Olufunmilayo Olopade, or "Funmi" to her friends and family, knew from a young age that she wanted to be a doctor. Growing up in Nigeria as a minister's daughter, she saw the suffering of her father's parishioners. She knew that as a minister, her father could only do so much to help them.
Olopade, 50, came to the United States more than 20 years ago as an oncologist at the University of Chicago Medical Center. But she has not forgotten her home country. Her studies focus on breast cancer patients in Nigeria as well as in the predominantly African American south side of Chicago.
While one in eight women will get breast cancer during their lives, their diseases will be different. The varying contributions of genetics and the environment to these cancers remain unclear. Olopade wants to tackle this question, and to move the field of breast oncology toward personalized treatments based on women's histories and genetics.
Recently, she found that woman of African descent are more likely to get a certain kind of aggressive breast cancer, indicating genetic differences in breast cancer among different races. In 2005, she was awarded the MacArthur Foundation's "genius grant," given for exceptionally creative research in the U.S. At the February 2008 American Association for the Advancement of Science meeting in Boston, she spoke about the need to understand the global differences in breast cancer.
You said that breast cancer is not one disease. What did you mean by that?
We've found that patterns of gene activation vary in different cancers from different patients. The outcome for the women depends on what's propelling the cancer. Some women have estrogen receptor negative breast cancer [a kind of cancer resistant to tamoxifen, the most widely used breast cancer drug], and they will respond to some types of chemotherapy and not others. Some have estrogen receptor positive breast cancer, and some have HER2 positive breast cancer.
How can people identify their risk factors for getting breast cancer?
The most important risk factors are age and family history. If you have a mother, aunt, or sister who had breast cancer, that history should make you want to get genetic counseling. Women who delay having children or who don't breast feed have increased risk. We now know there are low-risk genes that may contribute to risk, and in the next few years there may be tests available for those genes. So if we combine those low-risk genes with someone's lifestyle and family history, we may be able to come up with an algorithm that will actually tell a woman her risk of getting breast cancer.
What are some recent breakthroughs in breast cancer research?
We've made significant progress in three areas. In treatment, new drugs are being developed, and many more women who would have died from breast cancer are now living because we have figured out how to combine chemotherapy, radiation therapy, surgery, and hormonal therapy. We've also done work to understand the risk factors for breast cancer. Some of these include mutations in genes such as BRCA1 and BRCA2 [the most well-known genes associated with breast cancer] that women can be assessed for. Once you are identified as a high-risk individual, you can develop personalized ways to manage your risk. That might include taking drugs to lower your risk, or getting mammograms at a young age, or MRI [magnetic resonance imaging]. Breast cancer mortality is decreasing in the U.S. Unfortunately, it's not happening globally.
Why not?
A lot of the interventions are expensive. There is a big disparity between poor countries and rich countries, between haves and have nots. There has also been inattention to chronic problems in most developing countries. If you ask anyone what's the most important health problem in Africa, people will say HIV, or maybe malaria. But nobody will say breast cancer. And yet, African women who are surviving longer and having fewer children are getting into their 30s and 40s, only to find that they have to deal with breast cancer. We can't neglect that problem any longer. So some of our work is in Nigeria to understand who is getting breast cancer, what type of breast cancer they are getting, and what the risk factors are.
So as economies improve, women are living longer and not having as many children, which increases their risk for breast cancer, but they don't have the money to treat that.
The average lifespan in some of these poor countries is 42-48. So, many women will die before they even have a chance to get breast cancer. As more women are surviving, we're realizing that breast cancer rates are increasing.
What are you finding in Nigeria?
"If you ask anyone what's the most important health problem in Africa, people will say HIV, or maybe malaria. But nobody will say breast cancer. And yet, African women who are surviving longer and having fewer children are getting into their 30s and 40s, only to find that they have to deal with breast cancer. We can't neglect that problem any longer."
We wanted to ask what is common among Nigerian women and African American women who are getting breast cancer at a young age. They're getting a kind of cancer that grows quickly and is one of the most lethal types. We want to understand the genetic and environmental risks for breast cancer by studying women across two continents.
Are you finding differences between African American women and Nigerian women?
We're finding some similarities and some differences. For example, obesity and lack of exercise are major risk factors for breast cancer. We're trying to understand how breast cancer might manifest in Nigeria, where most women are not obese, and most women don't have cars to drive around and are hard at work in their farms or in the market.
You wrote that there are racial disparities in medical treatment in the U.S.
Over the last 50 years, we've had improvements in health outcomes for most economically advantaged Americans. They're living longer, and they have access to the best treatment if they can afford it. But African Americans continue to have the worst outcome of all ethnicities when we look at any disease, in particular for breast cancer. Is this because they have no access to healthcare, or is it because they have a different type of breast cancer? We've just never studied it. And even when women have equal access to care, sometimes their physicians don't offer them quality care because they have prejudices and biases.
So even in cases where people of different races appear to have equal access, it might not be truly equal.
Right.
You also wrote that minorities don't benefit as much from risk assessment even when they have equal access. Why?
When you've been segregated and had so much social injustice, you tend to develop a suspicion of the establishment. African Americans have suffered the consequences of research they have participated in. We keep coming back to the Tuskegee experiment, where blacks were not given antibiotics that could have cured their syphilis. That distrust of research and of the medical establishment has further hindered our ability to conduct research among minority populations, and especially among African Americans. We're partnering with people in the community [of Chicago's south side] to ask these questions. We found that sometimes our priority as researchers may not be the same as the priorities of the people we want to study.
Can you give me an example?
We wanted to ask them what they thought was causing breast cancer, and why, and what we could do about it. We wanted to write an education piece to tell women to get a mammogram. But when we asked the community what they thought would be most beneficial, they told us they wanted educational material targeted at the youth, to begin to learn healthy behaviors. And so rather than educating their parents, we started getting teenagers to talk to other teenagers about the importance of health and wellness. We also learned that one of the barriers for African Americans coming to get chemotherapy, a mainstay of treatment for breast cancer, is the horrible side effects. Women lose their hair. Women say they'd rather die than get the treatment.
What about women who are afraid of genetic screening because of what they might find out?
When we introduced genetic testing, we wanted to know whether women are going to suffer more harm than good if they know they have a mutation [that increases their risk]. Over the last 15 years we have learned that women do not have a bad psychological outcome. If anything, women who come forward and know feel more empowered. And some of the women who refuse to find out, even though they have a family history of breast cancer, continue to have symptoms of anxiety and depression and have a worse outcome.
What keeps you motivated?
I am a physician and a scientist, so when I'm in my laboratory I'm excited about the discoveries and how we can understand the mechanism of disease. Then when I go to my clinic and I sit across the table from women suffering from breast cancer, I have to remain motivated to figure out how we can do better so that all women can survive breast cancer. Until we understand all the different components of this complex disease, our work is not done.
Rachel Tompa, a graduate student in the Science Communication Program at UC Santa Cruz, earned a B.A. in biological sciences from the University of Chicago and a Ph.D. in molecular biology from UC San Francisco. She has worked as a reporting intern at the Stanford University News Service and the Monterey County Herald. Rachel will work at the UC Berkeley news office this summer as a writing intern.
© 2008 Rachel Tompa
