Breast cancer is a global issue. It is the most common cancer diagnosed in women worldwide and the leading cause of cancer deaths. In the U.S., the incidence of breast cancer has been stable for the last two decades and deaths have dramatically declined, but both incidence and deaths have increased in developing countries in Africa, Asia, and Latin America. Globally, an estimated 2 million new breast cancer diagnoses and 262,700 breast cancer deaths occurred in 2018.
Building capacity to improve breast cancer outcomes in Nigeria
When Dr. Olopade, a native of Nigeria, returned to the country to study breast cancer, she found there was no infrastructure, no electricity, no human capital. In addition, she was faced with a lack of awareness of and treatments for breast cancer.
“At that time, the health care priorities in Nigeria were treating and preventing infectious diseases. There was no word for cancer,” she said. “No one knew what to do with cancer and there were no treatments available.”
Since then, Dr. Olopade has been working to change all of that. With BCRF support, she established the Nigerian Breast Cancer Study, a trans-Atlantic collaboration focused on improving the quality of breast cancer care in underserved, low-resource communities through rigorous science, technology, and research infrastructure. These efforts have supported the establishment of a highly trained clinical care staff, a cancer risk clinic for genetic counseling and testing, and a platform for clinical trials.
This year the Nigerian Breast Cancer Study group is launching the first multicenter clinical study in Nigerian women with HER2-positive breast cancer. The study, which will enroll patients across four clinical sites in Nigeria, will be the first to examine neoadjuvant (pre-surgical) chemotherapy plus HER-directed therapy in a Nigerian cohort. The goal of the study is to determine whether some women may be spared additional chemotherapy after surgery.
“The clinical trial infrastructure established with support from BCRF will become increasingly important in Nigeria and across Sub-Saharan Africa, as there is currently no affordable standard of care for women in the region,” Dr. Olopade said. “With funding from BCRF, we will continue to develop a strong clinical research infrastructure, which can be used to further strengthen the country’s capacity to address and respond to emerging cancer care needs.”
Bringing clarity to the disparity in breast cancer risk and outcomes for women of African descent.
While Dr. Olopade’s success in Nigeria is fostered by collaborations within and between countries, scientific and technology breakthroughs in genetics, tumor pathology, and molecular profiling have been crucial to advancing our understanding of breast cancer risk in women of African descent across the diaspora.
It was with these tools that Dr. Olopade and her collaborators began to understand that the poor breast cancer outcomes in African-American women compared to white women have a biological underpinning (African-American women diagnosed with breast cancer in the U.S. are 40 percent more likely to die of their disease than white women.)
“We would see African-American women in our Chicago clinic with advanced breast cancers and attribute it to late diagnoses,” Dr. Olopade explained. “What we’ve learned is that many of those advanced cases were caused by aggressive disease, such as triple negative BRCA-driven and HER2-enriched breast cancers. This made me wonder if the same was true for breast cancers in Nigerian women.”
In collaboration with BCRF researcher Dr. Mary-Claire King, Dr. Olopade performed genetic analysis of Nigerian women with breast cancer. The results, published in the Journal of Clinical Oncology in 2018, did indeed reveal inherited mutations in BRCA and related genes in 12 percent of breast cancer cases, suggesting higher risk of aggressive breast cancer. The team followed that work with a collaboration with Novartis Institute for Biomedical Research, which found that 30 percent of these women had HER2 enriched breast cancers but lacked access to life-saving trastuzumab. The majority of women in the world diagnosed with HER2-positive breast cancer die from the disease because they have no money to pay for trastuzumab and have no health insurance to cover high-quality treatment.
Today, Dr. Olopade and her international colleagues are leveraging the infrastructure, training, and resources to improve the care of breast cancer patients across the diaspora. With BCRF support and a broad network of collaborators, she is seeking to understand the biology underlying the aggressiveness of breast cancers in women of African ancestry in comparison to women of European ancestry and identifying biomarkers that can be used to optimize more effective, less toxic therapies in low resource settings in the US and Nigeria.
“We have to imagine a world without cancer, where skilled people are deploying disruptive and innovative tools to treat cancer patients where they live,” she said. “If the tools, medicines, and resources available to patients in the U.S. and other high-income countries were available in low resource communities like those in Nigeria, we could save millions of lives. We must be in solidarity to have a world without breast cancer.”
This year, Dr. Olopade is the recipient of BCRF’s The Estée Lauder Companies’ North America Manufacturing & Distribution and Global Research & Development Award and The Ulta Beauty Award.
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