Improving National and Global Racial Disparities in Breast Cancer Care
By BCRF | November 25, 2020
By BCRF | November 25, 2020
Women of African descent are more likely to be diagnosed with aggressive breast cancers than white women and are more likely to die from their disease regardless of its type or stage. For those living in remote or low-resource areas, limited access to screening and genetic testing make improving outcomes even more challenging.
Dr. Funmi Olopade is renowned for her expertise in breast cancer, as well as her research that has advanced early detection, treatment, and prevention of breast cancer in high-risk women. Her work has focused on many areas, including the role of the BRCA1 and BRCA2 gene mutations in women of African descent.
Dr. Olopade, a BCRF investigator since 2001, serves as the founding director of the Cancer Risk and Prevention Clinic and associate dean for global health, both at the University of Chicago. Dr. Olopade has received honorary degrees from six universities, a MacArthur Foundation "Genius" Fellowship, an Officer of the Order of the Niger Award, among many other honors.
In this episode of our podcast, she talks about her work in Africa and Chicago, the critical importance of precision medicine, and why she’s “impatient” about eliminating barriers to breast cancer care around the world.
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Chris Riback: Dr. Olopade, thank you for joining me. I appreciate your time.
Dr. Funmi Olopade: Thank you for having me.
Chris Riback: So in reading about you, it seems obvious to me that we really ought to start with your personal story. Not everyone is the Nigerian-born daughter of an Anglican pastor, MacArthur fellow, tumor-suppressing, gene-finding scientist, associate dean of global health, medical entrepreneur, and by my count, that's only about 10 percent of what you've done in your life? So would you mind starting at the beginning? Where did you grow up in Nigeria, and when did you decide you were going to become a globally renowned oncologist and scientist?
Dr. Funmi Olopade: Wow, that's a loaded question.
Chris Riback: I know. Those are the only kind I ask, you know?
Dr. Funmi Olopade: Well, this audience is a really important one, because I do care about breast cancer, and I care about all of the work that the Breast Cancer Research Foundation has supported. I didn't start out wanting to become a famous oncologist. I grew up in Nigeria, went to boarding school when I was 12 years old, and so I considered myself really one of those privileged Nigerians who had the best education that Nigeria could provide. I went to an all-girls school, and then went to the University of Ibadan, where I went for my medical studies.
Now, [the] Nigerian education system was really structured toward the British system. So we had the O levels, A levels, and then you went straight to the university. And I think it was about from three that when you're 15, 16 years old, that you sort of get tracked into whether you were going to do sciences or you were going to the arts. And I remember toying briefly with the idea of maybe becoming a lawyer. But my parents really wanted a doctor in the family, and growing up as a pastor's daughter, and on many occasions, I saw my father pray for people to get well, and they didn't get well. And so I think he really wanted one of his children to be a medical doctor.
So, I happened to be [child] number five of six, and so I would say I went to medical school screaming and kicking because I would have rather done physics or something more mathematical. But here we are.
Chris Riback: Here we are. Is your father still alive, or did he remain alive long enough to see you become a doctor? I'm curious, how did a man of faith feel about his daughter going into the sciences?
Dr. Funmi Olopade: Well, I think in those good old days, history would have it that good people either went into medicine, law, or they became pastors. And so I think they took advantage of the opportunity you had, and was educated by missionaries, of course. And so he went to divinity school, and it was in theology, and he became a pastor. But I think he really was very intellectually curious and always wondered about science. And so I have my siblings before me who went into economics and engineering. And one of my siblings is a veterinary doctor and a nurse. But that was sort of his last hope to become a doctor.
And so that's why I did go to medical school. And I really appreciated the fact that growing up in Nigeria, where the resources were scarce to actually impact people who got sick, that there was still a lot that was unknown about the human condition. And so, I went to University of Ibadan Medical School, which I still believe remains the best medical school in Nigeria, they really had outstanding faculty who were outstanding clinicians. And we knew the diagnosis for any disease, or at least we thought we knew it, by talking to patients, touching patients, and then really having very broad differentials.
