Prof Sandra O'Toole

Senior Pathology Fellow - Translational Breast Cancer Research

Prof Sandra O'Toole

After graduating in Medicine from UNSW with the University Medal in 1997 and finishing my specialist training as a pathologist in 2003, I spent 2 years as a postdoctoral fellow at Johns Hopkins Hospital, completing my PhD in 2008 at the Garvan Institute of Medical Research. I currently divide my tim


After graduating in Medicine from UNSW with the University Medal in 1997 and finishing my specialist training as a pathologist in 2003, I spent 2 years as a postdoctoral fellow at Johns Hopkins Hospital, completing my PhD in 2008 at the Garvan Institute of Medical Research. I currently divide my time between Royal Prince Alfred Hospital (as Staff Specialist in the Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and Head of Diagnostic Molecular Oncology) and the Garvan Institute of Medical Research as Head of Translational Breast Cancer Research.

I am passionate about the translation of research into clinical practice, reflected in my clinical role as a molecular pathologist, integrating cutting edge technologies into the hospital setting. Working with clinical colleagues at RPAH and at the Garvan I have developed large tissue bank resources such as the Sydney Breast Cancer Foundation Tumour with over 1,000 patients with invasive breast carcinoma. This resource is continuously being expanded at the rate of 500 patients per year and is linked with high quality clinical data. We have also recently formed a partnership with The Strathfield Breast Centre to develop an even larger cohort of patients with breast cancer to promote the rapid translation of basic scientific discoveries into clinical practice.

I head the diagnostic molecular oncology service at RPAH, the first comprehensive mutation testing service in NSW to achieve NATA laboratory accreditation. This service has provided molecular pathology to guide the diagnosis and treatment of over 1,500 patients with cancer.

Awards and Honours

2013 - Poster commendations x 2 International Academy of Pathology Sydney
2012 - Winner Poster Award RCPA Updates Sydney
2011 - Winner Pathologist Category Poster International Academy of Pathology Sydney (presenting author)
2010 - Winner Pathologist Category Poster International Academy of Pathology Sydney (presenting author)
2009 - Poster commendation International Academy of Pathology, Sydney
2008 - Winner Pathologist Category Poster International Academy of Pathology Sydney (presenting author) 2 highly commended poster awards (co-author)
2006 - Highly commended poster International Academy of Pathology, Sydney
1996 - The Wallace Wurth Prize for the best performance throughout the Medical course (University Medal)
1996 - The Graduate Prize in Surgery
1996 - The Prince of Wales Senior Staff Prize for the best performance in the clinical years of the course
1996 - The Medical Women's Society Prize
1996 - The Novartis Prize for the top student in final year Medicine.
1995 - The Royal Hospital for Women Senior Medical Staff Prize for Obstetrics and Gynaecology
1995 - The 2/5 Australian General Hospital Prize for Community Medicine
1994 - Junior Investigator Award Australian Diabetes Society
1994 - Sugarman Prize in Clinical Pathology
1993 - Sugarman Prize in Experimental Pathology
1992 - G.R Cameron Memorial Prize for the highest aggregate in 3rd year Pathology


2008 – PhD, University of New South Wales “Studies in stem cell biology and developmental pathway regulation in the pancreas and breast” Garvan Institute of Medical Research, Sydney and Johns Hopkins Medical Institutions, Maryland, USA
2003 - Fellowship of the Royal College of Pathologists of Australasia
1997 - Bachelor of Medicine, Bachelor of Surgery, Honours I and the University Medal
1994 - Bachelor of Medical Science, Honours I and the Prize for Experimental Pathology

Selected Publications

Review articles in peer review journals 

Wendy Cooper and Sandra O’Toole. Molecular Pathology in Lung Cancer. Cancer Forum. 2013; 37:2:158-165

Rakha EA, O'Toole SA, Ellis IO, Tan PH. Breast pathology today: morphology and molecules. J Clin Pathol. 2013; 66(6):457.

Hui M, Cazet A, Nair R, Watkins DN, O'Toole SA, Swarbrick A. The Hedgehog signalling pathway in breast development, carcinogenesis and cancer therapy. Breast Cancer Res. 2013; 15(2):203. 

O'Toole SA, Beith JM, Millar EK, West R, McLean A, Cazet A, Swarbrick A, Oakes SR. Therapeutic targets in triple negative breast cancer. J Clin Pathol. 2013; 66(6):530-42.

Cooper CL, Karim RZ, Selinger C, Carmalt H, Lee CS, O'Toole SA.  Molecular alterations in metaplastic breast carcinoma. J Clin Pathol. 2013; 66(6):522-8.

Original articles in peer-reviewed journals

Radhika Nair, Daniel L Roden,Wee S Teo, Andrea McFarland, Simon Junankar, Sunny Ye, Akira  Nguyen, Jessica Yang, Iva Nikolic, Mun Hui, Adrienne Morey, Jaynish Shah, Adam D Pfefferle, Jerry Usary, Christina Selinger, Laura A Baker, Nicola Armstrong, Mark J Cowley, Mathew J Naylor, Christopher  J Ormandy, Sunil R Lakhani, Jason I Herschkowitz , Charles M Perou, Warren Kaplan, Sandra A O’Toole, Alexander Swarbrick. c-Myc and Her2 cooperate to drive a stem-like phenotype with poor prognosis in breast cancer. Oncogene July 2013 (in press)

