Award recipient’s advice to early-career oncologists: ‘Do not be bashful,’ ask questions
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The William L. McGuire Lecture Award will be presented to Olufunmilayo Olopade, MD, FAACR, at San Antonio Breast Cancer Symposium this month.
Olopade, the Walter L. Palmer distinguished service professor of medicine and human genetics and director of the Center for Clinical Cancer Genetics and Global Health at University of Chicago Medicine, is a pioneer in breast cancer genetics research and personalized medicine. Her research is focused on molecular mechanisms of breast cancer progression among high-risk individuals, as well as diverse populations.
The recognition highlights Olopade’s groundbreaking research in the role of genetics and the environment in the development of breast cancer among Black women.
“I am honored to receive this award in memory of Dr. McGuire who first defined heterogeneity in breast cancer by identifying the subset of women with breast cancer who had a high recurrence rate and could benefit from more aggressive combination chemotherapy,” Olopade said in a press release. “While the estrogen receptor remains the single most important determinant of outcomes in breast cancer, advances in genetic testing and genomics research have propelled us into a new era in precision oncology. We now have the tools to predict, treat or outright prevent the most lethal forms of breast cancer.”
Olopade spoke with Healio about her research, career choices and mentorship that led her to where she is today, and what future research plans she has in store.
Healio: How did you choose oncology as a career path and come to focus on cancer genetics?
Olopade: I came from Nigeria to the U.S. for my post-graduate training with the idea of going back to Nigeria. My original intention was to work in the field of cardiology, but after starting my internship at Cook County Hospital, I realized that the spectrum of heart problems that I would experience in Nigeria was very different from what I was seeing in America. The training would not prepare me to go back and work in Africa.
When I was a medical student in Nigeria, we had children with Burkitt lymphoma whose cancers ‘melted away’ when we treated them with chemotherapy. During my oncology service rotation as an intern at Cook County Hospital (CCH), I treated a very nice man with head and neck cancer with cisplatin chemotherapy whose tumor melted away and he kept asking for more chemotherapy just for ‘insurance’ after completing treatment; I will never forget him. I thought: ‘Wow, this is really powerful.’ My attending and residents also were very kind and took great care of the predominantly poor, underserved and understudied patients at CCH, and all of this led me to want to become an oncologist. I then worked hard to get to University of Chicago Medicine for my fellowship.
When I joined the faculty at University of Chicago, I was looking to identify what was different between the tumors that melted away from treatment vs. the tumors that did not respond. Most of my early training was in leukemia and lymphomas and describing genetic alterations and mapping genes involved in those cancers. As I started out in my own lab, it became clear that solid tumors also had these genetic alterations; we just didn’t have a way to study them. This is what led me to study chromosomal changes and to see what was different between solid tumors, particularly breast cancer, and leukemia and lymphoma.
Healio: What was your reaction upon being selected for this award?
Olopade: I was so excited because it is the most important prize in breast cancer research.
When the American Association for Cancer Research asked me to pick the most important papers of the century, I picked one of Dr. McGuire’s papers in which he showed that a subset of patients did not respond to hormonal therapy and instead needed chemotherapy. This was a seminal paper describing women who had ER-negative breast cancer, showing it was not a hormone-mediated cancer. This was the beginning of using chemotherapy to cure more women with breast cancer.
I was surprised to win this award because although most in breast cancer study the ER, I knew there was something about some breast cancers that are not ER-driven, and I wanted to determine the genetic basis for those cancers. I am all about ‘genetic justice’ and believe that advances in science should benefit all in society. These individuals did not ask to have an inherited mutation. It is our responsibility to ensure that we support these individuals no matter where they live and provide access to care and treatments that could potentially be lifesaving. Even within the richest country in the world, we have gross inequities, and to think of other countries in the world that have no access to life-saving medicines is devastating.
Throughout this work, my university and colleagues have been very supportive. This award is not about me; it is about the network of women and the people who believe that we must have global solidarity to eradicate breast cancer as a cause of premature death.
Healio: Can you talk about the research that you have conducted and what you have discovered so far?