However, when I got to the United States, and I had followed my brother who is a PhD student at Stanford, my option was to start at Cook County Hospital, and that was really when I saw the need for more research to understand cancer, and I became fascinated by cancer research. And so coming to the University of Chicago for my research training and post-doctoral training, I was fortunate to have been in post-doc with one of the best cancer geneticists of our time, Janet Rowley, who was studying chromosomes and leukemia. And at that time, we had the level of resolution of being able to do chromosome preps, caught chromosomes, and looked for changes in chromosomes. And I remember when I went to talk to her in the laboratory, she said, "Oh, no, no, no, this technology is not going to be here for the future. You should study molecular genetics; you should study molecular biology. And then apply that to problems in solid tumor.” Because at that time it was really very hard for us to culture cells from solid tumors.
And so that's really how I began working in the lab with one of the best human beings who was also a great scientist, generally.
Chris Riback: Yes, and I want to ask you about that in a moment. But before we get there, you passed over how in the world did you end up at Cook County? You talk about challenging resources in Nigeria having grown up and what you saw in med school there. Cook County Hospital, particularly in the '80s, that was a pretty tough place. You surely saw? everything there?
Dr. Funmi Olopade: Oh, absolutely. And actually, it was really just one of those things that happens to you when you're young and fully idealistic, and not really thinking much about the world, because I came to visit my brother at Stanford, and then I, of course, wanted to see when I could train at Stanford or [the University of California, San Francisco (UCSF)]. And going for the interview at UCSF, I was told, "Well, they didn't really take international graduates," and since, of course, my background from Nigeria wouldn't have been up to standards for people who are trained here, they gave me the advice of to look for county hospitals, and that maybe if I started at a county hospital, I may be able to work my way up.
I thought that was the best advice anyone gave me. I happened to have had a friend who was in the university with us, but now was going to school in Chicago. So, I came to Chicago I think it was the day after Labor Day that I had my interview at the county hospital. It was a beautiful day, and I got a job right there and then, because of course they were short-staffed, and they needed doctors. Any warm body that was available was hired to come and work at county.
But because I was married and I hadn't planned to leave Nigeria, I [initially] told them I couldn't take the job, but that I would go home, get the blessings of my parents, and then consider coming back. But I say that because I really had no idea how cold Chicago was.
Chris Riback: Yes, so I was going to say, I'm very glad, it's good for the rest of us, that your interview was the day after Labor Day, and not three months later.
Dr. Funmi Olopade: Right, right. And so, as soon as I got back to Nigeria, and I had had a wonderful summer in America. In fact, President Carter had really encouraged Nigerians to travel and discover America. So that was how right after graduating medical school, during my rotating internship, which was what you did before you actually got your license to practice, I then just took off to spend some time traveling across America. And I loved it. It was just totally beautiful. I thought everything was big in America, and while many Nigerians would have opted to go for post-graduate studies in the UK, I just couldn't wait to get back here.
So once they offered me the job, I thought, "How about starting right after Christmas?" And so that's how I ended in Chicago in January. I had never seen snow before, and it was kind of really interesting. You read about it, you thought about it, but as the plane landed, I saw the snow on the ground, and I didn't even know how I was going to walk on it. But here I am.
Chris Riback: Here you are, yes, and it's funny you mentioned it. Yes, you're right. It does snow every once in a while in Chicago. And I'm really wondering, should one of us give UCSF a call and let them know what they missed out on, or just should we forget that whole part?
Dr. Funmi Olopade: Well, one of my best collaborators and best friends is Laura Esserman. So, we talk about UCSF all the time. I collaborate with them. I work with them. And it's just one of those things. It's really the case that we have different ways of training in medicine, and biomedical research enterprise depends on what you have available in your country. So, I don't fault them.
Chris Riback: No, of course, I'm just teasing. How significant was it, and how rare was it, that you trained with a female scientist as you did at the University of Chicago?
Dr. Funmi Olopade: Yes, well, it's really one of those things that I really appreciate about the University of Chicago. At the time that I was looking to join a lab, we had some powerful women who were absolutely fantastic scientists, of course, Dr. Rowley being one of them, Elaine Fuchs, and [the late] Susan Lindquist. And these women were top-notch doing cancer research at the University of Chicago. And Janet said, "Before you settle on a lab, just go and interview a lot of people." And I can tell you, I interviewed four or five wonderful female scientists who could have been good mentors for me. And it boiled down to choosing whether I would work with Dr. Rowley or with Elaine Fuchs. And Elaine Fuchs, of course, is a famous scientist who is at the Rockefeller. And we see each other now and sort of joke about that moment in time.