Browne, Brigid; Hochgräfe, Falko; Wu, Jianmin; Millar, Ewan; Barraclough, Jane; Stone, Andrew; McCloy, Rachael; Lee, Christine; Roberts, Caroline; Ali, Naveid; Boulghourjian, Alice; Schmich, Fabian; Linding, Rune; Farrow, Lynn; Gee, Julia; Nicholson, Robert; O'Toole, Sandra; Sutherland, Robert; Musgrove, Elizabeth; Butt, Alison; Daly, Roger. Global characterization of signalling networks associated with tamoxifen resistance in breast cancer. FEBS Letters 2013; (in press)

Chris C. Wolford, Stephen J. McConoughey, Swati P. Jalgaonkar, Marino Leon,Anand S. Merchant, Johnna L. Dominick, Xin Yin,Yiseok Chang, Erik J. Zmuda, Sandra A. O’Toole, Ewan K.A. Millar, Stephanie L. Roller, Charles L. Shapiro, Michael C. Ostrowski, Robert L. Sutherland, and Tsonwin Hai.  Transcription factor ATF3 links host adaptive response to breast cancer metastasis.  J Clin Invest June 2013 (in press)

Tran TN, Selinger CI, Kohonen-Corish MR, McCaughan BC, Kennedy CW, O'Toole SA, Cooper WA. Fibroblast growth factor receptor 1 (FGFR1) copy number is an independent prognostic factor in non-small cell lung cancer. Lung Cancer. 2013; Jun 24.

Selinger CI, Rogers TM, Russell PA, O'Toole S, Yip P, Wright GM, Wainer Z, Horvath LG, Boyer M, McCaughan B, Kohonen-Corish MR, Fox S, Cooper WA, Solomon B. Testing for ALK rearrangement in lung adenocarcinoma: a multicenter comparison of immunohistochemistry and fluorescent in situ hybridization. Mod Pathol. 2013 Jun 7. doi: 10.1038/modpathol.2013.87.

Cooper WA, Yu B, Yip PY, Ng CC, Lum T, Farzin M, Trent RJ, Mercorella B, Clarkson A, Kohonen-Corish MR, Horvath LG, Kench JG, McCaughan B, Gill AJ, O'Toole SA. EGFR mutant-specific immunohistochemistry has high specificity and sensitivity for detecting targeted activating EGFR mutations in lung adenocarcinoma. J Clin Pathol. 2013 Jun 11. [Epub ahead of print]

Schade B, Lesurf R, Sanguin-Gendreau V, Bui T, Deblois G, O'Toole SA, Millar EK, Zardawi SJ, Lopez-Knowles E, Sutherland RL, Giguere V, Kahn M, Hallett M, Muller WJ.  β-catenin signaling is a critical event in ErbB2-mediated mammary tumor progression. Cancer Res. 2013 Jun 10. [Epub ahead of print]

Po Yee Yip, Bing Yu,Wendy A. Cooper, Christina I. Selinger, Chu Chin Ng, Catherine Kennedy, Maija R.J. Kohonen-Corish, Brian C. McCaughan, Ronald J. Trent, Michael J. Boyer, James G. Kench, Lisa G. Horvath, Sandra A. O’Toole. Patterns of DNA mutations and ALK rearrangement in resected node negative lung adenocarcinoma. J Thorac Oncol. 2013; 8(4):408-14.

Shields BJ, Wiede F, Gurzov EN, Wee K, Hauser C, Zhu HJ, Molloy TJ, O'Toole SA, Daly RJ, Sutherland RL, Mitchell CA, McLean CA, Tiganis T.  TCPTP regulates SFK and STAT3 signaling and is lost in triple-negative breast cancers. Mol Cell Biol. 2013; 33(3):557-70.

Coates AS, Millar EK, O'Toole SA, Molloy TJ, Viale G, Goldhirsch A, Regan MM, Gelber RD, Sun Z, Castiglione-Gertsch M, Gusterson B, Musgrove EA, Sutherland RL.  Prognostic interaction between expression of p53 and estrogen receptor in patients with node-negative breast cancer: results from IBCSG Trials VIII and IX. Breast Cancer Res. 2012;  14(6):R143

Colvin, EK, Susanto, JM, Kench, JG, Ong, VN, Mawson, A, Chang, DK, Rooman, I, O’Toole SA, Segara, D, Musgrive, EA, Sutherland, RL, Apte, MV, Scarlett, CJ, Biankin, AV. Retinoid signaling in pancreatic cancer, injury and regeneration. PLoS One 2011; 6 (12).

Millar EK, Graham PH, McNeil CM, Browne L, O'Toole SA, Boulghourjian A, Kearsley JH, Papadatos G, Delaney G, Fox C, Nasser E, Capp A, Sutherland RL. Prediction of outcome of early ER+ breast cancer is improved using a biomarker panel, which includes Ki-67 and p53. Br J Cancer. 2011; 105(2):272-80.

O'Toole SA, Machalek DA, Shearer RF, Millar EK, Nair R, Schofield P, McLeod D, Cooper CL, McNeil CM, McFarland A, Nguyen A, Ormandy CJ, Qiu MR, Rabinovich B, Martelotto LG, Vu D, Hannigan GE, Musgrove EA, Christ D, Sutherland RL, Watkins DN, Swarbrick A.  Hedgehog overexpression is associated with stromal interactions and predicts for poor outcome in breast cancer. Cancer Res. 2011; 71(11):4002-14.