Olopade: My first paper in breast cancer looked at the gene Bcl-x, and it was very clear that there was something about genes that were involved in lymphoma that were also involved in breast cancer. I thought I could use the knowledge I had as a lymphoma doctor to see if I could help women with breast cancer. Because I came into the breast cancer specialty from a totally different background, I was always focused on how genes worked. The first set of genes in breast cancer that I began working on was BRCA1. In 1996, I remember thinking this is a powerful gene, and that if oncologists could study this gene, it would be a game-changer. I was excited to find families with this genetic mutation and then to study how individuals go from having a mutation to being diagnosed with advanced triple-negative breast cancer. I dedicated myself to studying this with a focus on identifying high-risk women before they get cancer.
My colleagues and I started using MRI because mammography doesn't work in women with very dense breasts who are young. We have shown that if we screen these women more often with the technology that doesn’t involve radiation, we can pick up early breast cancer. Our future goals are to intercept those cancers before they have a chance to grow and kill any woman.
Healio: What is a challenge you have faced in your career, and how did you overcome that challenge?
Olopade: One challenge is always funding, especially funding for women and for genetics research when your community does not believe that there is any genetic basis for breast cancer. It took a lot of guts for me to have to mobilize resources and also get promoted as a young physician-scientist at a research university studying the genetic basis of breast cancer disparities. Once I made the observation that BRCA1 and BRCA2 are also prevalent among Black women, then the challenge for me was to begin to suggest that it could be one of the reasons why we have such inequities in breast cancer outcomes. I then went back to Nigeria to conduct research and tried to mobilize resources to conduct clinical trials there because that is where I made this observation in young women. After receiving Department of Defense and NIH grants, I was able to make the connection between genetics and aggressive breast cancer.
Healio: Have any mentors helped guide your career path, and what do you think makes a good mentor?
Olopade: My mentor, Janet D. Rowley, MD, was one of the best mentors anyone could have, and she was steadfast until the end as my advisor. She worked in lymphoma and leukemia and allowed me to develop my interest in solid tumors, supporting me with an NCI Outstanding Investigator Award. She introduced me to Mary-Claire King, PhD, with whom much of the work that I have done in breast cancer was in collaboration. I had female mentors who truly looked out for me, helped me publish papers and were instrumental in my career. I also have peer mentors who are cancer geneticists who are at the forefront of delivering cancer genetics into oncology practices and we all support each other.
Healio: What advice would you give to women who are in the early stages of their oncology careers?
Olopade: One of the lessons I learned is do not be bashful and make sure you ask important questions. If you see a patient and you have a question about that patient, go and study that question and publish, publish, publish. My first paper was based on a patient I saw. This is the importance of making observations and publishing on those observations because you must publish for your work to be recognized.
Healio: What is next?
Olopade: I always talk about changing my career every 10 years. This marks my 30th year at University of Chicago and, for the next decade, I want to focus on preventive oncology. I want to move from treating cancer to preventing cancer, and this is what I hope to convince my colleagues of with this award — that the time is right now for us to embrace preventive oncology. I promised myself that once I figure out the genetics of cancer, I would go into preventive oncology because we need to look at things that we can measure to prevent the disease. I have been very excited to engage with population management and have a genetic test available in every community where individuals can know their cancer risk. I started the company CancerIQ, which measures cancer genetic risk because I want everybody to know this information.
We can use what we have learned from the pandemic — we should do this work together. If we have solidarity, then the highest risk people will get everything they need to prevent them from dying prematurely. We can also help moderate-risk people to manage and reduce their risk. I want to ensure that all this work benefits every patient so that where an individual lives does not determine whether they live or not. This is what I am excited about.
After this pandemic, we will use genomics for population risk stratification so that an individual who is not at risk for breast cancer may not have to undergo a mammogram every year. Today, we give everyone the same message: When you are 40 years old, get a mammogram. But, maybe this isn’t the case for every woman. We can do better than this, and that is what I want to spend the next decade working on.
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For more information:
Olufunmilayo Olopade, MD, FACCR, can be reached at folopade@medicine.bsd.uchicago.edu.
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