And it came down to Elaine saying, "Well, you're a doctor. I'm just not sure about doctors in my laboratory because I don't know. It may be just so basic. And I don't know if that would be a good match for you." And then Dr. Rowley saying, "Well, I just was having a lot of fun collecting stamps, and my children thought I was doing stamp collection when I was cutting chromosomes and trying to understand chromosomes and cancer." And I thought, "I am a doctor. I really love being a doctor." And it probably would be a lot easier for me to begin to think about translational medicine as bringing questions from the clinic to the laboratory, instead of the reverse, where you spend time understanding mechanisms in the lab, and then you said, "Oh, by the way, does it work in the clinic?"
And so that was really what Dr. Rowley [imparted] on us, was that if you really want to solve the problem of cancer, bring a problem from the clinic, get samples from the patient, and then let's study it in the laboratory, and that really was just an amazing period where we had giants like Dr. Rowley had described chromosome rearrangements in leukemia and in cancer, and now, the next generation of postdocs in their laboratory now needed to find out what were the genes that are in this chromosome rearrangement? What are the genes that are in the deletions? And that's really how I started looking for tumor suppressor genes because there was a really good model that you will find deletions and then if you mapped the area of deletion, you might be able to come in and find tumor suppressor genes.
So the '80s really gave us a good foundation in terms of the link between chromosomal abnormalities and cancer, and then the '90s really we were equipped to be able to clone one gene at a time, figure out one translocation at a time, then go back to the lab, try to find out what these genes did, and then of course, once you identify genes, then you have to look at the function, and then of course figure out whether you can target them for treatment.
Chris Riback: Why do African American women and women of African descent often develop breast cancer at younger ages than Caucasian women?
Dr. Funmi Olopade: So the question about genes and cancer really became "Okay, so what causes all these deletions and chromosomal breaks in cancer cells?" And people are predisposed to getting cancer, and if they are, how do you find them? So that was sort of the other thing that happened in the '90s, was that as we started looking at tumor suppressor genes, we also had a parallel process where a human geneticist had actually mapped diseased genes to different chromosomes. And I remember a really wonderful collaboration that I had with Mark Skolnick at the University of Utah. He was mapping families at risk for melanoma, and it so happened that it was the same region that I was mapping on Chromosome 9, and that's why I got really interested in whether they are inherited alleles, inherited mutations that could point us to sort of ways to prevent cancer.
And so while I was mapping Chromosome 9, of course, other investigators were mapping the region for breast and ovarian cancer on Chromosome 17. And the same Chromosome 17 also harbored the HER2 gene that is frequently amplified in HER2-positive breast cancer. And so I became really good friends with Mary-Claire King, who wanted to collaborate to find families with breast and ovarian cancer, and also very good friends with Dennis Slamon, who had actually defined HER2 gene amplification and HER2 gene really becoming very important in breast cancer.
Dennis Slamon did his training at the University of Chicago, and he also had been inspired by Dr. Rowley. So early on in my career, I really ran into him, we did a study together looking at treating women with HER2-positive breast cancer and finding that just by developing Herceptin that could target the genetic abnormality in these tumors that you really had a dramatic response in women who ordinarily would have died within two years of having metastasis. And as you know, the University of Chicago is on the south side of Chicago. I was beginning to see if women come to me because they had a family history. They tended to be young when they develop their breast cancer. And then I also saw African American women, many of them very young, who also came with aggressive breast cancer.
And so that's how we began to really look at who has HER2 amplification in their tumor that could get testing and then be able to get on a clinical trial to be able to be treated with Herceptin, and then who had BRCA1 mutation because in 1994, BRCA1 was identified, and Myriad Genetics, by that time, Mark Skolnick had started Myriad Genetics. And so they approached me [asking] if I had families that they could test as part of their beta test, and lo and behold, we found some of these young African Americans that we had recruited to our study had mutations and BRCA1, and then shortly after that, BRCA2 was identified.
So that really got me very interested in what's driving young-onset breast cancer, because the face of breast cancer in Nigeria was that of a young woman. Of course, the population, we didn't have too many old women in Nigeria, given that the average lifespan was 52. So I really got very interested in trying to understand why young women develop breast cancer, and whether there's a commonality, whether you were Black or white, and then if there was a commonality, what was that? And that's what got us really collaborating.
