1 00:00:05,120 --> 00:00:08,720 >>GOOD AFTERNOON, 2 00:00:08,720 --> 00:00:10,160 EVERYBODY. 3 00:00:10,160 --> 00:00:10,920 REALLY NICE TO SEE SOME 4 00:00:10,920 --> 00:00:12,920 OF YOU IN PERSON. 5 00:00:12,920 --> 00:00:16,000 AND I'M SURE MANY, MANY 6 00:00:16,000 --> 00:00:17,600 MORE ON THE WEB. 7 00:00:17,600 --> 00:00:23,240 IT'S REALLY MY DISTINCT 8 00:00:23,240 --> 00:00:24,640 PLEASURE TO INTRODUCE 9 00:00:24,640 --> 00:00:26,680 DR. OLUFUNMILAYO OLOPADE 10 00:00:26,680 --> 00:00:28,640 AS THE MARSHAL NIRENBERG 11 00:00:28,640 --> 00:00:30,400 LECTURER THIS YEAR. 12 00:00:30,400 --> 00:00:36,960 DR. OLOPADE IS THE 13 00:00:36,960 --> 00:00:37,480 WALTER L. MARSHALL 14 00:00:37,480 --> 00:00:39,320 CENTER FOR MEDICINE AND 15 00:00:39,320 --> 00:00:39,920 GENETICS AND GLOBAL 16 00:00:39,920 --> 00:00:45,080 HEALTH AT THE UNIVERSITY 17 00:00:45,080 --> 00:00:45,360 OF CHICAGO. 18 00:00:45,360 --> 00:00:46,600 SHE HAS MANY, MANY 19 00:00:46,600 --> 00:00:48,120 AWARDS, TOO MANY TO LIST 20 00:00:48,120 --> 00:00:49,800 THEM ALL BUT A SAMPLING 21 00:00:49,800 --> 00:00:50,920 IF I MAY. 22 00:00:50,920 --> 00:00:52,720 SHE'S A MEMBER OF BOTH 23 00:00:52,720 --> 00:00:53,800 THE NATIONAL ACADEMY OF 24 00:00:53,800 --> 00:00:55,560 SCIENCE AND THE NATIONAL 25 00:00:55,560 --> 00:00:56,400 ACADEMY OF MEDICINE. 26 00:00:56,400 --> 00:00:58,760 SHE HAS A FELLOW OF THE 27 00:00:58,760 --> 00:00:59,240 AMERICAN ACADEMY OF ARTS 28 00:00:59,240 --> 00:00:59,760 AND SCIENCES AND A 29 00:00:59,760 --> 00:01:02,040 MEMBER OF THE AMERICAN 30 00:01:02,040 --> 00:01:02,640 PHILOSOPHICAL SOCIETY. 31 00:01:02,640 --> 00:01:07,440 AND SHE WAS AWARDED AN 32 00:01:07,440 --> 00:01:08,680 McARTHUR FELLOWSHIP IN 33 00:01:08,680 --> 00:01:08,880 2005. 34 00:01:08,880 --> 00:01:10,320 MANY OF YOU KNOW HER 35 00:01:10,320 --> 00:01:11,920 LABORATORY WAS THE FIRST 36 00:01:11,920 --> 00:01:16,320 TO DESCRIBE RECURRENT 37 00:01:16,320 --> 00:01:18,240 BRACOONE MUTATIONS WITH 38 00:01:18,240 --> 00:01:19,680 BREAST AND OVARIAN 39 00:01:19,680 --> 00:01:20,400 CANCERS. 40 00:01:20,400 --> 00:01:21,400 UNDERSCORING THE NEED 41 00:01:21,400 --> 00:01:24,200 FOR AT RISK WOMEN TO 42 00:01:24,200 --> 00:01:25,440 RECEIVE GENETIC 43 00:01:25,440 --> 00:01:26,120 COUNSELING, TESTING AND 44 00:01:26,120 --> 00:01:27,800 SCREENING AT YOUNGER 45 00:01:27,800 --> 00:01:28,560 AGES. 46 00:01:28,560 --> 00:01:29,720 HER CURRENT WORK 47 00:01:29,720 --> 00:01:33,880 CONTINUES TO FOC FOCUS ON 48 00:01:33,880 --> 00:01:37,960 FAMILIAL CHANCER CANCERS 49 00:01:37,960 --> 00:01:39,120 AND TUMOR PROGRESSION IN 50 00:01:39,120 --> 00:01:40,480 INDIVIDUALS AND GENETIC 51 00:01:40,480 --> 00:01:42,280 I NONGENETIC FACTORS 52 00:01:42,280 --> 00:01:43,640 CONTRIBUTING TO TUMOR 53 00:01:43,640 --> 00:01:44,120 PROGRESSION IN DIVERSE 54 00:01:44,120 --> 00:01:44,560 POPULATIONS. 55 00:01:44,560 --> 00:01:46,920 THE TITLE OF HER TALK 56 00:01:46,920 --> 00:01:49,960 TODAY, HETEROGENEITY OF 57 00:01:49,960 --> 00:01:51,120 BREAST CANCER GENOMES, 58 00:01:51,120 --> 00:01:53,320 GOING BEYOND THERAPY TO 59 00:01:53,320 --> 00:01:55,400 RISK ASSESSMENT AND 60 00:01:55,400 --> 00:01:55,880 PRECISION HEALTHCARE. 61 00:01:55,880 --> 00:01:57,800 PLEASE JOIN ME IN 62 00:01:57,800 --> 00:02:00,000 WELCOMING DR. OLOPADE. 63 00:02:00,000 --> 00:02:03,320 [ APPLAUSE ] 64 00:02:03,320 --> 00:02:04,240 Dr. Olopade: THANK YOU VERY 65 00:02:04,240 --> 00:02:07,240 MUCH FOR THAT KIND INTRODUCTION. 66 00:02:07,240 --> 00:02:10,920 AND I REALLY WANT TO 67 00:02:10,920 --> 00:02:13,560 THANK DR. GOSMAN FOR 68 00:02:13,560 --> 00:02:14,560 EMAILING ME AND 69 00:02:14,560 --> 00:02:17,120 INFORMING ME ABOUT THIS 70 00:02:17,120 --> 00:02:19,360 WONDERFUL, PRESTIGIOUS 71 00:02:19,360 --> 00:02:20,120 LECTURESHIP. 72 00:02:20,120 --> 00:02:21,000 IT'S WONDERFUL TO 73 00:02:21,000 --> 00:02:23,040 BE ABLE TO ACCEPT IT AND 74 00:02:23,040 --> 00:02:25,760 TO BE ABLE TO PRESENT 75 00:02:25,760 --> 00:02:26,040 PERSONALLY. 76 00:02:26,040 --> 00:02:28,040 I WANT TO THANK THE 77 00:02:28,040 --> 00:02:30,440 MEMBERS OF THE WOMEN OF 78 00:02:30,440 --> 00:02:33,280 COLOR COMMITTEE AND 79 00:02:33,280 --> 00:02:33,760 ESPECIALLY DR. DESOUSA 80 00:02:33,760 --> 00:02:37,320 FOR GIVING ME MY FIRST 81 00:02:37,320 --> 00:02:39,040 ZOOM TALK THIS MORNING. 82 00:02:39,040 --> 00:02:43,080 I REALLY ENJOYED MEETING 83 00:02:43,080 --> 00:02:43,880 EVERYONE. 84 00:02:43,880 --> 00:02:44,680 OF COURSE THE HIGHLIGHT 85 00:02:44,680 --> 00:02:50,760 OF MY DAY, THE YOUNG 86 00:02:50,760 --> 00:02:51,840 INTERNS I HAD LUNCH 87 00:02:51,840 --> 00:02:53,480 WITH, IT'S MADE IT 88 00:02:53,480 --> 00:02:56,200 WORTHWHILE TO COME TO 89 00:02:56,200 --> 00:02:58,520 D.C. AFTER MIDNIGHT LAST 90 00:02:58,520 --> 00:02:59,160 NIGHT. 91 00:02:59,160 --> 00:03:00,480 I'M STILL STANDING AND 92 00:03:00,480 --> 00:03:02,640 REALLY HOPING TO 93 00:03:02,640 --> 00:03:04,560 INTERACT WITH YOU. 94 00:03:04,560 --> 00:03:05,680 AND I CAN'T THANK ALL OF 95 00:03:05,680 --> 00:03:07,200 YOU ENOUGH FOR REALLY 96 00:03:07,200 --> 00:03:08,800 ORGANIZING AND MAKING IT 97 00:03:08,800 --> 00:03:10,080 EASY FOR ME TO GET HERE. 98 00:03:10,080 --> 00:03:12,000 SO I THOUGHT WHAT I 99 00:03:12,000 --> 00:03:14,160 WOULD DO IS JUST SHARE 100 00:03:14,160 --> 00:03:19,400 MY THOUGHTS ON WHAT I 101 00:03:19,400 --> 00:03:19,960 CALL DIFFERENCES AND 102 00:03:19,960 --> 00:03:20,480 SIMILARITIES BETWEEN ALL 103 00:03:20,480 --> 00:03:22,200 OF US, BECAUSE WE'RE ALL 104 00:03:22,200 --> 00:03:23,600 FROM WHAT THE ONE HUMAN 105 00:03:23,600 --> 00:03:24,800 RACE. 106 00:03:24,800 --> 00:03:26,880 SO I HAVE SOME 107 00:03:26,880 --> 00:03:28,000 DISCLOSURES. 108 00:03:28,000 --> 00:03:30,160 AND WHAT I WANTED TO DO 109 00:03:30,160 --> 00:03:31,800 IS TO ACTUALLY SHARE MY 110 00:03:31,800 --> 00:03:34,400 STORY BECAUSE I KNOW 111 00:03:34,400 --> 00:03:35,200 THAT A LOT OF PEOPLE 112 00:03:35,200 --> 00:03:37,760 WANT TO ASK ME, HOW DID 113 00:03:37,760 --> 00:03:38,280 YOU GET HERE? 114 00:03:38,280 --> 00:03:41,040 INSTEAD OF SAYING IN AN 115 00:03:41,040 --> 00:03:45,280 UBER, I READY REALLY 116 00:03:45,280 --> 00:03:47,240 WANTED DEDICATE THIS 117 00:03:47,240 --> 00:03:48,640 LECTURE TO THE MEMORY OF 118 00:03:48,640 --> 00:03:51,640 MY BELOVED PARENTS. 119 00:03:51,640 --> 00:03:53,160 DR. NIRENBERG, WHO IS A 120 00:03:53,160 --> 00:03:57,240 GREAT MAN, GREAT 121 00:03:57,240 --> 00:03:58,360 GENETICISTS, BECAUSE OF 122 00:03:58,360 --> 00:03:59,600 THE WORK DR. NIRENBERG 123 00:03:59,600 --> 00:04:01,120 DID WE HAVE THIS 124 00:04:01,120 --> 00:04:02,000 LECTURESHIP IN HIS 125 00:04:02,000 --> 00:04:03,160 HONOR. 126 00:04:03,160 --> 00:04:04,840 AND HE WAS REALLY 127 00:04:04,840 --> 00:04:06,400 WONDERFUL TO MEET HIS 128 00:04:06,400 --> 00:04:06,800 WIFE. 129 00:04:06,800 --> 00:04:08,160 IT WAS -- ON THE ZOOM 130 00:04:08,160 --> 00:04:10,640 CALL THIS MORNING. 131 00:04:10,640 --> 00:04:11,640 VERY KIND AND GENEROUS 132 00:04:11,640 --> 00:04:13,400 WITH HER TIME TO SPEND 133 00:04:13,400 --> 00:04:15,520 SOME TIME WITH ME. 134 00:04:15,520 --> 00:04:17,360 SO I'M NUMBER FIVE OF 135 00:04:17,360 --> 00:04:18,960 SIX CHILDREN. 136 00:04:18,960 --> 00:04:20,360 AND IT'S USUALLY YOU 137 00:04:20,360 --> 00:04:23,480 KNOW GROWING UP IN 138 00:04:23,480 --> 00:04:24,440 AFRICA, IT'S THE FIFTH 139 00:04:24,440 --> 00:04:26,400 PREGNANCY THAT IS 140 00:04:26,400 --> 00:04:27,160 USUALLY MOST TREACHEROUS 141 00:04:27,160 --> 00:04:28,640 FOR MOST WOMEN IN THE 142 00:04:28,640 --> 00:04:30,440 GLOBAL SOUTH. 143 00:04:30,440 --> 00:04:34,960 BUT MY MOTHER SURVIVED. 144 00:04:34,960 --> 00:04:37,680 MY FATHER BEING A PASTOR THOUGHT 145 00:04:37,680 --> 00:04:39,240 EVERYONE WAS EQUAL. 146 00:04:39,240 --> 00:04:44,000 WITHIN MY OWN FAMILY I WAS 147 00:04:44,000 --> 00:04:45,120 NEVER TREATED ANY DIFFERENT THAN 148 00:04:45,120 --> 00:04:50,560 MY SIBLINGS 149 00:04:50,560 --> 00:04:51,080 AND GREW UP IN A WONDERFUL 150 00:04:51,080 --> 00:04:51,320 FAMILY. 151 00:04:51,320 --> 00:04:52,880 WHEN I CAME TO THE UNITED STATES 152 00:04:52,880 --> 00:04:55,440 AND STARTED THINKING ABOUT 153 00:04:55,440 --> 00:04:57,920 WORKING IN BREAST CANCER, ONE OF 154 00:04:57,920 --> 00:05:03,560 THE THINGS THAT WAS CLEAR WAS I 155 00:05:03,560 --> 00:05:05,960 HAD THE IDEA WHEN WOMEN 156 00:05:05,960 --> 00:05:07,800 PRESENTED WITH WHAT WE CALL 157 00:05:07,800 --> 00:05:11,200 LOCALLY ADVANCED BREAST CANCER 158 00:05:11,200 --> 00:05:12,440 BECAUSE THEY WERE IN DENIAL THAT 159 00:05:12,440 --> 00:05:14,200 THEY HAD CANCER. 160 00:05:14,200 --> 00:05:15,840 AND THEY CAME IN TOO LATE. 161 00:05:15,840 --> 00:05:23,400 AND SO, THE CONVENTIONAL WISDOM 162 00:05:23,400 --> 00:05:25,400 WAS AT THAT TIME, IGNORE IT. 163 00:05:25,400 --> 00:05:29,240 HOWEVER, I WANT TO START MY TALK 164 00:05:29,240 --> 00:05:33,440 ON HETEROGENEITY GOING BACK TO 165 00:05:33,440 --> 00:05:38,560 THE SEMINOLE WORK BY MCGUIRE 166 00:05:38,560 --> 00:05:42,640 THAT BUILDS ON THE WORK AT THE 167 00:05:42,640 --> 00:05:43,600 UNIVERSE OF CHICAGO, DISCOVERING 168 00:05:43,600 --> 00:05:48,240 THE ANDROGEN AND ESTROGEN WERE 169 00:05:48,240 --> 00:05:48,480 RECEPTOR. 170 00:05:48,480 --> 00:05:50,240 NO ONE TRAINS IN THE '90S. 171 00:05:50,240 --> 00:05:53,880 YOU DIDN'T TRAIN TO BE A BREAST 172 00:05:53,880 --> 00:05:54,400 CANCER RESEARCHER WITHOUT 173 00:05:54,400 --> 00:05:58,440 ACTUALLY GOING TO TAKE A COST 174 00:05:58,440 --> 00:06:04,680 FROM DR. HOG US WHO AT 92 WAS 175 00:06:04,680 --> 00:06:07,440 TEACHING GENESIS EVEN WHEN HE 176 00:06:07,440 --> 00:06:08,440 COULD NO LONGER HEAR. 177 00:06:08,440 --> 00:06:10,360 WHAT WAS REALLY FUNDAMENTAL AND 178 00:06:10,360 --> 00:06:12,080 WHAT IS STILL THE CASE WAS THAT 179 00:06:12,080 --> 00:06:18,360 THIS PAPER ONLY HAD 145 WOMEN 180 00:06:18,360 --> 00:06:22,960 WHO HAD MASTECTOMY AFTER 181 00:06:22,960 --> 00:06:24,120 DIAGNOSED WITH BREAST CANCER. 182 00:06:24,120 --> 00:06:26,640 IT SHOWED A SEPARATION WITH 183 00:06:26,640 --> 00:06:29,680 WOMEN WITH GOOD PROGNOSIS AND 184 00:06:29,680 --> 00:06:35,120 WOMEN WHO NEEDED CHEMOTHERAPY. 