Beyond borders

Olufunmilayo Olopade is attacking cancer from all sides.

A A A

“I know that we can save many more women from dying from breast cancer,” oncologist Olufunmilayo Olopade says, leaning forward in her chair. Olopade, who goes by Funmi, is sitting in her office at the end of a long day, surrounded by stacks of paper on her desk and shopping bags on the floor, but she sounds like she could be addressing the World Health Organization. “The drugs are there, the women are out there,” she says. What’s missing, in her view, is a will to diagnose and treat people, wherever they live.

Olopade, who specializes in breast cancer, sees cancer as a personal threat and a global one. She evinces impatience with the disease and with what she sees as a laggardly response to it, especially in vulnerable and at-risk populations. In the United States, black women are more likely to die of breast cancer than women of any other ethnicity. Globally, more than half of all cancer deaths occur in developing countries. Olopade, in her determined way, has made it her business not only to understand those numbers but to budge them. “What I’m really trying to do is to prevent any woman from dying from breast cancer if I can help it.”

Her interests span medicine’s most narrowly focused and intimate concerns—Why did this particular woman get breast cancer? What distinguishes her tumor from other tumors?—and its most sweeping. Why is breast cancer more likely to be fatal in some populations than others? Why do women in developing countries die from cancers we know are treatable? Why is cancer on the rise globally? Why? In her mind, small questions are inseparable from big ones.

This dual focus is “the mark of any great scientist, and especially a clinical scientist,” says her colleague Blase Polite, AB’91, AM’92, assistant professor in hematology and oncology, and it’s part of what earned Olopade a MacArthur Fellowship in 2005. Despite the hype about translational medicine (the ability to take scientific research “from bench to bedside,” as the saying goes), “very few people do it well,” Polite observes. “Funmi does it very well.”

Olopade’s approach to her work is catholic, incorporating clinical care, research into genetics and cancer prevention, and collaboration with doctors and public health experts around the world. Her mouthful of a title—Walter L. Palmer Distinguished Service Professor of Medicine and Human Genetics; associate dean for global health; and director of the Center for Clinical Cancer Genetics—appears to mean, in practice, “does some of everything” and, at times, “does a lot of everything.” Her husband, pulmonologist Christoper Sola Olopade, jokes that every time she opens her mouth in a meeting she ends up on a new committee.

She is often in a hurry, partly because her schedule demands it—it’s not unknown for her colleagues to receive early morning phone calls from China to discuss grant proposals—but also because restlessness appears to be her natural mode. When she talks about curing cancer and improving global health, the subtext often seems to be: We know how to do this, so let’s get on with it.

 

Early in her oncology training, Olopade had a young patient with aggressive breast cancer. Despite multiple rounds of chemotherapy and a bone marrow transplant, the woman died. Everything they’d done failed to cure her cancer.

Olopade remembers it as a “watershed moment,” one that convinced her it wasn’t enough to tell women to get mammograms at 40 or 50—advice of no use to women diagnosed in their 20s. To help her patients, she needed to understand the root cause of breast cancer and why some women were more likely to get it than others.

She likes to say that breast cancer is not one disease, but many. Breast cancers are classified by factors including their location in the breast, by whether or not they’ve spread, and by the types of cells within the tumor. These different breast cancers demand different treatments. They may also have different origins, whether environmental, genetic, or a combination of the two.

It was Olopade’s mentor Janet Rowley, LAB’42, PhB’45, SB’46, MD’48, who pioneered the idea that cancer stems from genetic mutations. In the 1970s, she identified chromosomal abnormalities responsible for three different types of leukemia. Rowley’s discovery upended the conventional medical wisdom about cancer—previously, genetic aberrations like the one Rowley identified were thought to be a byproduct of the disease, not a driver of it—and ushered in a new era of medical research.

Cancer genetics was a burgeoning field when Olopade finished her internal medicine residency in 1986, and she applied for a fellowship in Rowley’s lab. The timing was fortunate. The early ’90s saw breakthrough after breakthrough as researchers identified important genetic underpinnings for cancer. Early in her research career, Olopade identified a gene on chromosome 9 that plays a key role in preventing tumor growth.