Another collaborator that I still enjoy collaborating with is Chuck Perou. Chuck Perou, too, had come through Chicago. He was, actually before going to grad school, was a technician here. So, I ran into him at a Gordon Research Conference, and we got talking. His sister was one of my colleagues and friends at the University of Chicago, and I was like, "Oh, I know you. You look like your sister." And then we really started chatting about what he had discovered at the time, which is the gene expression patterns in different tumor types. And so this basal-like breast cancer happened to be really common and very significant for women with inherited BRCA1 mutations.
And so we started really, then, thinking about how we could use gene expression signatures to understand heritable factors for breast cancer. And so, I really began looking for additional genes that were not BRCA1 and BRCA2. So, we did genome-wide association studies, and we were fortunate to get an idea grant funded by the Department of Defense, this was in 1998, because I had this idea that: Is it possible that there's a link between young women getting breast cancer in Nigeria and African Americans? How much of the African ancestry made you get aggressive young-onset breast cancer?
And so the story evolved, because for a very long time, the conventional wisdom was that these women denied that they had a problem, so it took them a while to get to the doctors. But what we found was that contrary to previous opinion that breast cancer grew very slowly, so you could go in, maybe in Europe, you could go in every two years to have your mammogram, I started saying, "Look, these women, when I talk to them, they will tell you they had a mammogram that was normal last year," or some at the time, we diagnosed the breast cancer, the mammogram was normal, because there's some breast cancers that just don't show up on your mammogram.
And so, I became really concerned that if our recommendation is that when you turn to 50, or if you get to 40, go ahead and get your mammogram, and here we have all these young women getting breast cancer before they were 40, how were they going to get diagnosed early? And so that's why I really was pushing that we should have more broader access to genetic testing. And I wrote an editorial in the New England Journal [of Medicine] in 1996 saying the only people who aren't getting tested for BRCA1 are people who don't understand the biology, because I assumed once we found the gene, and we know what the gene does, that the gene will increase your risk for cancer. To me, it was a no-brainer. Why wouldn't everybody want to know whether they have that mutation?
But it turned out that the medical community was not ready, and the genetics community certainly had not really dealt with an idea that you should be testing people for adult-onset cancer, right? They're born with a genetic mutation, but they are not getting cancer until their 30s or 40s. So what do you do? How do you tell them? What are the interventions?
So, I was appointed chair of the ASCO Cancer Genetics Task Force, and I think it was really my background from Nigeria and my training that prevention is better than cure, and we were told that preventive and social medicine was really key. As a doctor, you couldn't wait to treat cancer. You couldn't put the patient outside of the context of a social environment. So my medical training really emphasized preventive and social medicine. And so I became a real fanatic in terms of really making sure that we could get other oncologies to adopt the ASCO Cancer Genetics Task Force to make it a business of oncologies to find high-risk families, and to develop interventions to help them so that they don't have to wake up one day and find that they have advanced triple-negative breast cancer.
And that's really why and how I got into looking at African American patients and trying to figure out what is genetics, what is poverty, and certainly, Chicago is full of rich Black women, middle class Black women who are police officers, teachers, who are not only living in poverty. And so, the more I see the variety of Black women who are coming in with triple-negative breast cancer, the more I refuse to accept the fact that it was all poverty and their social determinants. And I really wanted to study the biology determinants of aggressive breast cancer.
Chris Riback: It's so interesting because you started to address what was going through my mind, which is, what was it about you that was driving questions that others weren't asking? Was it because of coming from Nigeria, your education there? Or was it because you started out as a medical doctor, or is there just a curiosity within you that's just part of who you are? What do you think encouraged you, inspired you to ask questions that so many others weren't asking?
Dr. Funmi Olopade: Well, I know certainly, it's because of my training as a physician. But I also know that if you, as a daughter of a pastor, there are many more questions than answers. And so I think growing up, my father actually really encouraged us to ask questions, because I think he himself must have been baffled about this God that would be afflicting so many misery over human beings, and so I think it started off with really having been brought up to ask questions. And the conventional wisdom was also always the case in our medical school that the British will ask you at your oral exam to give 10 courses of an ailment, and the thing is, you have to think about all the possible 10 reasons why somebody has a symptom. And so by having to think about broad differential diagnosis, my brain, I guess, was trained to always ask, "Okay, what else can it be? Why else should we be looking at this?"