185 00:06:35,120 --> 00:06:36,120 WE DESCRIBE BREAST CANCER IN 186 00:06:36,120 --> 00:06:38,320 TERMS OF WHETHER YOU NEED 187 00:06:38,320 --> 00:06:42,120 CHEMOTHERAPY OR GO WITH HORMONAL 188 00:06:42,120 --> 00:06:42,360 THERAPY. 189 00:06:42,360 --> 00:06:45,640 SINCE I STARTED MY CAREER IN 190 00:06:45,640 --> 00:06:48,240 CHICAGO, ETHNICALLY DIVERSE 191 00:06:48,240 --> 00:06:50,000 COMMUNITY, IT DOES MATTER. 192 00:06:50,000 --> 00:06:53,720 WHENEVER SOMEBODY SAYS, YOU KN 193 00:06:53,720 --> 00:06:55,640 KNOW, AGGRESSIVE BREAST CANCER, 194 00:06:55,640 --> 00:06:59,520 BLACK WOMEN DIE AT A HIGHER RATE 195 00:06:59,520 --> 00:06:59,920 THAN ANYBODY ELSE. 196 00:06:59,920 --> 00:07:02,200 I BEGAN TO THINK WHAT DISEASE -- 197 00:07:02,200 --> 00:07:05,480 DOES IT MEAN TO HAVE AGGRESSIVE 198 00:07:05,480 --> 00:07:06,400 BREAST CANCER. 199 00:07:06,400 --> 00:07:07,760 AS A HEMATOLOGIST, ONCOLOGIST, I 200 00:07:07,760 --> 00:07:12,360 DID A LOT OF WORK WITH JENNA 201 00:07:12,360 --> 00:07:16,160 ROWLEY LOOKING AT LEUKEMIA WE 202 00:07:16,160 --> 00:07:18,040 TREATED WITH CHEMOTHERAPY AND 203 00:07:18,040 --> 00:07:20,160 GOT WOMEN TO BE CURED OF 204 00:07:20,160 --> 00:07:21,200 LEUKEMIA. 205 00:07:21,200 --> 00:07:25,480 WHENEVER I REALLY THINK ABOUT 206 00:07:25,480 --> 00:07:26,800 AGGRESSIVE CANCER THAT'S HIGHLY 207 00:07:26,800 --> 00:07:30,640 PROLIFERATIVE, I JOINED BREAST 208 00:07:30,640 --> 00:07:31,840 CANCER THINKING MAYBE BREAST 209 00:07:31,840 --> 00:07:35,760 CANCER IS LIKE LEUKEMIA AND 210 00:07:35,760 --> 00:07:39,760 LYMPHOMA AND WE NEED BETTER 211 00:07:39,760 --> 00:07:40,720 BIOMARKERS. 212 00:07:40,720 --> 00:07:44,440 TO CUT A LONG STORY SHORT THAT'S 213 00:07:44,440 --> 00:07:47,560 HOW I STARTED THINKING ABOUT 214 00:07:47,560 --> 00:07:53,840 BREAST CANCER, AS IF IT WAS LIMB 215 00:07:53,840 --> 00:07:55,080 PHONA -- WHO WOULD FIGURE OUT 216 00:07:55,080 --> 00:07:58,800 WHAT TO DO, IT'S CLEAR MAYBE WE 217 00:07:58,800 --> 00:08:00,200 SHOULD THINK A LITTLE BIT MORE 218 00:08:00,200 --> 00:08:03,160 BROADLY ABOUT THE IMPORTANCE OF 219 00:08:03,160 --> 00:08:05,640 SYSTEMIC THERAPY IN CURING MORE 220 00:08:05,640 --> 00:08:07,040 PATIENTS WITH CANCER. 221 00:08:07,040 --> 00:08:12,080 HAVING SAID THAT, MY FIRST JOB 222 00:08:12,080 --> 00:08:13,840 AT THE UNIVERSITY OF CHICAGO WAS 223 00:08:13,840 --> 00:08:15,600 TO DEVELOP A CANCER RISK 224 00:08:15,600 --> 00:08:15,880 PLANNING. 225 00:08:15,880 --> 00:08:18,320 MY MENTOR THOUGHT I COULDN'T 226 00:08:18,320 --> 00:08:23,280 COMPETE WITH MY PROGRAM DIREC 227 00:08:23,280 --> 00:08:26,600 DIRECTOR, DR. GULLM, DIDN'T WANT 228 00:08:26,600 --> 00:08:27,800 ME TO COMPETE WITH DR. ROWLEY. 229 00:08:27,800 --> 00:08:30,800 FOR THE YOUNG ONES IN THE 230 00:08:30,800 --> 00:08:31,520 AUDIENCE, YOU HAVE TO DO 231 00:08:31,520 --> 00:08:33,960 SOMETHING ELSE THAN YOUR MENTOR 232 00:08:33,960 --> 00:08:36,400 OTHERWISE YOU ARE NOT GOING TO 233 00:08:36,400 --> 00:08:36,640 SURVIVE. 234 00:08:36,640 --> 00:08:39,640 MINE WAS TO START A CANCER RISK 235 00:08:39,640 --> 00:08:41,280 CLINIC BECAUSE WE WERE NOW 236 00:08:41,280 --> 00:08:43,800 BEGINNING TO UNDERSTAND GENES 237 00:08:43,800 --> 00:08:46,240 HAD BEEN MARKED TO CHROME SEWN. 238 00:08:46,240 --> 00:08:49,720 I MAPPED THE MELANOMA GENE TO 239 00:08:49,720 --> 00:08:54,480 I.P. AND KING MAPPED THE RC1 240 00:08:54,480 --> 00:08:57,320 GENE TO 17Q AND THE RACE WAS ON 241 00:08:57,320 --> 00:09:01,520 TO FIND SUPPRESSER GENES THAT 242 00:09:01,520 --> 00:09:02,800 CAUSE CANCER. 243 00:09:02,800 --> 00:09:04,680 PHYSICIAN/SCIENTISTS MY JOB WAS 244 00:09:04,680 --> 00:09:05,720 TO ACTUALLY FIND FAMILIES IN THE 245 00:09:05,720 --> 00:09:08,040 CLINIC. 246 00:09:08,040 --> 00:09:09,640 AND SO WHEN I THINK ABOUT 247 00:09:09,640 --> 00:09:10,400 TRANSLATION RESEARCH, I THINK 248 00:09:10,400 --> 00:09:12,640 ABOUT ASKING QUESTIONS FROM THE 249 00:09:12,640 --> 00:09:14,000 CLINIC, RIGHT? 250 00:09:14,000 --> 00:09:15,960 THE PART OF MY PATIENTS COMING 251 00:09:15,960 --> 00:09:17,480 INTO THE CLINIC AND GOING BACK 252 00:09:17,480 --> 00:09:20,680 TO THE LAB TO SAY WHAT IS IT I 253 00:09:20,680 --> 00:09:23,600 CAN DO ABOUT THIS PROBLEM THAT I 254 00:09:23,600 --> 00:09:25,800 FOUND IN THE CLINIC. 255 00:09:25,800 --> 00:09:30,360 SO IN 1992, I WAS LIKE -- 256 00:09:30,360 --> 00:09:32,800 FAMILIES WERE COMING AND THEY 257 00:09:32,800 --> 00:09:38,520 WANTED TO KNOW WHY DID THE 258 00:09:38,520 --> 00:09:41,720 GRANDMOTHER DIE OF BREAST 259 00:09:41,720 --> 00:09:44,240 CANCER, WHY DID MOTHER DIED OF 260 00:09:44,240 --> 00:09:44,480 CANCER. 261 00:09:44,480 --> 00:09:50,080 WE KNOW HOW TO PREEMPT AND 262 00:09:50,080 --> 00:09:51,200 HOPEFULLY PREVENT CANCER IN HIGH 263 00:09:51,200 --> 00:09:53,280 RISK POPULATION. 264 00:09:53,280 --> 00:09:55,520 THE CANCER IS HUGE BOTH IN THE 265 00:09:55,520 --> 00:09:56,320 COUNTRY AND GLOBALLY. 266 00:09:56,320 --> 00:09:59,440 WE DON'T KNOW HOW TO DO BETTER. 267 00:09:59,440 --> 00:10:08,440 SO FOR THOSE OF YOU WHO 268 00:10:08,440 --> 00:10:10,720 GENETICISTS, THIS WAS MY 269 00:10:10,720 --> 00:10:13,480 EXTENDED BLACK FAMILY IN 1992, 270 00:10:13,480 --> 00:10:20,800 BEFORE THE RC1 WAS IDENTIFIED. 271 00:10:20,800 --> 00:10:23,640 34-YEAR-OLD BLACK WOMEN WITH 272 00:10:23,640 --> 00:10:25,920 TRIPLE NEGATIVE BREAST CANCER, 273 00:10:25,920 --> 00:10:31,920 WE WERE DOING LUMPECTOMY AND 274 00:10:31,920 --> 00:10:36,080 RADIATION AND CHAIRMAN -- 275 00:10:36,080 --> 00:10:36,680 CHEMOTHERAPY. 276 00:10:36,680 --> 00:10:38,160 MY FIRST CONSULTATION SHE 277 00:10:38,160 --> 00:10:39,840 BROUGHT A PEDIGREE, FIVE 278 00:10:39,840 --> 00:10:43,160 GENERATIONS OF WOMEN AND MEN IN 279 00:10:43,160 --> 00:10:44,160 THIS FAMILY WHO HAD HAD CANCER. 280 00:10:44,160 --> 00:10:45,800 CAME FROM THE SOUTH. 281 00:10:45,800 --> 00:10:47,600 IF YOU KNOW, THE ORIGINS OF A 282 00:10:47,600 --> 00:10:53,440 LOT OF AFRICAN AMERICANS DURING 283 00:10:53,440 --> 00:10:54,400 SLAVE TRADE, JIM CROW, REALLY 284 00:10:54,400 --> 00:10:56,680 HELD ONTO THEIR FAMILY HISTORY. 285 00:10:56,680 --> 00:11:00,080 THEY ALREADY HAD THE PEDIGREE 286 00:11:00,080 --> 00:11:02,120 DRAWN AND WANTED TO PARTICIPATE 287 00:11:02,120 --> 00:11:02,480 IN RESEARCH. 288 00:11:02,480 --> 00:11:04,440 AND I'VE KEPT ENGAGING THEM WITH 289 00:11:04,440 --> 00:11:05,240 FAMILY UNION. 290 00:11:05,240 --> 00:11:11,120 AND WE GOT LINKED THE FAMILY TO 291 00:11:11,120 --> 00:11:12,680 CHROMOSOME 17. 292 00:11:12,680 --> 00:11:15,840 WE IDENTIFIED THE BRCA1 MUTATION 293 00:11:15,840 --> 00:11:19,200 AND MULTIPLE FAMILY MEMBER SAID. 294 00:11:19,200 --> 00:11:20,440 HAVING SURVIVED BREAST CANCER, 295 00:11:20,440 --> 00:11:24,240 WE NEEDED TO HELP THEM NOT DIE 296 00:11:24,240 --> 00:11:26,240 FROM OVARIAN CANCER. 297 00:11:26,240 --> 00:11:29,640 BECAUSE IT DAMAGED HER HEART, 298 00:11:29,640 --> 00:11:31,640 SHE COULD ACTUALLY NOT GET THE 299 00:11:31,640 --> 00:11:37,960 RISKING REDUCE OOPHORECTOMY SHE 300 00:11:37,960 --> 00:11:39,320 NEEDED. 301 00:11:39,320 --> 00:11:42,320 ONCE YOU HAVE TOXICITY FROM YOUR 302 00:11:42,320 --> 00:11:44,240 TREATMENT AND DON'T HAVE A JOB, 303 00:11:44,240 --> 00:11:46,360 NO INSURANCE, THE ONLY PLACE YOU 304 00:11:46,360 --> 00:11:51,280 CAN GET CARE IN CHICAGO WAS COOK 305 00:11:51,280 --> 00:11:52,000 COUNTY HOSPITAL IN CHICAGO. 306 00:11:52,000 --> 00:11:53,120 WHICH IS WHERE I STARTED. 307 00:11:53,120 --> 00:11:54,880 I LINKED HER UP WITH MY 308 00:11:54,880 --> 00:11:55,960 COLLEAGUES THERE. 309 00:11:55,960 --> 00:11:58,400 SHE REALLY WAS THE PERFECT FACE 310 00:11:58,400 --> 00:12:02,200 OF EVERY YOUNG BLACK WOMEN DYING 311 00:12:02,200 --> 00:12:03,400 PREMATURELY IN CHICAGO, BECAUSE 312 00:12:03,400 --> 00:12:07,520 OF THE WAY THE CITY IS ORGANIZED 313 00:12:07,520 --> 00:12:10,360 AND SHE PARTICIPATED IN RESEARCH 314 00:12:10,360 --> 00:12:11,920 AND REALLY GAVE ME CONFIDENCE 315 00:12:11,920 --> 00:12:14,080 THAT IN FACT IF WE PERSONALIZE 316 00:12:14,080 --> 00:12:17,400 CARE MAYBE WE'LL DO BETTER. 317 00:12:17,400 --> 00:12:20,680 THE FIRST STORY I HAD IN TERMS 318 00:12:20,680 --> 00:12:22,440 OF TALKING ABOUT PERSONALIZED 319 00:12:22,440 --> 00:12:25,520 MEDICINE WHEN MY THEN NEIGHBOR, 320 00:12:25,520 --> 00:12:29,440 PRESIDENT OBAMA, REALLY WANT WAD 321 00:12:29,440 --> 00:12:33,720 MME TO ADVISE HIS STAFF ABOUT 322 00:12:33,720 --> 00:12:35,080 PERSONALIZED MEDICINE. 323 00:12:35,080 --> 00:12:38,480 THE IDEA CAN WE STOP TALKING 324 00:12:38,480 --> 00:12:40,160 ABOUT BLACK AND WHITE AND THINK 325 00:12:40,160 --> 00:12:44,480 ABOUT WHAT PRECISION MEDICINE 326 00:12:44,480 --> 00:12:45,600 WOULD LOOK LIKE IF EVERYONE WAS 327 00:12:45,600 --> 00:12:48,160 TREATED LIKE A HUMAN BEING. 328 00:12:48,160 --> 00:12:50,400 WE BECAME FRIENDS AND SHE GOT 329 00:12:50,400 --> 00:12:52,360 THE MEDAL OF SCIENCE. 330 00:12:52,360 --> 00:12:54,200 BUT I STARTED THINKING ABOUT 331 00:12:54,200 --> 00:12:58,760 GETTING TO THE ROOT OF BREAST 332 00:12:58,760 --> 00:12:59,600 CANCER THROUGH HETEROGENEITY BY 333 00:12:59,600 --> 00:13:05,440 STUDYING BLACK WOMEN CRISIS THE 334 00:13:05,440 --> 00:13:07,040 AFRICAN DIASPORA. 335 00:13:07,040 --> 00:13:10,000 BLACK IS DEFINED ON A SOCIAL 336 00:13:10,000 --> 00:13:10,280 CONSTRUCT. 337 00:13:10,280 --> 00:13:11,200 BY THE TIME I STARTED THINKING 338 00:13:11,200 --> 00:13:14,480 ABOUT GENETICS, IT WAS HARD TO 339 00:13:14,480 --> 00:13:15,760 HAVE CONVERSATIONS WITH 340 00:13:15,760 --> 00:13:18,800 COMMUNITIES BECAUSE EVERYONE WAS 341 00:13:18,800 --> 00:13:21,920 VERY SURE IT'S BECAUSE OF THE 342 00:13:21,920 --> 00:13:28,600 SOCIAL, OVER 10 MILLION AFRICANS 343 00:13:28,600 --> 00:13:29,400 IN TRANSATLANTIC TRADE SLAVE. 344 00:13:29,400 --> 00:13:31,120 THE FACT THE MAJORITY OF WOMEN 345 00:13:31,120 --> 00:13:34,360 IN THE U.S., CARIBBEAN, AND HERE 346 00:13:34,360 --> 00:13:39,680 IS THIS LITTLE AREA IN BRAZIL 347 00:13:39,680 --> 00:13:41,280 WHERE THE AFRICAN DESCENT AND 348 00:13:41,280 --> 00:13:43,520 SLAVES ACTUALLY PRESERVED THEIR 349 00:13:43,520 --> 00:13:46,640 CULTURE AND ACROSS CUBA AND 350 00:13:46,640 --> 00:13:47,560 ACROSS THE CARIBBEAN YOU WILL 351 00:13:47,560 --> 00:13:52,520 HEAR THEM TALK ABOUT 352 00:13:52,520 --> 00:13:53,520 APHROCARIBBEAN. 