Management of Breast Diseases, 2nd Ed., I.Jatoi, A.Rody Ed, Springer International Publishing, Switzerland, 2016. p. 483-490.

Ragaz, J., Budlovsky, J. : Hormone Replacement Therapy [HRT]: A critical Review. In: Manual of Breast Disease; I. Jatoi, E. Kaufmann (eds.), Springer-Verlag, New York 2010, pp 451 - 473.

Ragaz, J. : Impact of HER-2/neu expression on natural history and outcome of human breast cancer. Breast diseases, J. Harris, M. Morrow, M. Lippman, K. Osborne, eds., Lippincott, Williams and Wilkins, June 2004.

Ragaz, J., Spinelli, J.J. : Survival impact of locoregional radiation in Stage I-II breast cancer: Evidence-based review. In: Breast Cancer Management: Application of clinical and translational evidence to patient care. Second edition; J.M. Nabholtz, K. Tonkin, D. Reese, M. Apro, A. Buzdar eds., W.W. Lippincott, New York, 2002.

Ragaz, J. : Hormone replacement therapy in patients with a prior breast cancer history: A critical review. In: Manual of Breast Disease. (ed) Ismail Jatoi. Lippincott Williams & Wilkins, 2002, 389-415.

Ragaz, J., Ariel I.M.,: Future and Developmental Aspects of High Risk Breast Cancer Therapy. In: High Risk Breast Cancer, J. Ragaz, I.M. Ariel (eds), Springer-Verlag, New York, Heidelberg, 493-511, 1991.

Ragaz, J. : Role of Preoperative Therapy in High Risk Breast Cancer: Review. In: High Risk Breast Cancer. J. Ragaz, I.M. Ariel (eds), Springer-Verlag, New York, Heidelberg, 71-85, 1991.

Ragaz, J., Ariel, I.M. : Therapeutic Highlights of High Risk Breast Cancer: Comments Related to Surgery, to Radiotherapy and Hormone Therapy. In: High Risk Breast Cancer - Therapy, IM Ariel (eds), Springer-Verlag, New York Heidelberg 2-25, 1991.

Ragaz, J., Simpson-Herren, L., Lippman, M., Fisher, B. : Questions related to the effects of therapy on biology and kinetics of the surviving tumor. Part A: Preclinical Aspects [Journal Article] Progress in Clinical & Biological Research. 354A:1-6, 1990. UI: 2247483

Ragaz, J., Ariel, I.M. : High risk breast cancer: Definition of the risk. In: High Risk Breast Cancer. J. Ragaz, I.M. Ariel (eds), Springer-Verlag (Heidelberg), 3-25; 1989.

Ragaz, J., Goldie, J.H., Baird, R., et al. : Experimental Basis and Clinical Reality of Preoperative (Neoadjuvant) Chemotherapy in Breast Cancer. In: Recent Results in Cancer Research, Springer-Verlag (Heidelberg), 115: 28-351; 1989.

Ragaz, J., Manji, M., Olivotto, I., Knowling, M., Basco, V., Plenderleith, I. : Preoperative Combined Modality (Neoadjuvant) Therapy of Locally Advanced Breast Cancer. In Fundamental Problems in Breast Cancer. Patterson, A.H.G., Lee, A., eds., Martinus Nijhof, 1987, 383-391.

Ragaz, J. : Management of Stage III Breast Cancer: New Developments. In Endocrine Related Breast Cancer, B. Stoll Ed.; 1986.

Rootman J., Ragaz, J., Cline, R., Lapointe, J. : Metastatic and Secondary Tumors of the Orbit. In J. Rootman Ed.: Diseases of the Orbit, 1987.