And so I think it was partly my upbringing at home to ask questions, to question God in a way. And then the other part of it is that there's so many things that were unknown, and I think the scientific method is the only way where you always have to keep asking questions. And so I think that got me to really not always accept that, "Okay, this is the answer," when we, unfortunately, hadn't even asked the questions.
And so when I was at Cook County Hospital, there was always the case, when people died, of wanting to know why did they die. And so in my medical school, we always wanted to get an autopsy, because of course, we didn't have CT scans, and we didn't have all of those things. And so when I was a chief resident at County, one of my duties was to make sure I met with families, and I asked them if it would allow us to do an autopsy. And that year that I was chief resident, I think our autopsy rate was probably about 70 percent, because when you explain to anyone, even when they're grieving, that, "Look, you're going to help us learn about your family member that just died," most people would say, "I give consent."
And so, at the University of Chicago, and when I also talked with my colleagues who think that black patients or African Americans don't want to participate, that was never my experience. My experience was that they wanted to be part of the solution. They wanted to be part of studies. There was never a patient of mine that I asked to consider a clinical trial who didn't say, "Okay, sign me up for it." And so I felt like there's a trust that the community had in me to ask questions and to help them find solutions. And so that was really my motivating factor was that I'm from this community, this community has a lot of questions, and how come no one is studying them?
And so it became a personal passion of mine to actually do cross-continental research, because I also went to school completely free of debt in Nigeria. In fact, Nigeria, I'm given a scholarship, a bursary, to just enjoy my time in medical school. So I feel like I had to help contribute to scientific advances in Nigeria. So as soon as I was able to do that, I started collaborating with former colleagues and collaborators in Nigeria. They taught me a lot, and I taught them too, and it became a really mutually beneficial partnership to do this cross-continent collaboration.
Chris Riback: And are those the clinics that you have opened and started? And maybe you can tell me about that. My understanding is the first one was in Nigeria? And there's progress from there. So tell me about the clinics that you're offering in Africa?
Dr. Funmi Olopade: Yes, so the good thing about what has happened is that we now live in a global village. There's direct flight from Atlanta to Lagos. And so in 2004, we had a meeting of professional women in Lagos, and we wanted to ask their opinion about, "What should we be doing, how should we be advancing some of this work that I am now able to do by collaborating with investigators in Nigeria?" And they had a communiqué at the end of our workshop. It was a 10-point communiqué, where they encouraged us not to just take samples out of Nigeria, but to actually build capacity.
So we, of course, realized the majority of women that were developing breast cancer in Nigeria had estrogen receptor-negative breast cancer. This is the most aggressive type of breast cancer. And it was 70 percent of them that had that. And that had never been reported in any medical journal. So when we tried to publish it in the Journal of Clinical Oncology, [their] thought it was, "Oh, it was just bad fixation. We just didn't do the correct experiment."
Chris Riback: Because why, because they couldn't imagine the numbers could be that high?
Dr. Funmi Olopade: They didn't imagine the numbers could be that and so after we studied the first 300, it was just not acceptable. So then I went to Senegal to collaborate with pathologies there, and we went to Cameroon, and then we went to Uganda, and what we really wanted to do was, "Okay, what's going on? Why are these young women across these sub-Saharan countries getting breast cancer, and when they get it, they get it at a very young age, and they get estrogen receptor-negative breast cancer." So that just turned everything on its head.
And then because many of these patients, when we then ask them, after they've given us their samples, and we've studied them, and then we wanted to ask about the follow-up, and we will be told, "Well, they came in, and because they couldn't afford treatment, they went back home, and they were dead. And we couldn't get follow-up because they were dead." And the soldiers who were working with us were frustrated, because most of the women presented in advanced stages. Then we started sending out students, we got a grant to bring doctors here, and we realized that in fact, these women were showing up, they were so young, some of the time, they had just had a baby, so even when they showed up in the doctor's office, or in a community health center, they were told they had a boil, they were told they had an infection. They were given antibiotics, and they had no idea they were dealing with breast cancer.