353 00:13:53,520 --> 00:13:56,360 I KNOW THEY WERE LONG-LOST 354 00:13:56,360 --> 00:13:59,560 RELATIVES BECAUSE OF THE STRONG 355 00:13:59,560 --> 00:14:00,520 CULTURE. 356 00:14:00,520 --> 00:14:03,920 ACROSS LATIN AMERICA, YOU WILL 357 00:14:03,920 --> 00:14:05,360 SEE GENETICISTS TALK ABOUT 358 00:14:05,360 --> 00:14:07,760 DIFFERENT LEVELS OF GENETIC 359 00:14:07,760 --> 00:14:08,000 MIXTURE. 360 00:14:08,000 --> 00:14:10,440 SO EVEN THOUGH YOU MAY HAVE, YOU 361 00:14:10,440 --> 00:14:15,520 KNOW, 50% AFRICAN ANCESTRY, YOU 362 00:14:15,520 --> 00:14:17,480 MAY HAVE BLOND, YOU MAY HAVE 363 00:14:17,480 --> 00:14:22,920 BLOND EYE, I MEAN, BLOND HAIR, 364 00:14:22,920 --> 00:14:23,920 BLUE EYES AND DARK SKIN BECAUSE 365 00:14:23,920 --> 00:14:27,200 DEPENDING ON HOW MUCH AFRICAN 366 00:14:27,200 --> 00:14:28,520 MIXTURE YOU HAVE. 367 00:14:28,520 --> 00:14:30,800 AND SO IN BRAZIL, THEY DON'T 368 00:14:30,800 --> 00:14:32,320 WANT TO TALK ABOUT WHETHER YOU 369 00:14:32,320 --> 00:14:35,200 ARE BLACK OR NOT. 370 00:14:35,200 --> 00:14:36,800 HOWEVER, THERE ARE SOME PARTS 371 00:14:36,800 --> 00:14:38,520 WHERE THERE IS LITTLE MIXTURE 372 00:14:38,520 --> 00:14:40,800 BECAUSE OF THE AFRICAN DESCENT 373 00:14:40,800 --> 00:14:42,880 DIDN'T MAKE IT AND THIS PAPER 374 00:14:42,880 --> 00:14:46,360 THAT WAS PUBLISHED BY 23ANDME 375 00:14:46,360 --> 00:14:49,120 MADE ON PEOPLE WHO ACTUALLY WENT 376 00:14:49,120 --> 00:14:50,080 TO GET TESTED. 377 00:14:50,080 --> 00:14:54,720 YOU KNOW, TO AND THEY WANTED TO 378 00:14:54,720 --> 00:14:56,920 KNOW THE ANCESTRY. 379 00:14:56,920 --> 00:15:00,720 YOU KNOW ANCESTRY.COM, SO MANY 380 00:15:00,720 --> 00:15:02,560 PEOPLE ARE TRYING TO CONNECT 381 00:15:02,560 --> 00:15:03,560 WITH THEIR ROOTS. 382 00:15:03,560 --> 00:15:05,360 WAS REALLY PROBLEMATIC FOR ME 383 00:15:05,360 --> 00:15:07,000 BECAUSE IT SHOWED THE SUFFERING 384 00:15:07,000 --> 00:15:10,080 THAT BLACK PEOPLE HAD COMING TO 385 00:15:10,080 --> 00:15:12,880 THE NEW, TO AMERICA. 386 00:15:12,880 --> 00:15:14,680 AND SO EVERY TIME YOU HEAR BLACK 387 00:15:14,680 --> 00:15:17,440 WOMEN HAVE THE HIGHEST DEATH 388 00:15:17,440 --> 00:15:20,000 RATE FROM BREAST CANCER, YOU 389 00:15:20,000 --> 00:15:22,560 KNOW, UNDERSTUDIED AND 390 00:15:22,560 --> 00:15:24,960 UNDERSERVED, IT REALLY MAKES ME 391 00:15:24,960 --> 00:15:28,040 WONDER WHETHER IN FACT THIS 392 00:15:28,040 --> 00:15:29,680 SEGREGATION AND THE RACISM AND 393 00:15:29,680 --> 00:15:32,680 OF COURSE ACROSS THE GLOBAL 394 00:15:32,680 --> 00:15:35,080 SOUTH, THE COLONIALISM THAT'S 395 00:15:35,080 --> 00:15:36,160 PREVENTING US FROM DOING WHAT WE 396 00:15:36,160 --> 00:15:37,680 NEED TO DO. 397 00:15:37,680 --> 00:15:40,200 THAT'S WHY I STARTED ASKING THE 398 00:15:40,200 --> 00:15:44,040 QUESTION, BECAUSE CHUCK PERU 399 00:15:44,040 --> 00:15:46,440 FROM NORTH CAROLINA, YOU CAN SEE 400 00:15:46,440 --> 00:15:50,040 IN THE DEEP SOUTH MAJORITY OF 401 00:15:50,040 --> 00:15:51,040 THE WOMEN, I WILL CALL THEM, 402 00:15:51,040 --> 00:15:55,840 THEY HAVE ABOUT THE SAME GENETIC 403 00:15:55,840 --> 00:16:00,040 ARCHITECTURE AS WOMEN IN AFRICA 404 00:16:00,040 --> 00:16:02,120 VERY LITTLE -- I CALL THEM 405 00:16:02,120 --> 00:16:04,320 INDIGENOUS AFRICANS LIVING IN 406 00:16:04,320 --> 00:16:04,960 NORTH CAROLINA AND IN THE DEEP 407 00:16:04,960 --> 00:16:05,160 SOUTH. 408 00:16:05,160 --> 00:16:07,720 IF THAT'S THE CASE, HOW DO WE 409 00:16:07,720 --> 00:16:13,160 THEN DO, YOU KNOW, COMPARATIVE 410 00:16:13,160 --> 00:16:13,760 ANALYSIS? 411 00:16:13,760 --> 00:16:16,480 WE STARTED THINKING ABOUT 412 00:16:16,480 --> 00:16:17,920 ESTABLISHING THE NIGERIAN BREAST 413 00:16:17,920 --> 00:16:19,240 CANCER STUDY. 414 00:16:19,240 --> 00:16:21,240 AND THEN WE PUBLISHED NOW 415 00:16:21,240 --> 00:16:25,480 LOOKING AT THE CANCER GENOME ADD 416 00:16:25,480 --> 00:16:27,680 CLASS AND THE MORE WE'RE ABLE TO 417 00:16:27,680 --> 00:16:31,400 ACTUALLY LOOK AT MUTATIONS, 418 00:16:31,400 --> 00:16:36,120 MUTATION NOW IN MY LAB, WE'RE 419 00:16:36,120 --> 00:16:38,200 DOING WHOLE GENOME SEQUENCING, 420 00:16:38,200 --> 00:16:40,520 TRYING TO UNDERSTAND 421 00:16:40,520 --> 00:16:43,160 INTERACTIOACTIONS BETWEEN GERM E 422 00:16:43,160 --> 00:16:44,600 AND SEMATIC MUTATIONS. 423 00:16:44,600 --> 00:16:47,280 ALLOWING US TO THINK ABOUT 424 00:16:47,280 --> 00:16:54,840 ANCESTRY POPULATIONS AND GENOMIC 425 00:16:54,840 --> 00:16:57,000 AND EVOLUTIONARY TRAJECTORY OF 426 00:16:57,000 --> 00:16:57,320 BREAST CANCER. 427 00:16:57,320 --> 00:16:58,600 THE REASON IT'S IMPORTANT IS 428 00:16:58,600 --> 00:17:01,280 BECAUSE, YOU KNOW, WE ALL CAME 429 00:17:01,280 --> 00:17:01,720 OUT OF AFRICA. 430 00:17:01,720 --> 00:17:07,280 AND YOU KNOW, IF YOU USE 431 00:17:07,280 --> 00:17:08,920 MITOCHONDRIA DNA YOU CAN TRACK 432 00:17:08,920 --> 00:17:10,480 YOUR LINEAGE, I DIDN'T NEED 433 00:17:10,480 --> 00:17:12,120 MITOCHONDRIA OR DNA GROWING UP 434 00:17:12,120 --> 00:17:12,360 IN AFRICA. 435 00:17:12,360 --> 00:17:15,360 I SAW THE HISTORY AND WHAT I WAS 436 00:17:15,360 --> 00:17:18,160 TOLD IS LIFE BEGAN AND NOW 437 00:17:18,160 --> 00:17:20,360 SCIENCE ACCEPTED OR PROVEN THAT 438 00:17:20,360 --> 00:17:22,840 IN FACT WE ALL CAME OUT OF 439 00:17:22,840 --> 00:17:23,080 AFRICA. 440 00:17:23,080 --> 00:17:27,000 AS WE'VE COME OUT WE'VE HAD THE 441 00:17:27,000 --> 00:17:28,240 DIVERGENCE. 442 00:17:28,240 --> 00:17:32,600 WHEN I KNOW HERE'S THE BASIC 443 00:17:32,600 --> 00:17:33,800 GENETIC ARCHITECTURE ACROSS 444 00:17:33,800 --> 00:17:34,720 AFRICA, HOW ABOUT THE 445 00:17:34,720 --> 00:17:38,000 REPRODUCTIVE PATTERNS? 446 00:17:38,000 --> 00:17:38,960 MY MOTHER HAD SIX CHILDREN. 447 00:17:38,960 --> 00:17:41,120 IN ONE GENERATION, WE'RE HAVING 448 00:17:41,120 --> 00:17:42,600 FEWER AND FEWER CHILDREN. 449 00:17:42,600 --> 00:17:44,240 SO WHAT'S THE DIFFERENCE IN 450 00:17:44,240 --> 00:17:47,840 TERMS OF THE REPRODUCTIVE 451 00:17:47,840 --> 00:17:50,680 PATTERNS OF THE AVERAGE AFRICAN 452 00:17:50,680 --> 00:17:50,880 WOMEN. 453 00:17:50,880 --> 00:17:53,360 CAN I COMPARE THAT TO THE 454 00:17:53,360 --> 00:17:55,720 AVERAGE AFRICAN AMERICANS OR 455 00:17:55,720 --> 00:17:59,400 WHITE WOMEN IN THE LITERATURE. 456 00:17:59,400 --> 00:18:00,480 WE FOUND AFRICAN WOMEN HAVE LOTS 457 00:18:00,480 --> 00:18:03,480 OF CHILDREN. 458 00:18:03,480 --> 00:18:05,440 AND THEY HAVE LATER AGE, AND 459 00:18:05,440 --> 00:18:08,480 HIGH LEVELS OF BREASTFEEDING. 460 00:18:08,480 --> 00:18:09,840 THE HIGH LEVELS OF 461 00:18:09,840 --> 00:18:11,200 BREASTFEEDING, ALL OF THOSE 462 00:18:11,200 --> 00:18:12,680 THINGS ARE SUPPOSED TO BE 463 00:18:12,680 --> 00:18:15,160 PROTECTIVE, WHY DO THEY GET 464 00:18:15,160 --> 00:18:15,520 BREAST CANCER? 465 00:18:15,520 --> 00:18:17,800 WE OF COURSE LOOKED AT THE 466 00:18:17,800 --> 00:18:19,560 POPULATION STRUCTURE AND FOUND 467 00:18:19,560 --> 00:18:23,160 THAT IN FACT MANY OF THESE WOMEN 468 00:18:23,160 --> 00:18:24,960 DIE IN CHILD BIRTH FROM, YOU 469 00:18:24,960 --> 00:18:28,440 KNOW, DIARRHEAL DISEASES, THINGS 470 00:18:28,440 --> 00:18:29,360 THAT WILL NOT KILL YOU IN 471 00:18:29,360 --> 00:18:29,720 AMERICA. 472 00:18:29,720 --> 00:18:31,200 THE POPULATIONS THAT WE'RE 473 00:18:31,200 --> 00:18:33,920 STUDYING IS ACTUALLY REALLY IN 474 00:18:33,920 --> 00:18:37,280 ROOT FOR YOUNG ONSET BREAST 475 00:18:37,280 --> 00:18:37,520 CANCER. 476 00:18:37,520 --> 00:18:40,320 AND THAT'S WHAT WE HEAR ABOUT 477 00:18:40,320 --> 00:18:43,080 THAT BLACK WOMEN IN THE U.S. 478 00:18:43,080 --> 00:18:48,320 HAVE OVERREPRESENTED OF EARLY 479 00:18:48,320 --> 00:18:49,640 ONSET BREAST CANCER. 480 00:18:49,640 --> 00:18:53,440 THE AVERAGE AGE STUDIES IN 481 00:18:53,440 --> 00:18:59,120 NIGERIAN AND CAMAROON AND THAT'S 482 00:18:59,120 --> 00:19:00,200 REPLICATED IN AFRICAN COUNTRIES 483 00:19:00,200 --> 00:19:03,800 FOR POPULATIONS OF EUROPEAN 484 00:19:03,800 --> 00:19:04,840 ANCESTRY HERE AND IN EUROPE. 485 00:19:04,840 --> 00:19:08,400 AND HIGHER RISK OF AGGRESSIVE ER 486 00:19:08,400 --> 00:19:08,880 NEGATIVE BREAST CANCER. 487 00:19:08,880 --> 00:19:10,560 BECAUSE, YOU KNOW, EVERYONE SAYS 488 00:19:10,560 --> 00:19:12,600 WHEN I WAS A MEDICAL SCHOOL, 489 00:19:12,600 --> 00:19:14,160 COMMON THINGS ARE COMMONLY. 490 00:19:14,160 --> 00:19:18,480 IF YOU HAVE A LUMP IN YOUR 491 00:19:18,480 --> 00:19:19,720 BREAST, THEY WILL THINK IT'S 492 00:19:19,720 --> 00:19:22,520 TUBERCULOSIS OR A ABSCESS. 493 00:19:22,520 --> 00:19:30,040 THEY WILL HAVE MASTITIS AFTER 494 00:19:30,040 --> 00:19:30,240 BIRTH. 495 00:19:30,240 --> 00:19:32,160 WHEN THEY INTERVIEW WOMEN 496 00:19:32,160 --> 00:19:34,360 WAITING TO BE DIAGNOSED AFTER 497 00:19:34,360 --> 00:19:35,800 ADVANCED CANCER, THEY WILL SAY 498 00:19:35,800 --> 00:19:38,600 NO, THEY SHOWED UP TO THE 499 00:19:38,600 --> 00:19:41,680 COMMUNITY HEALTH WORKSER OR 500 00:19:41,680 --> 00:19:44,280 DISPENSARY, IT'S THE DELAY THAT 501 00:19:44,280 --> 00:19:45,440 LED TO MORE OVERALL OUTCOMES. 502 00:19:45,440 --> 00:19:50,080 WE FOUND THE SAME IN CHICAGO. 503 00:19:50,080 --> 00:19:50,880 CHICAGO WOMEN WILL GET, YOU 504 00:19:50,880 --> 00:19:54,320 KNOW, OUTREACH TO THEIR -- AND 505 00:19:54,320 --> 00:19:56,920 YOU FIND CANCER ON THE CHURCH ON 506 00:19:56,920 --> 00:19:58,320 THE SOUTH SIDE OF CHICAGO. 507 00:19:58,320 --> 00:20:00,160 THERE ARE NO DOCTORS TO TAKE 508 00:20:00,160 --> 00:20:01,520 CARE OF THIS PATIENT BECAUSE 509 00:20:01,520 --> 00:20:03,560 THERE IS NO HEALTHCARE. 510 00:20:03,560 --> 00:20:05,000 AND SO IT'S NOT THAT THEY ARE 511 00:20:05,000 --> 00:20:06,840 NOT FEELING THE LUMP. 512 00:20:06,840 --> 00:20:09,760 THEY FEEL THE LUMP, THEY DON'T 513 00:20:09,760 --> 00:20:12,520 WANT TO ACCEPT THEM INTO THE 514 00:20:12,520 --> 00:20:14,320 HEALTH SYSTEM. 