In 1990, Mary-Claire King, now of the University of Washington, suggested that a defect in a gene on the long arm of chromosome 17 was responsible for elevating breast cancer risk. Four years later, a team of scientists identified the precise location of the gene, which they dubbed BRCA 1—the so-called breast cancer gene. (It also raises ovarian cancer risk.) The discovery of a second key gene, BRCA 2, followed in 1995. Individuals with these mutations have a 45 to 65 percent chance of developing breast cancer by age 70 and tend to get more fatal types. Today, in addition to BRCA 1 and BRCA 2, researchers have identified several other genes that may be linked to breast cancer.


In the United States, black women are more likely to die from breast cancer than women of any other race. Olopade believes this stems from differences in tumor biology as well as disparities in health care delivery. (Graphic courtesy Centers for Disease Control and Prevention, adapted by Mei Moy)

The discovery of BRCA 1 and BRCA 2 was revelatory. Women who had watched their mothers, sisters, and aunts suffer finally had an explanation—and hope for themselves and their daughters. They could opt for preventive mastectomies, have their ovaries removed, or take prophylactic courses of the chemotherapy drug Tamoxifen, which has been shown to prevent the development of breast cancer.

Convinced she could bring the benefits of genetic research to her patients, Olopade founded the University’s Cancer Risk Clinic in 1992. Now the Center for Clinical Cancer Genetics, it provides genetic testing and guidance on disease prevention and management to individuals at high risk for cancer. It was the first clinic of its kind in Illinois and somewhat controversial at the time. Skeptics feared genetic testing might overwhelm patients and cause unneeded stress and harm. Others worried about patient privacy and genetic discrimination by health insurers.

But Olopade believed these genetic tests could save lives, and she was frustrated that they weren’t more widely available. By the mid-’90s, patients with means were already paying steep prices to commercial labs to be tested for BRCA 1 and BRCA 2 mutations. “At present, the only women at high risk who are not being tested are those who are economically disadvantaged or uninformed. This situation is clearly unfair,” Olopade wrote in the New England Journal of Medicine in 1996.

 

Olopade has been keenly attuned to medical inequity since arriving in the United States from Nigeria in 1983. She did her internship and residency at Cook County Hospital, which was filled with talented doctors, many of them immigrants like her, trying to deliver the best possible care in a bare-bones setting. In many ways, it was a great place to train. With time and money in short supply, doctors couldn’t count on the latest tools and tests to help them, so they came to rely on their own knowledge and diagnostic skill. Olopade says the spirit of ingenuity and collaboration she learned in residency is something she carries with her, even though she has more resources at her disposal now.

At County, Olopade encountered many African American patients with a family history of breast cancer. “I was really curious about whether that was something peculiar to people of the African diaspora—whether it was poverty, or an underlying genetic factor we had not paid attention to,” she told the Scientist. But at a busy public hospital, there was no time for research. “It was frustrating to feel that all the discoveries, all the advances, might not reach your patient, even though they are in the United States, in God’s own country,” which even then was spending more per capita on health care than any other developed nation.

Still, Olopade loved Cook County Hospital and connected easily with the staff and her patients. It’s where she learned the importance of building relationships with the people she treats. Though she’s gotten busier as her profile has risen, Olopade’s patients still “become part of her life, and she treats them as she would someone in the family,” her UChicago colleague Polite says. “When Funmi establishes a relationship with you, it’s pretty serious.”


Through the Center for Global Health, Olopade hopes to reduce health disparities worldwide. Colleen Denny, MD’12, took this photo of a newborn weighing day while working at a women’s health organization in Tanzania with CGH. (Photography by Colleen Denny)

Often that relationship centers on God. Olopade’s father was an Anglican minister, and she still goes to church regularly at St. James Cathedral in downtown Chicago. “Nigerians are the most spiritual and the most musical human beings that you can imagine,” she says.

She is open about her faith, which many of her patients appreciate. “Many of them want to know that, as they’re praying, that you can pray with them.” Smiling, she adds, “I will often tell my patients ... ‘Pray for me to have wisdom—but take this medicine.’”

Despite the suffering she sees as an oncologist, Olopade’s faith is unshaken: “The whole premise of faith is that there will be challenges in this world, and by being a believer, you’re going to be able to overcome.”

She warbles a line from “We Shall Overcome,” then says, “If you’re able to sing those spiritual songs, and if you’re able to actually believe it, then that’s your therapy.” Medicine, she believes, takes many different forms.

 

When she began her fellowship at the University of Chicago in 1987, Olopade saw many African American patients with family histories of breast cancer and aggressive cases of the disease, as she had at County. Now she had time to figure out why.