And so we then thought that the onus was on us to now raise awareness about the fact that there's a change in demographics. Women are no longer dying in childbirth. Women are no longer dying from infectious complications. In fact, women are now getting breast cancer. And that demographic change is happening all over the global south, all over Africa, all over Latin America.
And so because we have been so successful in helping women survive, now we have this burden of chronic, non-communicable conditions. And so, in a country where people were not even thinking that breast cancer was a problem, doctors were not even trained. There was no word for breast cancer in Nigeria when we started our work. And so we then felt that it was really important, getting these women professionals who were on top of their game, who were now part of the health systems, who that were now part of the government, who were now in industry, and they all gathered together with market women, and they said, "Yes, we're not dying. We want you to think about how to diagnose cervical cancer, how to diagnose breast cancer. And yes, we also want to participate in BRCA research," right? Maybe women also have BRCA1 and BRCA2 mutation, we want access to that as well, because we want to use it for prevention.
So that's how we started now training doctors to now be able to start our cancer risk clinic so they can also offer these women genetic testing, and then of course, we kept pushing and asking, and we were so fortunate to have funding from the Breast Cancer Research Foundation who then said, "Oh, we're going to fund your work in Nigeria. And not only are we going to fund your work in Nigeria, we're going to help you access drugs to treat these women in Nigeria because we're going to help you develop a clinical trials platform." There's one thing is to do genetics research, to do epidemiology research, to know so many things that were going on, but a different thing to actually say, "We're going to put money to treat you so you have a chance to survive."
And so, we're on our second clinical trial now, partly aided by money that we were able to raise in the US to buy drugs, to rush pharmaceutical company to give us drugs so we can treat women and have the opportunity to cure many women. The first clinical trial we did was for Xeloda®. It's an oral medication. And when we started, we thought, "This will be really great. These women come in with triple-negative breast cancer. We give them a pill, and the pill melts their cancer away." How remarkable would that be? And that study, we couldn't finish it because we were looking for women who did not have metastasis. And for 25 years, we could not find enough women who were not showing up with metastasis.
So we closed that study, and then we went back to the drawing board, just trying to understand why is this cancer so aggressive in these women? Why couldn't we find women that were picked up at an early stage? We did the same in Chicago. We started saying "Why these cancers are presenting so aggressively?" And that's why we started using MRI to screen these women. And instead of asking women with BRCA1 to get MRI once a year, we started saying, "Maybe we should be doing it twice a year," because these cancers are presenting as interval cancer, and we learned a lot, because some of these women came in and they didn't want to have bilateral mastectomy. They wanted another option. They wanted us to push prevention instead of just offering bilateral mastectomy to them. And I certainly learned a lot from these women. And you know Chicago, it's Polish women, it's women from Ukraine, it's African American women. It's everything.
Chris Riback: Yes, it's an incredible melting pot.
Dr. Funmi Olopade: Right, it's a melting pot. It's everybody. And then as our clinic got more famous, we had people fly to us from all over. And some of them, because they were so used to plastic surgery, no matter what I told them, they were going to have both breasts removed and have plastic surgery. And then on the other hand, I went back to Cook County Hospital, and I would tell them, "We should do prevention," and my African American patient had said, "Oh, you know what, we're not into that yet. We have so many other things to worry about, don't put this additional burden on us again, because we're healthy now, so why would we be taking our body parts?"
And so that's why I really felt like we can learn from our patients, and patients come in diverse shapes and forms, and my job as a doctor is to be able to meet patients wherever they are, whatever they need to do, and then what we don't know to study it.
Chris Riback: Indeed. In preparing for this conversation, I watched a 2009 video that you did, and in it, you said virtually the same thing, and it was remarkable when I listened to it, but now I'm hearing your philosophy and more of your approach, and really you redefined what it means translational. Translational for you is not just you connecting the lab and the medical office, it's connecting continents, and I hear the lessons and the through line of your story and what you've learned. But in that 2009 video, you said, "My patients are my best teachers."
Dr. Funmi Olopade: Absolutely.
Chris Riback: And you still feel that way?
Dr. Funmi Olopade: Absolutely, absolutely.
Chris Riback: Yes. The work now, extending your research, the genomic biomarker-based oncology clinical trials, what's next on that work?