515 00:20:14,320 --> 00:20:16,840 FAST FORWARD, THIS PAPER WAS 516 00:20:16,840 --> 00:20:18,120 PUBLISHED FROM THE NCI. 517 00:20:18,120 --> 00:20:21,480 AND I REALLY ENJOYED READING IT 518 00:20:21,480 --> 00:20:23,000 BECAUSE NOW WE HAD THE ABILITY 519 00:20:23,000 --> 00:20:29,200 TO LOOK AT THOUSANDS OF GENE 520 00:20:29,200 --> 00:20:30,200 EXPRESSION PROFILING. 521 00:20:30,200 --> 00:20:34,480 AND THIS PAPER PUBLISHED BY 522 00:20:34,480 --> 00:20:35,440 JEFF'S GROUP WAS REALLY PRECISE. 523 00:20:35,440 --> 00:20:38,720 THERE WERE NOT A LOT OF THE 524 00:20:38,720 --> 00:20:41,720 TUMORS. 525 00:20:41,720 --> 00:20:46,400 BRCA1 CARRIER, SPORADIC CARRIER, 526 00:20:46,400 --> 00:20:47,800 SPORADIC BREAST TUMORS AND 527 00:20:47,800 --> 00:20:48,240 BRCA1. 528 00:20:48,240 --> 00:20:49,720 THEY USED THE TECHNOLOGY FOR THE 529 00:20:49,720 --> 00:20:52,440 FIRST TIME AND SHOWED THERE IS A 530 00:20:52,440 --> 00:20:56,080 CLEAR DISTINCTION BETWEEN BRCA1 531 00:20:56,080 --> 00:20:58,080 MUTATION CARRIERS AND BRCA2. 532 00:20:58,080 --> 00:21:00,480 THEY SHOWED THAT IN FACT FOR 533 00:21:00,480 --> 00:21:05,160 THAT ONE TUMOR THAT WAS 534 00:21:05,160 --> 00:21:05,720 MISCLASSIFIED IT WAS BECAUSE 535 00:21:05,720 --> 00:21:09,040 THAT BRCA1 WAS METHYLATED IN THE 536 00:21:09,040 --> 00:21:09,920 TUMOR OF THIS PATIENT. 537 00:21:09,920 --> 00:21:12,200 YOU CAN EITHER MUTATE TO GET 538 00:21:12,200 --> 00:21:15,640 THIS PATTERN OF GENE EXPRESSION 539 00:21:15,640 --> 00:21:16,000 OR METHYLATE. 540 00:21:16,000 --> 00:21:20,840 FOR THOSE OF YOU WHO DO CANCER 541 00:21:20,840 --> 00:21:22,360 BIOLOGY, THAT'S A GOOD WAY TO 542 00:21:22,360 --> 00:21:23,240 TURN GENES ON AND OFF. 543 00:21:23,240 --> 00:21:26,040 YOU CAN TURN THAT ON AND OFF 544 00:21:26,040 --> 00:21:29,040 BASED ON ENVIRONMENTAL EXPOSURE. 545 00:21:29,040 --> 00:21:31,160 WE GOT REALLY INTERESTED IN 546 00:21:31,160 --> 00:21:32,240 TRYING TO FIGURE OUT WHAT'S 547 00:21:32,240 --> 00:21:32,840 GOING ON. 548 00:21:32,840 --> 00:21:36,160 AND THAT'S WHEN WE HAVING FOUND 549 00:21:36,160 --> 00:21:39,160 MY EXTENDED AFRICAN AMERICAN 550 00:21:39,160 --> 00:21:41,240 FAMILIES WITH BRCA1 MUTATION, I 551 00:21:41,240 --> 00:21:44,680 WANTED TO ACTUALLY LOOK AT THE 552 00:21:44,680 --> 00:21:46,720 PREVALENCE OF BRCA1 MUTATION AS 553 00:21:46,720 --> 00:21:49,760 A WAY TO UNDERSTAND AGGRESSIVE 554 00:21:49,760 --> 00:21:51,600 ER NEGATIVE BREAST CANCER. 555 00:21:51,600 --> 00:21:55,240 AND SO FINALLY, WE WERE ABLE TO 556 00:21:55,240 --> 00:21:57,040 DO THE EXPERIMENT. 557 00:21:57,040 --> 00:22:01,920 AND THIS IS AN IMAGE ON THE 558 00:22:01,920 --> 00:22:04,480 INTERNET. 559 00:22:04,480 --> 00:22:07,800 WE HAD ASSEMBLED CASES AND 560 00:22:07,800 --> 00:22:13,640 CONTROLS IN NIGERIA. 561 00:22:13,640 --> 00:22:14,280 ONCE GENOMIC TESTING WAS MUCH 562 00:22:14,280 --> 00:22:14,720 CHEAPER. 563 00:22:14,720 --> 00:22:17,160 WE WANTED TO DO A THOUSAND CASE 564 00:22:17,160 --> 00:22:19,120 AND A THOUSAND CONTROLS. 565 00:22:19,120 --> 00:22:20,160 AND CONSECUTIVE CASES, YOU CAN 566 00:22:20,160 --> 00:22:22,160 SEE THIS WOMEN THE AVERAGE AGE 567 00:22:22,160 --> 00:22:25,360 IS UNDER 50. 568 00:22:25,360 --> 00:22:30,040 AND WE HAD A MUTATION DETECTION 569 00:22:30,040 --> 00:22:31,680 RATE OF ABOUT 14.5%. 570 00:22:31,680 --> 00:22:36,080 SO ONE IN 8 EIGHT OF THE WOMEN 571 00:22:36,080 --> 00:22:41,680 HAD MUTATIONS IN BRCA1, BRCA2. 572 00:22:41,680 --> 00:22:43,800 WE SAW THE FREQUENCY. 573 00:22:43,800 --> 00:22:48,240 LET'S GO TO CAMAROON AND 574 00:22:48,240 --> 00:22:48,480 ACANADA. 575 00:22:48,480 --> 00:22:50,560 SAME THING. 576 00:22:50,560 --> 00:22:51,440 WE UGANDA. 577 00:22:51,440 --> 00:22:55,920 THIS WAS MORE OF A FAMILY BASED, 578 00:22:55,920 --> 00:22:58,520 YOUNG WOMEN AND HAVING HIGH RA 579 00:22:58,520 --> 00:23:02,640 RATES OF BRCA1 AND BRCA2 AND 580 00:23:02,640 --> 00:23:03,040 [INDISCERNIBLE] 2. 581 00:23:03,040 --> 00:23:06,240 THIS IS HIGHLY -- MUTATION WHICH 582 00:23:06,240 --> 00:23:08,240 MEANS YOU HAVE A 50% CHANCE OF 583 00:23:08,240 --> 00:23:12,600 PASSING IT ONTO YOUR CHILDREN. 584 00:23:12,600 --> 00:23:14,680 AND OF COURSE, IF YOU ARE 585 00:23:14,680 --> 00:23:16,520 GETTING THIS MUTATION AT 40 OR 586 00:23:16,520 --> 00:23:20,280 EVEN YOUNGER THAN 40, THERE IS 587 00:23:20,280 --> 00:23:22,240 NO STRATEGY FOR SCREENING FOR 588 00:23:22,240 --> 00:23:25,320 THIS MUTATION BECAUSE WE ASK 589 00:23:25,320 --> 00:23:27,320 EVERY WOMEN TO GO GET SCREENED, 590 00:23:27,320 --> 00:23:28,400 THAT'S AT AGE 40. 591 00:23:28,400 --> 00:23:31,840 IN SOME COUNTRIES, AGE 50. 592 00:23:31,840 --> 00:23:35,880 AND NOBODY EVEN IS THINKING 593 00:23:35,880 --> 00:23:36,840 ABOUT HOW ABOUT THOSE 594 00:23:36,840 --> 00:23:38,280 INDIVIDUALS WHO ARE AT RISK OF 595 00:23:38,280 --> 00:23:41,000 HAVING BRCA1 MUTATION. 596 00:23:41,000 --> 00:23:43,000 SO SHORTLY AFTER WE PUBLISHED 597 00:23:43,000 --> 00:23:47,240 THIS IN 2 28 -- 2018, TWO PAPERS 598 00:23:47,240 --> 00:23:50,680 PUBLISHED BACK TO BACK IN THE 599 00:23:50,680 --> 00:23:51,320 NEW ENGLAND JOURNAL LAST YEAR 600 00:23:51,320 --> 00:23:53,680 LOOKING AT A COHORT OF AFRICAN 601 00:23:53,680 --> 00:23:57,320 AMERICANS AND THEN THE CARRIER 602 00:23:57,320 --> 00:23:59,760 COHORT, 32 THOUSAND CASES IN 603 00:23:59,760 --> 00:24:02,400 WHITE WOMEN AND 32 THOUSAND 604 00:24:02,400 --> 00:24:02,680 CONTROLS. 605 00:24:02,680 --> 00:24:04,200 THIS IS WHY I TALK ABOUT, IT'S 606 00:24:04,200 --> 00:24:07,240 NOT THE POWER OR THE NUMBERS 607 00:24:07,240 --> 00:24:08,840 THAT MATTER. 608 00:24:08,840 --> 00:24:12,040 IF A SIGNAL IS HE YOU DON'T NEED 609 00:24:12,040 --> 00:24:14,360 32 THOUSAND CASES AND CONTROLS 610 00:24:14,360 --> 00:24:16,480 TO ACTUALLY GET THE SIGNAL YOU 611 00:24:16,480 --> 00:24:16,880 WANT. 612 00:24:16,880 --> 00:24:18,680 THIS IS ALMOST 15 YEARS OLDER 613 00:24:18,680 --> 00:24:19,960 THAN OUR COHORT. 614 00:24:19,960 --> 00:24:21,120 THE AFRICAN AMERICAN AGE IS SORT 615 00:24:21,120 --> 00:24:22,080 OF IN BETWEEN. 616 00:24:22,080 --> 00:24:24,320 EVEN THE AFRICAN AMERICANS YOU 617 00:24:24,320 --> 00:24:25,880 CAN SEE THEY HAVE A MUCH HIGHER 618 00:24:25,880 --> 00:24:28,360 RATE COMPARED TO THE OLDER WHITE 619 00:24:28,360 --> 00:24:29,280 WOMEN. 620 00:24:29,280 --> 00:24:31,960 AND SO WHENEVER WE TALK ABOUT 621 00:24:31,960 --> 00:24:33,840 WHO NEEDS TO HAVE ACCESS TO 622 00:24:33,840 --> 00:24:40,400 GENETIC TESTING, A LOT OF 623 00:24:40,400 --> 00:24:41,480 ACTIVITIES AND THERE IS, YOU 624 00:24:41,480 --> 00:24:44,360 KNOW, THE FIRST PAPERS THAT CAME 625 00:24:44,360 --> 00:24:47,440 OUT WAS THE STUDY BY JEFF, 626 00:24:47,440 --> 00:24:50,200 LOOKING AT IN SYNAGOGUES IN 627 00:24:50,200 --> 00:24:56,360 WASHINGTON D.C., 5000 ASCONASY 628 00:24:56,360 --> 00:24:57,760 JEWISH MEN AND WOMEN, SHOWING 629 00:24:57,760 --> 00:25:00,960 THEY HAD A ONE AND 40 CHANCE OF 630 00:25:00,960 --> 00:25:05,480 HAVING A BRCA1 MUTATION. 631 00:25:05,480 --> 00:25:07,520 I KEPT SAYING THIS IS ALSO MORE 632 00:25:07,520 --> 00:25:09,000 PREVALENT IN THOSE POPULATIONS 633 00:25:09,000 --> 00:25:10,720 AND WE NEED TO REALLY STUDY IT. 634 00:25:10,720 --> 00:25:14,800 SO NOW THAT WE KNOW THAT A 635 00:25:14,800 --> 00:25:15,760 SIGNIFICANT FRACTION OF WOMEN 636 00:25:15,760 --> 00:25:18,720 WHO ARE COMING IN HAVE MUTATIONS 637 00:25:18,720 --> 00:25:20,760 AND WE'VE ALSO DONE THE STUDY IN 638 00:25:20,760 --> 00:25:23,920 OUR PRACTICE IN CHICAGO. 639 00:25:23,920 --> 00:25:27,160 WHAT ELSE CAN WE DO TO 640 00:25:27,160 --> 00:25:28,840 UNDERSTAND ETIOLOGY OF BREAST 641 00:25:28,840 --> 00:25:30,680 CANCER, EVEN WITH A MUTATION 642 00:25:30,680 --> 00:25:33,760 DETECTION REALITY OF 15 -- RATE 643 00:25:33,760 --> 00:25:37,280 OF 15%, 85% UNEXPLAINED. 644 00:25:37,280 --> 00:25:39,120 THAT'S WHERE NOW WE HAVE THE 645 00:25:39,120 --> 00:25:44,200 ABILITY TO NOT ONLY SEQUENCE THE 646 00:25:44,200 --> 00:25:48,600 GENE LINE BUT SEMATIC SEQUENCING 647 00:25:48,600 --> 00:25:53,040 TO TRY AND UNDERSTAND MUTE 648 00:25:53,040 --> 00:25:55,400 GENESIS AND CANCER DEVELOPMENT. 649 00:25:55,400 --> 00:26:00,280 WHEN I EXPOSED TO ULTRA VIOLET 650 00:26:00,280 --> 00:26:01,200 LIGHT THERE IS A MUTATION YOU 651 00:26:01,200 --> 00:26:01,440 HAVE. 652 00:26:01,440 --> 00:26:04,920 THERE IS A SEQUENCE GIVEN US 653 00:26:04,920 --> 00:26:07,840 INSIGHT INTO THINGS WE MAY B 654 00:26:07,840 --> 00:26:08,680 MAY BE ABLE TO PLOD DOWN IN 655 00:26:08,680 --> 00:26:10,840 TERMS OF RISK FACTORS, WHAT IS 656 00:26:10,840 --> 00:26:12,640 GENETIC AND WHAT IS ENVIRONMENT 657 00:26:12,640 --> 00:26:13,280 THERE. 658 00:26:13,280 --> 00:26:21,800 SO THIS THEN LED US TO LOOK AT 659 00:26:21,800 --> 00:26:24,040 EXOME SEQUENCING, LOOKING AT TWO 660 00:26:24,040 --> 00:26:27,320 NIGERIAN WOMEN AND COMPARING TO 661 00:26:27,320 --> 00:26:31,680 TUMORS FROM THE CANCER GENOME 662 00:26:31,680 --> 00:26:33,480 ADD CLASS. 663 00:26:33,480 --> 00:26:36,640 THIS STUDY HAD 74 NIGERIAN WOMEN 664 00:26:36,640 --> 00:26:41,760 AND 88 BLACKS AND ABOUT 284 665 00:26:41,760 --> 00:26:43,760 [INDISCERNIBLE] THAT COULD DO 666 00:26:43,760 --> 00:26:45,160 COMPARATIVE ANALYSIS. 667 00:26:45,160 --> 00:26:49,120 NOW, THIS STUDY OF COURSE WAS 668 00:26:49,120 --> 00:26:49,760 UNDERPOWERED TO SEE WHAT WAS 669 00:26:49,760 --> 00:26:50,880 GOING ON. 670 00:26:50,880 --> 00:26:53,960 BUT AT LEAST GIVE US SOME 671 00:26:53,960 --> 00:26:54,200 INSIGHT. 672 00:26:54,200 --> 00:26:57,840 AND WE'VE KNOWN THAT P52 673 00:26:57,840 --> 00:26:59,200 MUTATIONS AND [INDISCERNIBLE] 674 00:26:59,200 --> 00:27:04,360 MUTATIONS TEND TO BE THE 675 00:27:04,360 --> 00:27:06,040 PREVALENCE TEND TO BE DIFFERENT 676 00:27:06,040 --> 00:27:09,120 IN AFRICAN ANCESTRY GROUPS. 677 00:27:09,120 --> 00:27:13,880 CDH1 AND THE AFRICAN ANCESTRY 678 00:27:13,880 --> 00:27:16,720 GROUP HAD MORE FREQUENT 679 00:27:16,720 --> 00:27:17,880 VARIATIONS AND WHAT WAS REALLY 680 00:27:17,880 --> 00:27:21,280 INTERESTING WAS THAT THE 681 00:27:21,280 --> 00:27:23,880 ACTIVITY OF THE COMBINATION 682 00:27:23,880 --> 00:27:24,480 DEFICIENCY MUTATION SIGNATURE 683 00:27:24,480 --> 00:27:27,160 WAS ACTUALLY QUITE HIGH IN THE 684 00:27:27,160 --> 00:27:31,600 BLACK AND THE U.S. AND AFRICAN 685 00:27:31,600 --> 00:27:32,040 NIGERIANS. 