Taken together, Olopade’s pioneering work helps to explain why breast cancer often hits women of African descent earlier and harder than white women. Her research has shown that West African women are more likely to have triple-negative tumors, which don’t respond to common treatments like Tamoxifen, and basal-like breast cancers, a virulent type of cancer that occurs frequently in women with BRCA 1 gene mutations. Olopade also coauthored a 2013 study that found many African American women with breast cancer had inherited genetic mutations, including BRCA 1 and BRCA 2, that put them at higher risk for the disease.

But Olopade thinks differences in tumor biology aren’t the only reasons African and African American women have worse outcomes than others. “There remain variations by race and ethnicity in the quality of breast cancer screening that contribute to this disparity,” she wrote in the Journal of the American Medical Association in 2015. Black women, she noted, often receive delayed and inadequate treatment for their cancer. And despite similar genetic ancestry, African women have higher rates of more aggressive tumors than even African American women, suggesting that environmental and lifestyle factors like tobacco use, diet, and chemical exposure matter too.

For years the data that existed about breast cancer was taken from a majority white population, so it’s no surprise that treatments and research focused on the types of tumors they had. But more data and better data taken from a diverse sample—Olopade recently joined a National Cancer Institute consortium of researchers working on just this issue—means a clearer biological understanding of what puts someone at risk for breast cancer, regardless of their race. With a deeper understanding of the disease, Olopade hopes the focus can shift from “Who dies from breast cancer?” to “What can we do to prevent anyone from dying from it?”

That includes women in developing countries, where cancer is on the rise—partly because people are living long enough to get the disease. Olopade wants to help countries like Bangladesh, Malawi, and her native Nigeria “leapfrog” so they don’t repeat the West’s mistakes and setbacks. For instance, Olopade hopes to see foreign doctors learn about personalized risk assessment for breast cancer rather than just mammography.

This summer, through the Center for Global Health, which Olopade directs, a Nigerian radiologist came to the University of Chicago to train on the latest equipment so she can teach others back home. “They don’t have to go through 30 years of bad imaging,” Olopade explains. “We’re going to train them on the best that we have here and hope that they can innovate on it.”

The Center for Global Health formalized and broadened work Olopade and her husband, Sola, had been doing for years, returning to Nigeria to share what they’d been learning in the United States with doctors there. Now the center sends students from across UChicago to work and study in hospitals and clinics around the world. The center also brings international medical professionals to Chicago to study.

The two-way exchange, according to Sola, the center’s clinical director, is especially meaningful to him. As a foreign-trained doctor himself, he knows how valuable these opportunities for study in the United States can be. When he and Funmi arrived in Chicago in the ’80s, “there was no way we could come to an institution like the University of Chicago.” He believes “if our students are going to be taking advantage of being out there, other people should be able to come here and take advantage of what we have.”

Sola and Funmi met in medical school, and despite being a firsthand witness, he marvels at his wife’s achievements. “I don’t know how she does all that she does,” he confesses. He says he feels no competition—she was, after all, the smartest person in their medical school class of more than 200.

An active sportswoman in her youth, Olopade has an athelete’s drive and mental discipline. She does not allow herself hopelessness (“You can’t be an oncologist and not stay positive,” she says, as though this is very simple) or self-congratulation for having balanced her medical career with raising three children. “I knew that everything would work out,” she says with equanimity. “I never felt that it wasn’t possible.”

The belief that difficult things are possible is one that continues to buoy her. When a patient asks a question she can’t yet answer, it’s not a source of frustration—just more motivation to continue her research.

Her mentor Rowley shared Olopade’s sense of urgency and focus about cancer research. (A framed photo of Rowley, whom Olopade still respectfully calls “Dr. Rowley,” hangs in Olopade’s office.) Olopade was on sabbatical the last year of Rowley’s life and visited her frequently. Together they talked about the disease they had devoted their lives to studying, the disease that was overtaking Rowley’s body.

“I think because she herself was dying from cancer, she said, ‘We’ve got to do more to find cures, to find treatments, to find better treatments, and those treatments have to come faster than the pace at which we’re doing research now,’” Olopade remembers.

She believes the key to cancer prevention is to attack the problem from all sides, with the help of all possible allies. “We can’t do business as usual,” she says. There is no time to waste.

Join The Discussion

Log in with Disqus to automatically enter your contact information.