Dr. Funmi Olopade: Oh, we're really very excited. Of course, now, we have a pandemic, and we're all sort of shut down. And now we're thinking about what does this mean for health equity, and of course, we also have the Black Lives Matter [movement] and sort of the social unrest around social injustices. And so, one of the ethical frameworks that I've always used as a geneticist is that you really have to think about social justice. If you're born and you have a genetic mutation, the onus is on us to help you live the best life possible. And so when I am offering genetic testing, and when we first started, the first women who came to me wrote a check for $2,500 and said, "I'm just curious, I want to know," and by knowing that she had a BRCA1 mutation, she saved the life of every woman and man in her family, because she was proactive. And she wrote that check even at the time when our medical community said it couldn't be done, and it shouldn't be done.
And I learned a lot from that woman. And I was thinking, "How about that woman who has the same risk, but is totally unaware of it, is not educated enough to know about this," or, doesn't have the resources.
Chris Riback: Doesn't have the $2,500 to write the check.
Dr. Funmi Olopade: Right, doesn't have the $2,500 to write the check. What is my role, as a healer, to reach out to that person? How do I use my voice as an advocate to make sure everybody has a chance?
And so that's why I tend to work with a lot of advocacy groups. And my patients, I remember the first time that a patient of mine went to Springfield to lobby the Illinois state...
Chris Riback: Yes, the state capitol in Illinois. Yep.
Dr. Funmi Olopade: ... the state capitol in Illinois to say, "We have to cover genetic testing." And it was compelling. My former governor was the first to approve genetic testing for patients on Medicaid because it just doesn't make any sense that because you don't have insurance, you cannot have the same access to genetic testing that somebody with a third-party payer or with money has. And whether it's passing privacy laws, or I also remember going to then Senator Obama at the time when he was first appointed to the Senate going to work with his staffers, that we have to have precision medicine. And a lot of people would say, "Oh, precision medicine is going to take money away from what we should be doing about social determinants." But I knew how patients who came to me from northern Indiana, at the time when we had clinical trials for Herceptin, lived because they were able to get the test to find out that they had HER2 gene amplification.
And that was a game-changer for me, was that these patients in northern Indiana, they just happened to think about coming to the University of Chicago, they were Black patients, and they got into the clinical trial, and now, what would have been a sure death for them, came out of there alive, because they came to the University of Chicago. And so not everybody in Chicago can come to the University of Chicago. But our best practices can be disseminated into the community, and we can partner with community doctors. We can accelerate the time it takes to get us to get these advances to everyone.
So, if there's a cure for breast cancer, our goal is to make sure that everyone in a global village knows about it and can be part of new treatments, a movement to get women to live longer. I go back to when I first came to this country, it was [during] the AIDS epidemic. I was at Cook County Hospital, and our patients were dying. They were dying by the numbers. We didn't even know what was going on. But then, there was a whole idea around solidarity. And now we know that HIV/AIDS, we can eradicate it with developing vaccines. We have a cocktail of drugs.
The same thing, we should be thinking about cancer research as research that we all have to participate in—it doesn't matter where we live, whether we're in Nigeria, in Bolivia, anywhere we are in the world, there's knowledge that can be created. And so my goal is that precision medicine means precision medicine. We need to study every patient, everywhere, so that we can find the right drug for the right patient at the right time, and that's why I'm in a hurry. I'm impatient about how we have really been negligent as a scientific community in terms of helping to eliminate the barriers. The inequities are just unacceptable to me.
And so this moment, we have a pandemic, and we know without testing, people are getting infected. So how about testing, testing, testing, to personalize cancer care?
Chris Riback: Well, it's clear that this is a moment that you have come to naturally, and the totality of your experiences, and you're the daughter of a pastor, and the Nigerian education, and starting professional life as a medical doctor, but then your research and the experience, and the clear love that you have for Chicago and the U.S. and the people and the world, and the fact that you took a chance on this guy, Obama, I'm not really sure he's going to become anything. I kind might be wasting your time there, but okay, you make your own decisions. If anyone is going to be able to push testing, testing, testing and cancer and push us towards a cure, I think I might have put my $2,500 check, and maybe even a little bit more on you.
So thank you, thank you so much for the work that you do, and for taking the time to tell me about it.
Dr. Funmi Olopade: Thank you very much it's been a really wonderful interview, and I've enjoyed talking to you. Thank you for what you do.
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