686 00:27:32,040 --> 00:27:35,960 SO YOU CAN SEE THE CLUSTERING 687 00:27:35,960 --> 00:27:41,280 WHERE THE SIGNATURE IS MORE AND 688 00:27:41,280 --> 00:27:45,360 BCA IS OVER HERE AND YOU CAN SEE 689 00:27:45,360 --> 00:27:51,120 THE P53 AND C1 AND 2 CLUSTERING 690 00:27:51,120 --> 00:27:52,320 SEPARATELY. 691 00:27:52,320 --> 00:27:54,280 SO THEN ABOUT THE TIME THAT WE 692 00:27:54,280 --> 00:27:57,400 WERE DOING THE EXOME SEQUENCE 693 00:27:57,400 --> 00:27:58,840 AND DOING OUR WORK, MY HUSBAND 694 00:27:58,840 --> 00:28:03,560 IS A PULL MONNOLOGIST AND 695 00:28:03,560 --> 00:28:06,840 STUDIED ASTHMA AND AIR 696 00:28:06,840 --> 00:28:07,360 POLLUTION. 697 00:28:07,360 --> 00:28:08,280 THERE IS ALWAYS A HYPOTHESIS WHY 698 00:28:08,280 --> 00:28:09,680 BLACKS ARE DYING AT A HIGHER 699 00:28:09,680 --> 00:28:11,840 RATE. 700 00:28:11,840 --> 00:28:13,560 IN CHICAGO, THE BLACKS HAD THE 701 00:28:13,560 --> 00:28:15,400 HIGHEST DEATH RATE FROM ASTHMA. 702 00:28:15,400 --> 00:28:18,920 AND I SAY BLACKS HAVE THE 703 00:28:18,920 --> 00:28:20,240 HIGHEST DEATH RATE FROM BREAST 704 00:28:20,240 --> 00:28:20,480 CANCER. 705 00:28:20,480 --> 00:28:22,960 WE THEN STARTED THINKING, WELL 706 00:28:22,960 --> 00:28:27,360 MAYBE WE SHOULD STUDY ASTHMA AND 707 00:28:27,360 --> 00:28:30,720 BREAST CANCER ACROSS THE AFRICAN 708 00:28:30,720 --> 00:28:31,000 DIASPORA. 709 00:28:31,000 --> 00:28:36,440 THIS PAPER ACTUALLY REALLY WAS A 710 00:28:36,440 --> 00:28:39,880 CONSORTIUM EFFORT LOOKING AT 711 00:28:39,880 --> 00:28:41,800 AFRICAN ANCESTRY POPULATIONS, 712 00:28:41,800 --> 00:28:44,680 7000 ASTHMA CASES AND MORE THAN 713 00:28:44,680 --> 00:28:46,080 7500 CONTROLS. 714 00:28:46,080 --> 00:28:50,200 AND WHAT WAS CLEAR, SO THIS IS 715 00:28:50,200 --> 00:28:51,320 CHICAGO IN A REALLY NICE 716 00:28:51,320 --> 00:28:53,040 BEAUTIFUL -- THERE IS A REASON 717 00:28:53,040 --> 00:28:54,480 WHY I STAYED IN CHICAGO. 718 00:28:54,480 --> 00:28:54,680 RIGHT? 719 00:28:54,680 --> 00:28:56,760 BECAUSE I QUICKLY FORGET ABOUT 720 00:28:56,760 --> 00:28:59,800 THE COLD BITTER WINTERS. 721 00:28:59,800 --> 00:29:03,000 THIS PAPER REALLY SAID, YOU 722 00:29:03,000 --> 00:29:05,520 KNOW, WHEN YOU DO GENOME 723 00:29:05,520 --> 00:29:08,360 SEQUENCING OF 910 AFRICAN 724 00:29:08,360 --> 00:29:10,880 INDIVIDUALS, WE FOUND THAT 725 00:29:10,880 --> 00:29:14,080 NEARLY 296 MILLION BASES WERE 726 00:29:14,080 --> 00:29:17,360 MISSING FROM THE REFERENCED 727 00:29:17,360 --> 00:29:17,600 GENOME. 728 00:29:17,600 --> 00:29:19,680 THAT'S 10% THAT WAS MISSING. 729 00:29:19,680 --> 00:29:21,720 UNTIL YOU SEQUENCE IT, UNTIL YOU 730 00:29:21,720 --> 00:29:23,840 STUDY IT, YOU DON'T KNOW 731 00:29:23,840 --> 00:29:24,920 ANYTHING ABOUT IT. 732 00:29:24,920 --> 00:29:26,480 THAT'S WHAT WE'RE FINDING. 733 00:29:26,480 --> 00:29:30,360 WE THEN LOOKED AT SO WE HAVE 734 00:29:30,360 --> 00:29:33,440 ONGOING NOW SEQUENCING, OLD 735 00:29:33,440 --> 00:29:35,560 GENOME OF TUMOR PAIRS FROM 736 00:29:35,560 --> 00:29:39,600 NIGERIAN TO REALLY GET A DEEPER 737 00:29:39,600 --> 00:29:40,920 KNOWLEDGE OF GENOMIC ABRISIONS. 738 00:29:40,920 --> 00:29:43,960 IF YOU ARE NOT IN GENOMICS, THIS 739 00:29:43,960 --> 00:29:47,040 MAY NOT BE AN IMAGE THAT YOU CAN 740 00:29:47,040 --> 00:29:47,920 UNDERSTAND. 741 00:29:47,920 --> 00:29:51,400 BUT YOU KNOW, I SEE NOW THAT 742 00:29:51,400 --> 00:29:52,280 [INDISCERNIBLE] IGNITION IS ALL 743 00:29:52,280 --> 00:29:57,160 YOU NEED TO BECOME A COMPETITION 744 00:29:57,160 --> 00:29:58,360 AT BIOLOGY. 745 00:29:58,360 --> 00:30:01,440 SINGLE BASED SUBSTITUTION, THE 746 00:30:01,440 --> 00:30:04,560 HR NATURE THAT WE COULD GENERATE 747 00:30:04,560 --> 00:30:06,440 USING EXOMES, THAT GETS YOU 748 00:30:06,440 --> 00:30:06,840 SOMETHING. 749 00:30:06,840 --> 00:30:08,520 RIGHT? 750 00:30:08,520 --> 00:30:10,240 BUT IT DOESN'T QUITE GET YOU THE 751 00:30:10,240 --> 00:30:14,840 WHOLE STORY BECAUSE WE ALSO KNOW 752 00:30:14,840 --> 00:30:16,240 THERE IS DOUBLE BASE 753 00:30:16,240 --> 00:30:17,920 SUBSTITUTION, AND SHOWED HIGHER 754 00:30:17,920 --> 00:30:19,440 ACTIVITY IN NIGERIAN TUMORS. 755 00:30:19,440 --> 00:30:23,680 AND THEN WHEN YOU LOOK FOR 756 00:30:23,680 --> 00:30:26,440 INDULLS, THEN YOU ARE ALSO NOW 757 00:30:26,440 --> 00:30:27,280 SEEING DIFFERENCES THAT YOU 758 00:30:27,280 --> 00:30:31,680 WOULDN'T HAVE SEEN IF YOU HADN'T 759 00:30:31,680 --> 00:30:32,320 DONE THE GENOME. 760 00:30:32,320 --> 00:30:36,440 SO BY REALLY DOING COMPARATIVE 761 00:30:36,440 --> 00:30:37,680 ANALYSIS ACROSS BLACKS IN THE 762 00:30:37,680 --> 00:30:41,520 U.S., NIGERIANS AND WHITE, WE 763 00:30:41,520 --> 00:30:46,000 BEGAN TO SEE THE PROPORTION OF 764 00:30:46,000 --> 00:30:46,520 THESE DIFFERENT MUTATION 765 00:30:46,520 --> 00:30:48,200 SIGNATURE. 766 00:30:48,200 --> 00:30:51,480 AND THE [INDISCERNIBLE] OF 767 00:30:51,480 --> 00:30:54,440 COURSE HAD UNDERREPRESENTATION 768 00:30:54,440 --> 00:30:56,080 OF AFRIC AFRICAN AMERICANS. 769 00:30:56,080 --> 00:30:58,040 WITH EVERY DATA SET YOU LOOK AT, 770 00:30:58,040 --> 00:30:59,560 IT'S AN INCOMPLETE STORY. 771 00:30:59,560 --> 00:31:01,200 A STORY IS EVOLVING. 772 00:31:01,200 --> 00:31:03,120 I HOPE I WILL CONTINUE TO 773 00:31:03,120 --> 00:31:04,840 GENERATE MORE DATA. 774 00:31:04,840 --> 00:31:10,280 SO THEN, MY STUDENTS, WE THEN 775 00:31:10,280 --> 00:31:14,040 SORT OF WANTED TO KNOWT NOW THAT 776 00:31:14,040 --> 00:31:17,760 WE CAN CATEGORIZE THE TUMORS 777 00:31:17,760 --> 00:31:21,480 USING SIGNATURE, STRUCTURE 778 00:31:21,480 --> 00:31:24,400 VARIANTS, WHAT PROPORTION OF 779 00:31:24,400 --> 00:31:26,000 THE TUMORS COULD WE CATEGORIZE 780 00:31:26,000 --> 00:31:30,920 AS DEFINITELY DUE TO HUHMOLOGOUS 781 00:31:30,920 --> 00:31:33,080 DEFICIENCY, AND HOW MANY MIGHT 782 00:31:33,080 --> 00:31:36,400 BE DRIVEN BY BRCA1 OR BRCA2 OR 783 00:31:36,400 --> 00:31:40,240 SOME OTHER GENES THAT WE REALLY 784 00:31:40,240 --> 00:31:44,800 HADN'T HAD THE ABILITY TO 785 00:31:44,800 --> 00:31:45,480 IDENTIFY. 786 00:31:45,480 --> 00:31:48,040 THIS IS THE CRITICAL PAGE HERE. 787 00:31:48,040 --> 00:31:52,960 YOU CAN SEE THIS IS THE NIGERIAN 788 00:31:52,960 --> 00:31:55,200 COHORT TO THE EXTREME HERE. 789 00:31:55,200 --> 00:31:56,440 THE BLACKS IN BETWEEN AND THEN 790 00:31:56,440 --> 00:31:57,200 WHITE. 791 00:31:57,200 --> 00:32:01,400 AND WE WERE ABLE TO SHOW LOTS OF 792 00:32:01,400 --> 00:32:08,040 BRCA1 AND BRCA2 SIGNATURE. 793 00:32:08,040 --> 00:32:12,520 CLEARLY 34% OF OUR SAMPLES WERE 794 00:32:12,520 --> 00:32:17,720 CLASSIFIES AS THE HOMOLOGOUS 795 00:32:17,720 --> 00:32:18,360 REPAIRED DEFICIENCY. 796 00:32:18,360 --> 00:32:22,600 THIS HAS CLINICAL IMPLICATIONS. 797 00:32:22,600 --> 00:32:26,760 WE HAVE FOUR OR FIVE POP 798 00:32:26,760 --> 00:32:27,880 INHIBITORS, MAKING A DIFFERENCE 799 00:32:27,880 --> 00:32:30,040 IN THE CLINIC BECAUSE YOU CAN 800 00:32:30,040 --> 00:32:32,320 TAKE AN ORAL NEEDLE IF YOU ARE 801 00:32:32,320 --> 00:32:37,760 BRCA1 MUTATION, YOU CAN TAKE IT, 802 00:32:37,760 --> 00:32:39,360 A NEEDLE IF YOU RECOLLECT BRC2 803 00:32:39,360 --> 00:32:40,480 MUTATION BECAUSE THE STUDIES ARE 804 00:32:40,480 --> 00:32:41,560 DONE. 805 00:32:41,560 --> 00:32:44,320 THE QUESTION IS WHEN WILL THE 806 00:32:44,320 --> 00:32:46,240 DRUGS ACTUALLY REACH UNDERSERVED 807 00:32:46,240 --> 00:32:47,840 POPULATIONS WHO HAVE AN 808 00:32:47,840 --> 00:32:52,680 ENRICHMENT OF HRD IN THEIR 809 00:32:52,680 --> 00:32:53,000 TUMORS. 810 00:32:53,000 --> 00:32:56,640 THESE ARE REASONS WHO -- WHY 811 00:32:56,640 --> 00:33:00,240 WHEN WE SAY SOMEBODY HAS AN 812 00:33:00,240 --> 00:33:01,200 AGGRESSIVE TUMOR, THE QUESTION 813 00:33:01,200 --> 00:33:04,240 IS WE HAVE THE RIGHT DRUG FOR 814 00:33:04,240 --> 00:33:06,320 THE RIGHT PATIENT AT THE RIGHT 815 00:33:06,320 --> 00:33:07,160 TIME. 816 00:33:07,160 --> 00:33:09,080 THE STORY CONTINUES BECAUSE 817 00:33:09,080 --> 00:33:13,640 WHAT WE THEN WANTED TO DO WAS TO 818 00:33:13,640 --> 00:33:19,120 NOW LOOK AT ONCE YOU ARE ABLE TO 819 00:33:19,120 --> 00:33:21,720 DO WHOLE GENOME SEQUENCING YOU 820 00:33:21,720 --> 00:33:26,320 CAN ACTUALLY NOW LOOK AT THE 821 00:33:26,320 --> 00:33:31,160 EVOLUTIONARY TRAJECTORY OF 822 00:33:31,160 --> 00:33:37,960 DIFFERENT MUTATIONS AND 823 00:33:37,960 --> 00:33:40,240 DIFFERENT COPY CHANGES. 824 00:33:40,240 --> 00:33:44,320 SO HERE YOU SEE LOSSES AS IN 825 00:33:44,320 --> 00:33:49,560 GREEN AND THEN YOU SEE GENE 826 00:33:49,560 --> 00:33:53,120 AMPLIFICATION AND HERE YOU SEE 827 00:33:53,120 --> 00:33:56,560 WHOLE GENOME DUPLICATION. 828 00:33:56,560 --> 00:33:58,080 WHEN YOU SEE THOSE CHROMOSOMAL 829 00:33:58,080 --> 00:33:59,920 CHANGES, THEY ARE GOING TO MAKE 830 00:33:59,920 --> 00:34:02,600 YOUR TUMOR UNDER THE MICROSCOPE 831 00:34:02,600 --> 00:34:03,720 TO HAVE HIGRADE. 832 00:34:03,720 --> 00:34:05,960 IF YOU ASK ANY PATHOLOGIST, IN 833 00:34:05,960 --> 00:34:09,680 FACT ONE OF THE THINGS I WAS A 834 00:34:09,680 --> 00:34:11,600 MY LAB, HAVING LOOKED AT LOTS 835 00:34:11,600 --> 00:34:15,440 AND LOTS OF BREAST CANCER IN 836 00:34:15,440 --> 00:34:17,680 NORWAY, AND HE SAYS, YOU KNOW, 837 00:34:17,680 --> 00:34:20,000 THE BREAST CANCERS I'M SEEING IN 838 00:34:20,000 --> 00:34:23,360 MY PATIENT IN NIGERIA DON'T LOOK 839 00:34:23,360 --> 00:34:26,040 LIKE THE BREAST CANCERRESS I'M 840 00:34:26,040 --> 00:34:28,520 LOOKING AT IN THE NORWEGIAN 841 00:34:28,520 --> 00:34:29,800 WOMEN. 842 00:34:29,800 --> 00:34:30,760 SOMEONE SOLD HIM TO WORK WITH 843 00:34:30,760 --> 00:34:31,200 ME. 844 00:34:31,200 --> 00:34:33,000 WE LOOKED AT LOCAL MORPHOLOGY. 845 00:34:33,000 --> 00:34:36,800 AND CLEARLY THE TUMORS WOULD 846 00:34:36,800 --> 00:34:40,320 ALWAYS BE CLASSIFIED AS HIGH 847 00:34:40,320 --> 00:34:41,000 GRADE. 848 00:34:41,000 --> 00:34:42,560 WE SAW THE PATIENTS HAVE 849 00:34:42,560 --> 00:34:43,720 MUTATIONS. 850 00:34:43,720 --> 00:34:47,520 AND IN THIS COHORT, THE PATIENTS 851 00:34:47,520 --> 00:34:48,040 WHO HAD [INDISCERNIBLE] 852 00:34:48,040 --> 00:34:51,080 MUTATIONS AS AN EARLY EVENT THAT 853 00:34:51,080 --> 00:34:52,680 PROPELLING THE CANCER WERE 10 854 00:34:52,680 --> 00:34:55,640 YEARS YOUNGER THAN PATIENTS WHO 855 00:34:55,640 --> 00:34:58,400 DIDN'T HAVE THE [INDISCERNIBLE] 856 00:34:58,400 --> 00:34:58,880 MUTATION. 857 00:34:58,880 --> 00:35:03,560 IF YOU HAVE EARLY B53 MUTATIONS 858 00:35:03,560 --> 00:35:06,440 YOU WILL HAVE MORE GENOMIC 859 00:35:06,440 --> 00:35:06,920 INSTABILITIES. 860 00:35:06,920 --> 00:35:11,520 THESE WERE GIVING HINTS WHY THE 861 00:35:11,520 --> 00:35:15,680 EVOLUTIONARY TRAJECTORY OF THE 862 00:35:15,680 --> 00:35:16,360 CANCER MAYBE LETHAL. 863 00:35:16,360 --> 00:35:21,000 LET'S TALK ABOUT SCREEN SCREENIR 864 00:35:21,000 --> 00:35:21,360 BREAST CANCER. 865 00:35:21,360 --> 00:35:24,080 DO YOU SCREEN EVERY TWO YEARS OR 866 00:35:24,080 --> 00:35:24,760 SIX MONTHS? 867 00:35:24,760 --> 00:35:27,720 IF YOUR CANCER HAS AN 868 00:35:27,720 --> 00:35:29,840 ACCELERATED TRAJECTORY. 869 00:35:29,840 --> 00:35:36,000 SO THIS PAPER AND DEBATES ABOUT 870 00:35:36,000 --> 00:35:37,040 SCREENING HAS ALWAYS BEEN ABOUT 871 00:35:37,040 --> 00:35:38,760 WE'RE DOING OVERDOSE. 872 00:35:38,760 --> 00:35:40,360 IF YOU ASK THE AVERAGE BLACK 873 00:35:40,360 --> 00:35:43,240 WOMEN, NO, YOU ARE TELLING US 874 00:35:43,240 --> 00:35:44,280 OUR CANCERS ARE AGGRESSIVE AND 875 00:35:44,280 --> 00:35:45,760 YOU ARE TELLING US DON'T SCREEN 876 00:35:45,760 --> 00:35:47,320 OR SCREEN EVERY TWO YEARS. 877 00:35:47,320 --> 00:35:48,600 WHAT SHOULD WE DO? 878 00:35:48,600 --> 00:35:50,680 SO THAT'S WHY IT'S REALLY THE 879 00:35:50,680 --> 00:35:52,480 CASE THAT WE DON'T HAVE THE 880 00:35:52,480 --> 00:35:53,640 RIGHT SCREENING TOOLS. 881 00:35:53,640 --> 00:35:56,120 AND WE REALLY NEED TO THINK 882 00:35:56,120 --> 00:36:00,280 ABOUT THE HETEROGENOUS 883 00:36:00,280 --> 00:36:01,680 POPULATION IN THE U.S. THAT ARE 884 00:36:01,680 --> 00:36:03,120 NOT GOING TO GET THE SLOW 885 00:36:03,120 --> 00:36:06,520 GROWING DCI WE'RE OVERDIAGNOSING 886 00:36:06,520 --> 00:36:08,880 AND GOING TO HAVE AN ACCELERATED 887 00:36:08,880 --> 00:36:10,360 EVOLUTION OF THEIR BREAST 888 00:36:10,360 --> 00:36:10,600 CANCER. 889 00:36:10,600 --> 00:36:11,760 BECAUSE ALL THE TIMES THAT WE'VE 890 00:36:11,760 --> 00:36:14,840 BEEN SCREENING, YOU CAN SEE THE 891 00:36:14,840 --> 00:36:16,400 PROPORTION OF PATIENTS WHO HAVE 892 00:36:16,400 --> 00:36:19,680 PRESENTED WITH DE NOVO 893 00:36:19,680 --> 00:36:22,360 METASTATIC BREAST CANCER HAS NOT 894 00:36:22,360 --> 00:36:22,640 DECLINED. 895 00:36:22,640 --> 00:36:25,200 SO WHY IS THAT THE CASE? 896 00:36:25,200 --> 00:36:27,640 NOW I THINK WHAT WE ARE THINKING 897 00:36:27,640 --> 00:36:30,440 ABOUT IS WHETHER WE CAN BUILD 898 00:36:30,440 --> 00:36:31,320 BETTER MODELS FOR RISK 899 00:36:31,320 --> 00:36:32,720 ASSESSMENT. 900 00:36:32,720 --> 00:36:39,400 THIS IS WHERE YOU KNOW, GENETIC 901 00:36:39,400 --> 00:36:41,800 CYSTS LOOKING AT STUDIES TALKING 902 00:36:41,800 --> 00:36:45,760 ABOUT HERITABILITY, HOW BREAST 903 00:36:45,760 --> 00:36:47,840 CANCER IS INHERITED. 904 00:36:47,840 --> 00:36:51,720 I USE THE EXAMPLE OF N.B.A. 905 00:36:51,720 --> 00:36:52,040 BASKETBALLERS. 906 00:36:52,040 --> 00:36:55,160 THEY ARE TALL, THEY GET TO BE 907 00:36:55,160 --> 00:36:58,240 BE 7 FEET, FIVE INCHES, HOW DO 908 00:36:58,240 --> 00:37:00,400 THEY GET TO BE THAT TALL? 909 00:37:00,400 --> 00:37:02,880 LIKE WINNING THE LOTTERY BASED 910 00:37:02,880 --> 00:37:07,480 ON HOW YOUR GEN GENES ARE STRAM. 911 00:37:07,480 --> 00:37:09,800 WE'RE TRYING TO LOOK AT WHAT 912 00:37:09,800 --> 00:37:11,920 MODEL WILL BEST TELL US THE 913 00:37:11,920 --> 00:37:14,680 RISKING IN DIFFERENT 914 00:37:14,680 --> 00:37:15,720 POPULATIONS. 915 00:37:15,720 --> 00:37:17,880 WHETHER A STUDY ACTUALLY SAYS WE 916 00:37:17,880 --> 00:37:20,320 FOUND LOCALS THAT IS 917 00:37:20,320 --> 00:37:21,320 [INDISCERNIBLE] WITH BREAST 918 00:37:21,320 --> 00:37:23,200 CANCER RISK, IF WE TRY TO 919 00:37:23,200 --> 00:37:26,200 REPLICATE THAT IN A AFRICAN 920 00:37:26,200 --> 00:37:28,000 ANCESTRY COHORT, WE GET WHAT WE 921 00:37:28,000 --> 00:37:30,880 CALL THE FLIP-FLOP PHENOMENON 922 00:37:30,880 --> 00:37:33,680 BECAUSE OF THE SHORT L.D. OF 923 00:37:33,680 --> 00:37:34,720 AFRICAN POPULATIONS. 924 00:37:34,720 --> 00:37:38,840 SO IT MAY BE A PROTECTIVE ALLELE 925 00:37:38,840 --> 00:37:42,600 IN ONE POPULATION, AND A RISK 926 00:37:42,600 --> 00:37:43,880 ALLELE IN THE OTHER. 927 00:37:43,880 --> 00:37:46,520 HISPANIC HAVE AN ALLELE THAT 928 00:37:46,520 --> 00:37:49,120 ACTUALLY VERY PROTECTIVE AGAINST 929 00:37:49,120 --> 00:37:49,840 BREAST CANCER. 930 00:37:49,840 --> 00:37:53,840 AND THAT'S WHY HISPANICS HAVE A 931 00:37:53,840 --> 00:37:57,600 LOWER RISK OF BREAST CANCER, 932 00:37:57,600 --> 00:37:59,520 ESPECIALLY IF THEY HAVE THAT 933 00:37:59,520 --> 00:38:00,480 NATIVE AMERICAN ALLELE THAT IS 934 00:38:00,480 --> 00:38:00,800 PROTECTIVE. 935 00:38:00,800 --> 00:38:04,120 SO THE THERE IS A LOT THAT WE CN 936 00:38:04,120 --> 00:38:05,240 LEARN FROM DIFFERENT POPULATIONS 937 00:38:05,240 --> 00:38:08,000 BECAUSE OUR CHROMOSOMES ARE 938 00:38:08,000 --> 00:38:11,240 SCRAMBLED DIFFERENTLY. 939 00:38:11,240 --> 00:38:13,480 SO A GROUP HAS BEEN REALLY 940 00:38:13,480 --> 00:38:19,520 WORKING WITH THE AFRICAN 941 00:38:19,520 --> 00:38:20,720 ANCESTRY BREAST CANCER GENETIC 942 00:38:20,720 --> 00:38:21,000 CONSORTIUM. 943 00:38:21,000 --> 00:38:21,880 I'M NOT GOING THROUGH IT IN THE 944 00:38:21,880 --> 00:38:22,880 INTEREST OF TIME. 945 00:38:22,880 --> 00:38:24,760 PULLING DATA AND TRYING TO SEE 946 00:38:24,760 --> 00:38:28,280 WHETHER WE CAN ACTUALLY DO 947 00:38:28,280 --> 00:38:31,600 BETTER BY BEGINNING TO 948 00:38:31,600 --> 00:38:33,000 UNDERSTAND THAT ER POSITIVE 949 00:38:33,000 --> 00:38:34,320 BREAST CANCER IS DIFFERENT FROM 950 00:38:34,320 --> 00:38:35,400 ER NEGATIVE BREAST CANCER. 951 00:38:35,400 --> 00:38:39,760 AND TRYING TO, YOU CAN SEE FOR 952 00:38:39,760 --> 00:38:42,880 ROOT CONSORTIUM, THE AVERAGE ACT 953 00:38:42,880 --> 00:38:45,320 IS YOUNGER, THE -- AGE, GHANA, 954 00:38:45,320 --> 00:38:49,120 MORE THAN 2000 BREAST CANCER 955 00:38:49,120 --> 00:38:50,800 CASES, ALSO YOUNGON SET. 956 00:38:50,800 --> 00:38:55,080 WHEN WE LOOK AT THE YOUNG ONSET 957 00:38:55,080 --> 00:38:58,200 CASES, MAYBE WE'LL HAVE BETTER 958 00:38:58,200 --> 00:38:58,400 TOOLS. 959 00:38:58,400 --> 00:39:02,360 THAT IS SHOWN WITH THE CROSS 960 00:39:02,360 --> 00:39:06,160 ANCESTRY IDENTIFYING SIX BREAST 961 00:39:06,160 --> 00:39:07,520 CANCER IN AFRICAN AND EUROPEAN 962 00:39:07,520 --> 00:39:07,920 ANCESTRY WOMEN. 963 00:39:07,920 --> 00:39:11,480 THIS HAS BEEN PUBLISHED. 964 00:39:11,480 --> 00:39:13,520 BUT THE POINT THAT WE'RE TRYING 965 00:39:13,520 --> 00:39:16,680 TO MAKE IS THAT BREAST CANCER IS 966 00:39:16,680 --> 00:39:20,080 NOT ONE DOES, IT'S HETEROGENOUS. 967 00:39:20,080 --> 00:39:24,880 IF YOU DEFINE THE PHENOTYPE 968 00:39:24,880 --> 00:39:27,040 ADEQUATELY, YOU MAY BEGIN TO 969 00:39:27,040 --> 00:39:28,400 MAKE PROGRESS. 970 00:39:28,400 --> 00:39:30,520 IF YOU CAN GET, YOU KNOW, 971 00:39:30,520 --> 00:39:32,080 ADDITIONAL LUSIGH, WOULD IT THEN 972 00:39:32,080 --> 00:39:37,200 BE POSSIBLE FOR US TO CREATE A 973 00:39:37,200 --> 00:39:39,520 POLYGENIC MODEL FOR 974 00:39:39,520 --> 00:39:40,000 INHERITABILITY. 975 00:39:40,000 --> 00:39:43,560 FOR THOSE OF YOU WHO ARE NOT 976 00:39:43,560 --> 00:39:46,720 GENETICISTS, THIS IS WHITE -- 977 00:39:46,720 --> 00:39:48,640 WHITE -- QUITE CLEAR. 978 00:39:48,640 --> 00:39:55,800 IT'S CONTRIBUTED -- CONTRIBUTED 979 00:39:55,800 --> 00:39:57,080 CONTRIBUTED — DISTRIBUTED IN A 980 00:39:57,080 --> 00:39:57,360 BELL CURVE. 981 00:39:57,360 --> 00:39:59,120 IF WE CAN GET A SET OF MARKERS 982 00:39:59,120 --> 00:40:03,000 THAT WOULD ALLOW US TO DO 983 00:40:03,000 --> 00:40:09,040 POPULATION STRATIFICATION, THEN 984 00:40:09,040 --> 00:40:09,640 PEOPLE AT THIS EXTREME RACE WE 985 00:40:09,640 --> 00:40:10,640 CAN FIND THEM. 986 00:40:10,640 --> 00:40:12,800 PEOPLE AT LOWER RISK MAYBE THEY 987 00:40:12,800 --> 00:40:14,920 DON'T NEED TO SCREEN AS OFTEN. 988 00:40:14,920 --> 00:40:17,440 THAT'S SORT OF WHERE THAT 989 00:40:17,440 --> 00:40:18,520 COMMENT IS COMING FROM. 990 00:40:18,520 --> 00:40:22,400 YOU CAN SEE THERE IS A VERY NICE 991 00:40:22,400 --> 00:40:26,960 PRS CORE THAT IS BEING GENERATED 992 00:40:26,960 --> 00:40:28,080 WITH 94 THOUSAND EUROPEAN 993 00:40:28,080 --> 00:40:30,080 ANCESTRY CASES AND CONTROLS. 994 00:40:30,080 --> 00:40:33,560 AND YOU KNOW, IT'S PERFORMING 995 00:40:33,560 --> 00:40:37,760 MODERATELY WELL, IT'S BEEN 996 00:40:37,760 --> 00:40:40,600 REPLICATED IN HISPANICS, 997 00:40:40,600 --> 00:40:43,520 REPLICAREPLICATED IN SOUTHEAST , 998 00:40:43,520 --> 00:40:46,800 FOR THE AFRICAN GROUP, IT'S A 999 00:40:46,800 --> 00:40:47,320 FLIP OF THE COIN. 1000 00:40:47,320 --> 00:40:48,280 WE HAVE WORK TO DO TO CONTINUE 1001 00:40:48,280 --> 00:40:49,000 TO DO THIS. 1002 00:40:49,000 --> 00:40:52,520 THE REASON IS ALREADY IF WE WANT 1003 00:40:52,520 --> 00:40:58,480 TO USE THIS, I I IT MAY HELP 1004 00:40:58,480 --> 00:41:00,800 EXACERBATE HEALTH DISPARAGES. 1005 00:41:00,800 --> 00:41:03,200 WHAT WE'RE SEEING WITH THE 1006 00:41:03,200 --> 00:41:05,080 GENOME SEQUENCING, WE'RE REALLY 1007 00:41:05,080 --> 00:41:06,720 TOUCHING THE TIP OF THE ICEBERG. 1008 00:41:06,720 --> 00:41:09,880 THE HETEROGENEITY ON THE AFRICAN 1009 00:41:09,880 --> 00:41:11,760 CONTINENT, O ON THE AFRICAN 1010 00:41:11,760 --> 00:41:14,640 GENOME, HAS NOT BEEN STUDIED 1011 00:41:14,640 --> 00:41:17,000 BECAUSE THIS IS THE FOUNDATION, 1012 00:41:17,000 --> 00:41:20,040 THE SUBSET IS EUROPEAN AND A 1013 00:41:20,040 --> 00:41:22,840 SUBSET IS ASIAN. 1014 00:41:22,840 --> 00:41:27,880 AND THIS IS WHAT IS PRESENT IN 1015 00:41:27,880 --> 00:41:28,160 DATABASE. 1016 00:41:28,160 --> 00:41:33,880 VERY FEW FROM AFRICAN ANCESTRY 1017 00:41:33,880 --> 00:41:34,200 POPULATIONS. 1018 00:41:34,200 --> 00:41:36,760 IN TRYING TO SEE HOW THAT MODEL 1019 00:41:36,760 --> 00:41:40,080 WORKS, THIS IS BEEN PUBLISHED 1020 00:41:40,080 --> 00:41:43,640 NOW BY MUNCIE AND THE GROUP 1021 00:41:43,640 --> 00:41:45,720 REALLY TRYING TO SEE WHETHER WE 1022 00:41:45,720 --> 00:41:48,440 CAN GET IT PRS CORE THAT 1023 00:41:48,440 --> 00:41:49,240 FUNCTION WELL. 1024 00:41:49,240 --> 00:41:51,840 AND YOU CAN SEE THAT IT 1025 00:41:51,840 --> 00:41:56,040 FUNCTIONS WELL IN SEPARATING 1026 00:41:56,040 --> 00:41:57,920 HIGH RISK POPULATIONS FROM LOW 1027 00:41:57,920 --> 00:42:00,120 RISK. 1028 00:42:00,120 --> 00:42:04,000 BUT IN AFRICAN ANCESTRY GROUP, 1029 00:42:04,000 --> 00:42:07,200 IT'S NOT WORKING AS WELL. 1030 00:42:07,200 --> 00:42:12,880 WHEN YOU LOOK AT HOWEVER FOR ER 1031 00:42:12,880 --> 00:42:14,040 NEGATIVE BREAST CANCER, YOU CAN 1032 00:42:14,040 --> 00:42:17,200 SEE THE SAME ANALYSIS IS, YOU 1033 00:42:17,200 --> 00:42:19,640 HAVE BETTER SEPARATION OF THE 1034 00:42:19,640 --> 00:42:22,400 HIGHEST RISK CATEGORY FROM THE 1035 00:42:22,400 --> 00:42:24,200 LOWER RISK CATEGORY IN AFRICAN 1036 00:42:24,200 --> 00:42:26,760 AMERICANS FOR ER NEGATIVE BUT 1037 00:42:26,760 --> 00:42:30,360 IT'S NOT AS GREAT WITH EUROPEAN 1038 00:42:30,360 --> 00:42:31,680 ANCESTRY GROUP. 1039 00:42:31,680 --> 00:42:33,640 THAT'S BECAUSE THE PREDOMINANT 1040 00:42:33,640 --> 00:42:35,160 TYPE OF BREAST CANCER THAT YOU 1041 00:42:35,160 --> 00:42:40,680 SEE IN EUROPEAN ANCESTRY WOMEN 1042 00:42:40,680 --> 00:42:42,800 IS A RECEPTOR POSITIVE AND GROWS 1043 00:42:42,800 --> 00:42:43,520 VERY SLOWLY. 1044 00:42:43,520 --> 00:42:46,120 THIS IS GIVING US HOPE WE CAN 1045 00:42:46,120 --> 00:42:47,840 REALLY BEGIN TO THINK ABOUT 1046 00:42:47,840 --> 00:42:48,800 THIS. 1047 00:42:48,800 --> 00:42:52,160 SO LET ME THEN SWITCH TO, SO NOW 1048 00:42:52,160 --> 00:42:55,280 IF YOU HAVE, YOU ARE HIGH RISK 1049 00:42:55,280 --> 00:42:57,320 AND WE'VE DONE RISK 1050 00:42:57,320 --> 00:42:58,600 STRATIFICATION, WHAT IS A 1051 00:42:58,600 --> 00:43:00,000 CLINICAL IMPLICATION OF THAT? 1052 00:43:00,000 --> 00:43:03,040 WELL THE CLINICAL IMPLICATION, 1053 00:43:03,040 --> 00:43:05,800 IF YOU HAVE A BRCA1 MUTATION, 1054 00:43:05,800 --> 00:43:08,000 YOU WOULDN'T HAVE YOUR BREAST 1055 00:43:08,000 --> 00:43:08,720 CANCER DIAGNOSED EARLY. 1056 00:43:08,720 --> 00:43:10,280 IT DOESN'T MATTER THE AGE. 1057 00:43:10,280 --> 00:43:12,160 YOU HAVE DENSE BREASTS, THE 1058 00:43:12,160 --> 00:43:13,400 CANCER IS LOCKED IN THERE. 1059 00:43:13,400 --> 00:43:15,480 YOU NOW NEED TO DO MRI. 1060 00:43:15,480 --> 00:43:20,280 WE HAVE THE IDEA IN 2004 BECAUSE 1061 00:43:20,280 --> 00:43:22,000 OF COURSE, YOU KNOW, I PRACTICED 1062 00:43:22,000 --> 00:43:24,680 ON THE SOUTH SIDE OF CHICAGO. 1063 00:43:24,680 --> 00:43:26,120 IF YOU GO AND TELL AN AFRICAN 1064 00:43:26,120 --> 00:43:27,760 AMERICAN WOMEN, YOU KNOW YOU 1065 00:43:27,760 --> 00:43:30,320 HAVE A HIGH RISK, TAKE BOTH 1066 00:43:30,320 --> 00:43:30,600 BREASTS OFF. 1067 00:43:30,600 --> 00:43:32,200 THEY ARE GOING TO LOOK AT YOU 1068 00:43:32,200 --> 00:43:33,400 AND SAY, WHAT? 1069 00:43:33,400 --> 00:43:35,440 THERE IS NOTHING WRONG WITH ME, 1070 00:43:35,440 --> 00:43:37,480 WHY WOULD I TAKE MY BREAST OFF. 1071 00:43:37,480 --> 00:43:40,240 WE HAD TO FIGURE OUT A BEST WAY 1072 00:43:40,240 --> 00:43:43,360 TO SUPPORT THESE WOMEN, AND THEN 1073 00:43:43,360 --> 00:43:45,480 LEARN FROM THEM. 1074 00:43:45,480 --> 00:43:46,920 THAT'S HOW WE WERE ABLE TO LEARN 1075 00:43:46,920 --> 00:43:50,120 IN FACT WHEN YOU DO MRI EVERY 1076 00:43:50,120 --> 00:43:52,000 SIX MONTHS KNOWING THE 1077 00:43:52,000 --> 00:43:53,200 TRAJECTORY OF THE CANCER, YOU 1078 00:43:53,200 --> 00:43:54,880 ARE GOING TO PICKUP CANCER. 1079 00:43:54,880 --> 00:43:55,480 THE PAPER THAT IS ALREADY 1080 00:43:55,480 --> 00:43:59,360 PUBLISHED AND THE COMMENTS ON IT 1081 00:43:59,360 --> 00:44:03,640 IS MOST MRI BREAST SCREENING IN 1082 00:44:03,640 --> 00:44:05,960 BRCA1 MUTATION CARRIER. 1083 00:44:05,960 --> 00:44:10,040 WITHIN SIX MONTHS THEY HAD RAPID 1084 00:44:10,040 --> 00:44:10,560 PROGRESSION OF CANCER. 1085 00:44:10,560 --> 00:44:13,000 IN THE STUDY THE AVERAGE TUMOR 1086 00:44:13,000 --> 00:44:16,080 STAYS THAT WE DETECTED WAS 1087 00:44:16,080 --> 00:44:16,400 6-MILLIMETER. 1088 00:44:16,400 --> 00:44:21,600 AND EVERYONE HAD THE CANCER 1089 00:44:21,600 --> 00:44:23,080 DIAGNOSED ONE CENTIMETER AND NO 1090 00:44:23,080 --> 00:44:24,120 NEGATIVE. 1091 00:44:24,120 --> 00:44:27,760 IF YOU CAN DOWN STATE THE 1092 00:44:27,760 --> 00:44:29,240 AGGRESSIVE ER NEGATIVE BREAST 1093 00:44:29,240 --> 00:44:30,960 CANCER IN ALL POPULATIONS YOU 1094 00:44:30,960 --> 00:44:31,880 WILL SAVE MORE LIVES. 1095 00:44:31,880 --> 00:44:36,000 THE QUESTION IS, USE MRI FOR 1096 00:44:36,000 --> 00:44:36,640 EVERYBODY OR THINK A LITTLE BIT 1097 00:44:36,640 --> 00:44:38,800 OUTSIDE THE BOX AND DO SOMETHING 1098 00:44:38,800 --> 00:44:39,000 ELSE? 1099 00:44:39,000 --> 00:44:41,520 SO THAT'S WHY WE ARE 1100 00:44:41,520 --> 00:44:46,600 COLLABORATING WITH LAURA ESMAN 1101 00:44:46,600 --> 00:44:49,360 AND DOING THE WISDOM STUDY. 1102 00:44:49,360 --> 00:44:51,320 WOMEN INFORM TO SCREEN BASED ON 1103 00:44:51,320 --> 00:44:52,320 MEASURES OF RISK. 1104 00:44:52,320 --> 00:44:54,760 THIS STUDY IS RECRUITING ALL 1105 00:44:54,760 --> 00:44:55,640 ACROSS THE COUNTRY. 1106 00:44:55,640 --> 00:44:57,840 AND I'M HOPING THAT I'VE JOINED 1107 00:44:57,840 --> 00:44:59,520 IT, THAT MORE WOMEN WILL JOIN SO 1108 00:44:59,520 --> 00:45:02,520 WE CAN LEARN AND BE ABLE TO 1109 00:45:02,520 --> 00:45:04,720 FIND HIGH-RISK PATIENTS BEFORE 1110 00:45:04,720 --> 00:45:05,440 THEY GET CANCER. 1111 00:45:05,440 --> 00:45:07,440 FOR NOW, WE'RE LEFT WITH REALLY 1112 00:45:07,440 --> 00:45:09,520 THINKING ABOUT TREATMENT. 1113 00:45:09,520 --> 00:45:11,480 BECAUSE WE TEST MOSTLY WHEN 1114 00:45:11,480 --> 00:45:14,640 PEOPLE SHOW UP HAVING BEEN 1115 00:45:14,640 --> 00:45:17,080 DIAGNOSED WITH BREAST CANCER. 1116 00:45:17,080 --> 00:45:18,480 SO THIS WAS AN EDITORIAL I 1117 00:45:18,480 --> 00:45:19,400 PUBLISHED IN 1996. 1118 00:45:19,400 --> 00:45:22,280 AND I ASKED RITA, WHO WAS MY 1119 00:45:22,280 --> 00:45:24,880 FELLOW AT THAT TIME TO THINK 1120 00:45:24,880 --> 00:45:25,920 ABOUT IF YOU ACTUALLY LOOK AT 1121 00:45:25,920 --> 00:45:31,320 THIS PAPER, THEY HAD ONLY JUST 1122 00:45:31,320 --> 00:45:33,880 43 WOMEN WITH [INDISCERNIBLE] 1123 00:45:33,880 --> 00:45:35,080 MUTATIONS WHO HAD OVARIAN 1124 00:45:35,080 --> 00:45:35,320 CANCER. 1125 00:45:35,320 --> 00:45:38,360 AND THEY TREATED THEM WITH STIFF 1126 00:45:38,360 --> 00:45:38,640 PLATINUM. 1127 00:45:38,640 --> 00:45:41,720 YOU CAN SEE THE SEPARATION 1128 00:45:41,720 --> 00:45:43,000 BETWEEN WOMEN DOING WELL IF THEY 1129 00:45:43,000 --> 00:45:44,040 HAD THE GERM LINE MUTATION AND 1130 00:45:44,040 --> 00:45:45,800 THEN THE OTHER COHORT THAT DID 1131 00:45:45,800 --> 00:45:48,000 NOT HAVE A GERM LINE MUTATION. 1132 00:45:48,000 --> 00:45:50,640 AND THIS WAS REALLY WHERE IT WAS 1133 00:45:50,640 --> 00:45:53,240 VERY CLEAR THAT YOUR GERM LINE 1134 00:45:53,240 --> 00:45:54,680 GENETICS ACTUALLY CAN DETERMINE 1135 00:45:54,680 --> 00:45:56,440 YOUR RESPONSE TO TREATMENT. 1136 00:45:56,440 --> 00:45:57,080 RIGHT? 1137 00:45:57,080 --> 00:46:00,480 SO IT'S NOT JUST ABOUT THE TUMOR 1138 00:46:00,480 --> 00:46:01,280 ALONE, IT'S ABOUT WHAT IS 1139 00:46:01,280 --> 00:46:04,120 DRIVING THE EVOLUTIONARY 1140 00:46:04,120 --> 00:46:04,400 TRAJECTORY. 1141 00:46:04,400 --> 00:46:07,200 AND SO IN 1996, I THOUGHT 1142 00:46:07,200 --> 00:46:09,640 GENETICS IN CLINICAL CANCER 1143 00:46:09,640 --> 00:46:12,560 CARE, THE FUTURE IS NOW! WELL, 1144 00:46:12,560 --> 00:46:14,680 WAS I WRONG BECAUSE NO ONE WAS 1145 00:46:14,680 --> 00:46:16,840 PREPARED TO ACTUALLY THINK ABOUT 1146 00:46:16,840 --> 00:46:19,920 HOW TO GET WOMEN TESTED AND HOW 1147 00:46:19,920 --> 00:46:22,200 TO PERSONALIZE THERAPY. 1148 00:46:22,200 --> 00:46:27,240 SO FAST FORWARD, WE STARTED A 1149 00:46:27,240 --> 00:46:29,720 PROSPECTIVE COHORT OF PATIENTS. 1150 00:46:29,720 --> 00:46:31,640 AND THAT CAME IN THROUGH MY 1151 00:46:31,640 --> 00:46:33,080 CLINIC BECAUSE WE REALLY WANTED 1152 00:46:33,080 --> 00:46:34,520 TO KNOW HOW PEOPLE WERE DOING. 1153 00:46:34,520 --> 00:46:37,440 BECAUSE WE'RE ON THE SOUTH SIDE 1154 00:46:37,440 --> 00:46:39,720 OF CHICAGO, WE'VE NOW HAD MORE 1155 00:46:39,720 --> 00:46:42,560 THAN 4000 WOMEN, ABOUT 40% OF 1156 00:46:42,560 --> 00:46:44,400 OUR PATIENTS ARE BLACK. 1157 00:46:44,400 --> 00:46:48,560 AND WITH A MEDIAN FOLLOW-UP OF 1158 00:46:48,560 --> 00:46:49,240 ABOUT 5.4 YEARS. 1159 00:46:49,240 --> 00:46:51,600 WE WANTED TO KNOW WHAT IS THE 1160 00:46:51,600 --> 00:46:52,520 CHARACTERISTICS OF WOMEN WHO 1161 00:46:52,520 --> 00:46:57,240 SHOW UP AT OUR DOOR. 1162 00:46:57,240 --> 00:47:00,600 AND SO CONTRARY TO WHAT I SHOWED 1163 00:47:00,600 --> 00:47:02,120 WHERE IN THE CASE CONTROL 1164 00:47:02,120 --> 00:47:04,240 COHORT, THE WHITE WOMEN WERE 1165 00:47:04,240 --> 00:47:06,280 OLDER, HERE THE BLACK WOMEN 1166 00:47:06,280 --> 00:47:09,160 ACTUALLY ARE OLDER BECAUSE WE 1167 00:47:09,160 --> 00:47:10,440 PRACTICED IN A PRIVATE HOSPITAL. 1168 00:47:10,440 --> 00:47:12,200 THEY HAVE INSURANCE, THEY HAVE 1169 00:47:12,200 --> 00:47:13,560 MEDICARE, AND THAT'S HOW THEY 1170 00:47:13,560 --> 00:47:14,880 GET IN. 1171 00:47:14,880 --> 00:47:15,520 RIGHT? 1172 00:47:15,520 --> 00:47:22,160 AND IF YOU LOOK AT THIS TYPES OF 1173 00:47:22,160 --> 00:47:23,880 BREAST CANCER, ALWAYS IN EVERY 1174 00:47:23,880 --> 00:47:26,360 CASE, BLACK WOMEN TEND TO HAVE 1175 00:47:26,360 --> 00:47:29,280 MORE TRIPLE NEGATIVE BREAST 1176 00:47:29,280 --> 00:47:29,520 CANCER. 1177 00:47:29,520 --> 00:47:31,640 AND BECAUSE THIS WOMEN NOW HAVE 1178 00:47:31,640 --> 00:47:32,680 BEEN FOLLOWED FOR A VERY LONG 1179 00:47:32,680 --> 00:47:34,840 TIME, WE WANTED TO KNOW WHAT WAS 1180 00:47:34,840 --> 00:47:37,560 THE OUTCOME, ESPECIALLY IF WE 1181 00:47:37,560 --> 00:47:42,720 TREATED THEM WITH NEW 1182 00:47:42,720 --> 00:47:43,080 CHEMOTHERAPY. 1183 00:47:43,080 --> 00:47:43,640 [INDISCERNIBLE] CHEMOTHERAPY 1184 00:47:43,640 --> 00:47:44,280 MEANS WE CAN GIVE YOU 1185 00:47:44,280 --> 00:47:45,440 CHEMOTHERAPY AND THEN LOOK AT 1186 00:47:45,440 --> 00:47:47,160 WHAT IS YOUR RESPONSE? 1187 00:47:47,160 --> 00:47:47,600 RIGHT? 1188 00:47:47,600 --> 00:47:49,120 BEFORE TAKING THE TUMOR OUT. 1189 00:47:49,120 --> 00:47:53,680 AND THIS IS WHAT WE FOUND. 1190 00:47:53,680 --> 00:47:55,160 PATIENTS OF COURSE BLACK 1191 00:47:55,160 --> 00:48:02,920 PATIENTS HAD MORE C COMORMIB 1192 00:48:02,920 --> 00:48:03,360 BIBTIES. 1193 00:48:03,360 --> 00:48:03,920 MORBIDITY. 1194 00:48:03,920 --> 00:48:07,520 IN MORE DELAY INITIATING 1195 00:48:07,520 --> 00:48:07,840 CHEMOTHERAPY. 1196 00:48:07,840 --> 00:48:09,680 AND OF COURSE IN TERMS OF 1197 00:48:09,680 --> 00:48:11,880 PRIMARY CARE INSURANCE, MOST OF 1198 00:48:11,880 --> 00:48:13,960 THE PATIENTS MORE BLACK WOMEN 1199 00:48:13,960 --> 00:48:18,280 WERE ON MEDICAID COMPARED TO 1200 00:48:18,280 --> 00:48:21,120 PRIVATE INSURANCE. 1201 00:48:21,120 --> 00:48:22,920 BECAUSE ANYONE WHO, IN FACT, WE 1202 00:48:22,920 --> 00:48:27,760 DID STUDIED THE FARTHER YOU 1203 00:48:27,760 --> 00:48:30,760 LIVED TO US, THE BETTER YOUR 1204 00:48:30,760 --> 00:48:31,520 CANCER OUTCOMES. 1205 00:48:31,520 --> 00:48:33,200 THE PEOPLE IN THE NEIGHBORHOOD 1206 00:48:33,200 --> 00:48:34,840 WHO CAN'T COME BECAUSE WE HAVE A 1207 00:48:34,840 --> 00:48:36,480 PRIVATE HOSPITAL WITH THE WORST 1208 00:48:36,480 --> 00:48:37,080 OUTCOME. 1209 00:48:37,080 --> 00:48:38,800 IS THAT RELATE TODAY THE 1210 00:48:38,800 --> 00:48:40,880 DISTANCE OR RELATED TO THE 1211 00:48:40,880 --> 00:48:42,120 SOCIOECONOMIC STATUS? 1212 00:48:42,120 --> 00:48:43,480 THOSE ARE SOME OF THE THINGS 1213 00:48:43,480 --> 00:48:46,920 WHEN YOU DO STUDIES, YOU HAVE TO 1214 00:48:46,920 --> 00:48:47,920 [INDISCERNIBLE] IN THE CONTEXT 1215 00:48:47,920 --> 00:48:49,680 OF WHERE YOU ARE PRACTICING. 1216 00:48:49,680 --> 00:48:50,520 THIS WHAT WE FOUND. 1217 00:48:50,520 --> 00:48:54,360 IF YOU GET A CR, THERE IS NO 1218 00:48:54,360 --> 00:48:57,280 DIFFERENCE BETWEEN BLACK AND 1219 00:48:57,280 --> 00:48:57,880 WHITE IN TERMS OF LONG TERM 1220 00:48:57,880 --> 00:48:58,160 DOING WELL. 1221 00:48:58,160 --> 00:49:03,120 AND THEN, PATIENTS WITHOUT PCR 1222 00:49:03,120 --> 00:49:05,040 BETWEEN BLACK AND WHITE, BLACKS 1223 00:49:05,040 --> 00:49:07,680 ARE NOT DOING AS WELL IF THEY 1224 00:49:07,680 --> 00:49:09,640 DON'T GET A CR. 1225 00:49:09,640 --> 00:49:14,160 WE LOOKED AT RECURRENCE FREE 1226 00:49:14,160 --> 00:49:15,320 SURVIVAL. 1227 00:49:15,320 --> 00:49:17,760 YOU GET OPTIMAL THERAPY. 1228 00:49:17,760 --> 00:49:20,760 IT DOESN'T MATTER HOW YOU GET TO 1229 00:49:20,760 --> 00:49:24,960 POD CR, IF YOU CAN GET THERE, 1230 00:49:24,960 --> 00:49:27,040 YOU WILL HAVE BETTER LONG-TERM 1231 00:49:27,040 --> 00:49:27,320 SURVIVAL. 1232 00:49:27,320 --> 00:49:29,720 IF QUESTION IS WHY YOU ARE NOT 1233 00:49:29,720 --> 00:49:32,680 GETTING PAT CR. 1234 00:49:32,680 --> 00:49:34,680 THE STUDY WAS POSSIBLE BECAUSE 1235 00:49:34,680 --> 00:49:37,400 WE GOT A CANCER HEALTH 1236 00:49:37,400 --> 00:49:38,000 DISPARITIES PLANNING GRANT. 1237 00:49:38,000 --> 00:49:40,920 AND WE LOOKED AT OVERALL YOU CAN 1238 00:49:40,920 --> 00:49:44,600 SAY WELL, MAYBE THE PCR AGE IS 1239 00:49:44,600 --> 00:49:46,720 NOT SO BAD. 1240 00:49:46,720 --> 00:49:49,760 HERE IS WHERE WE WERE FLOORED. 1241 00:49:49,760 --> 00:49:51,080 TWO POSITIVE BREAST CANCER. 1242 00:49:51,080 --> 00:49:53,440 THIS IS NOW THE MOST TREATABLE 1243 00:49:53,440 --> 00:49:54,560 BREAST CANCER. 1244 00:49:54,560 --> 00:49:58,520 AND YES, THEY HAVE THE WORST PCR 1245 00:49:58,520 --> 00:50:00,160 READ, RIGHT? 1246 00:50:00,160 --> 00:50:01,400 TRIPLE NEGATIVE BREAST CANCER 1247 00:50:01,400 --> 00:50:02,520 ARE NOT SO HIGH. 1248 00:50:02,520 --> 00:50:05,760 AND THEN WE ASKED THE QUESTION, 1249 00:50:05,760 --> 00:50:12,640 WHAT IS THE REASON WHY THIS IS 1250 00:50:12,640 --> 00:50:12,920 OCCURRING. 1251 00:50:12,920 --> 00:50:17,560 WE WERE ABLE TO NOW GO BACK AND 1252 00:50:17,560 --> 00:50:19,440 DO PANEL SEQUENCE IN THE TUMOR. 1253 00:50:19,440 --> 00:50:22,080 IS THE EVOLUTIONARY TRAJECTORY? 1254 00:50:22,080 --> 00:50:25,280 LOOKING AT 186 OF THIS SUBSET WE 1255 00:50:25,280 --> 00:50:27,120 WERE ABLE TO SEQUENCE, WE WERE 1256 00:50:27,120 --> 00:50:29,480 REALLY INTERESTED IN THE 1257 00:50:29,480 --> 00:50:31,920 DISTRIBUTION OF THE PATIENT. 1258 00:50:31,920 --> 00:50:35,360 AND WE'RE LEARNING BECAUSE THIS 1259 00:50:35,360 --> 00:50:37,080 EXPERIMENT IS VERY EXPENSIVE AND 1260 00:50:37,080 --> 00:50:40,400 YOU CAN DO SHORT COST BY DOING 1261 00:50:40,400 --> 00:50:42,960 PANEL SEQUENCING OR WHOLE GENOME 1262 00:50:42,960 --> 00:50:44,000 SEQUENCING TO FIGURE OUT WHAT IS 1263 00:50:44,000 --> 00:50:44,720 GOING ON. 1264 00:50:44,720 --> 00:50:47,200 IN THE FIRST PAIRS OF SAMPLES WE 1265 00:50:47,200 --> 00:50:51,360 DID, WELL, WHEN YOU DO ADVAN 1266 00:50:51,360 --> 00:50:54,040 THERAPY, THE TUMOR CHANGES 1267 00:50:54,040 --> 00:50:54,440 CHARACTERISTICS. 1268 00:50:54,440 --> 00:50:54,640 RIGHT? 1269 00:50:54,640 --> 00:51:00,960 YOU KNOW, THE TUMOR MUTATION -- 1270 00:51:00,960 --> 00:51:01,680 SEVEN REDUCED. 1271 00:51:01,680 --> 00:51:03,720 FIVE INCREASES. 1272 00:51:03,720 --> 00:51:04,640 ONE STAYED THE SAME. 1273 00:51:04,640 --> 00:51:06,120 TWO POSITIVE PATIENTS WITH 1274 00:51:06,120 --> 00:51:09,120 [INDISCERNIBLE] DISEASE, ONE NO 1275 00:51:09,120 --> 00:51:12,600 LONGER HAD THE B2 AMPLIFICATION. 1276 00:51:12,600 --> 00:51:15,720 WHEN WE DO DRUG STUDIES NOW WE 1277 00:51:15,720 --> 00:51:17,320 TREAT EVERYBODY THE SAME. 1278 00:51:17,320 --> 00:51:21,000 WITHOUT REALLY GETTING THE 1279 00:51:21,000 --> 00:51:22,800 GRANULAR DATA WHY DIDN'T YOU 1280 00:51:22,800 --> 00:51:23,440 TUMOR RESPOND TO THERAPY? 1281 00:51:23,440 --> 00:51:25,880 WELL, THE OTHER ONE RESPONDED. 1282 00:51:25,880 --> 00:51:27,360 I THINK THESE ARE THE CHALLENGES 1283 00:51:27,360 --> 00:51:31,640 I SEE AS WE GO TOWARDS PRECISION 1284 00:51:31,640 --> 00:51:31,880 MEDICINE. 1285 00:51:31,880 --> 00:51:33,880 THIS IS A PAPER MY MEDICAL 1286 00:51:33,880 --> 00:51:37,200 STUDENT PRESENTED AT SA SAN 1287 00:51:37,200 --> 00:51:37,760 ANTONIO. 1288 00:51:37,760 --> 00:51:42,280 NATIONAL OF CLINICAL OUTCOMES 1289 00:51:42,280 --> 00:51:45,960 AND [INDISCERNIBLE] TWO TRIALS. 1290 00:51:45,960 --> 00:51:47,720 THIS IS A NATIONWIDE STUDY, 1291 00:51:47,720 --> 00:51:51,880 PUTTING PATIENTS WHO HAVE HIGH 1292 00:51:51,880 --> 00:51:53,520 RISK BREAST CANCER INTO 1293 00:51:53,520 --> 00:51:56,040 INNOVATIVE ANY ACCESS TO 1294 00:51:56,040 --> 00:51:56,400 CLINICAL TRIALS. 1295 00:51:56,400 --> 00:51:56,680 ALL RIGHT. 1296 00:51:56,680 --> 00:51:57,800 WE LOOKED AT IT. 1297 00:51:57,800 --> 00:52:00,160 WHETHER YOU ARE WHITE, BLACK, 1298 00:52:00,160 --> 00:52:04,240 ASIAN, IF YOU HAVE YOUR PAP CR, 1299 00:52:04,240 --> 00:52:04,960 YOU DO OKAY. 1300 00:52:04,960 --> 00:52:06,720 THERE IS NO RACIAL DISPARITY. 1301 00:52:06,720 --> 00:52:10,160 IF YOU DON'T GET A PASS CR, YOU 1302 00:52:10,160 --> 00:52:13,160 CAN SEE THAT THERE IS OF COURSE 1303 00:52:13,160 --> 00:52:14,920 DISPARITY IN WHO IS SURVIVING 1304 00:52:14,920 --> 00:52:16,520 AND NOT. 1305 00:52:16,520 --> 00:52:19,640 SO LET ME BARROW THIS SLIDE. 1306 00:52:19,640 --> 00:52:25,480 THINKING ABOUT THIS EVOLUTION 1307 00:52:25,480 --> 00:52:28,400 THAT CHARLES DARWIN WROTE IN HIS 1308 00:52:28,400 --> 00:52:28,880 NOTEBOOK. 1309 00:52:28,880 --> 00:52:31,120 NOTHING IN CANCER MAKES SENSE 1310 00:52:31,120 --> 00:52:32,400 EXCEPT IN THE LIGHT OF 1311 00:52:32,400 --> 00:52:33,440 EVOLUTION. 1312 00:52:33,440 --> 00:52:35,720 EVOLUTION VULNERABILITY TO 1313 00:52:35,720 --> 00:52:36,760 CANCER. 1314 00:52:36,760 --> 00:52:38,080 CANCER PROGRESSION BY 1315 00:52:38,080 --> 00:52:41,400 NATURALIZED SELECTION IN TISSUE 1316 00:52:41,400 --> 00:52:41,760 ECOSYSTEMS. 1317 00:52:41,760 --> 00:52:43,080 WHEN WE TALK ABOUT THE 1318 00:52:43,080 --> 00:52:44,040 MICROENVIRONMENT, IS IT 1319 00:52:44,040 --> 00:52:45,920 DIFFERENT OR THE SAME. 1320 00:52:45,920 --> 00:52:49,960 EMERGENCE OF DRUG RESISTANT 1321 00:52:49,960 --> 00:52:51,560 VARIANTS ON SELECTIVE PRESSURE 1322 00:52:51,560 --> 00:52:51,920 OF THERAPY. 1323 00:52:51,920 --> 00:52:53,520 HOW DO WE DESIGN THE NEXT 1324 00:52:53,520 --> 00:52:55,480 GENERATION OF STUDIES? 1325 00:52:55,480 --> 00:52:58,320 I'M GOING TO END BY SAYING I 1326 00:52:58,320 --> 00:53:02,000 WORK IN NIGERIA, WE NEED TO 1327 00:53:02,000 --> 00:53:03,680 THINK ABOUT IN THE GLOBAL HEALTH 1328 00:53:03,680 --> 00:53:05,040 WHERE WE HAVE ALL THIS DATA, 1329 00:53:05,040 --> 00:53:07,880 THESE WOMEN DON'T HAVE ACCESS TO 1330 00:53:07,880 --> 00:53:11,080 ANY TREATMENT BECAUSE IT'S SO 1331 00:53:11,080 --> 00:53:11,360 EXPENSIVE. 1332 00:53:11,360 --> 00:53:16,200 WHAT IS OUR OBLIGATION TO MAKE 1333 00:53:16,200 --> 00:53:17,560 SURE THEY ARE TREATED. WE HAVE 1334 00:53:17,560 --> 00:53:19,760 A STUDY WE'RE COLLABORATING TO 1335 00:53:19,760 --> 00:53:22,720 TREAT THE WOMEN OPTIMALLY, THE 1336 00:53:22,720 --> 00:53:26,120 FIRST TIME THEY WILL GET TREATED 1337 00:53:26,120 --> 00:53:27,040 FOR BREAST CANCER SO WE KNOW WHO 1338 00:53:27,040 --> 00:53:28,400 WILL RESPOND AND WHO IS NOT 1339 00:53:28,400 --> 00:53:28,720 RESPONDING. 1340 00:53:28,720 --> 00:53:30,120 BECAUSE IF WE'RE ABLE TO 1341 00:53:30,120 --> 00:53:34,080 ACTUALLY LEARN AND YOU KNOW, DO 1342 00:53:34,080 --> 00:53:36,600 THE RIGHT EXPERIMENT, WHEN WE'RE 1343 00:53:36,600 --> 00:53:39,600 ABLE TO SAMPLE WHETHER WE DO 1344 00:53:39,600 --> 00:53:43,760 BULK SEQUENCING, WE DO WHOLE 1345 00:53:43,760 --> 00:53:45,720 GENOME OR LIQUID BIOS, WE CAN 1346 00:53:45,720 --> 00:53:49,240 FIGURE OUT HOW TO OPTIMIZE 1347 00:53:49,240 --> 00:53:49,920 THERAPY. 1348 00:53:49,920 --> 00:53:50,760 I THINK THAT SHOULD BE THE WAVE 1349 00:53:50,760 --> 00:53:51,400 OF THE FUTURE. 1350 00:53:51,400 --> 00:53:54,560 IF IT WE WANT TO GET TO EQUITY, 1351 00:53:54,560 --> 00:53:56,520 I TEACH GLOBAL HEALTH TO MY 1352 00:53:56,520 --> 00:53:56,760 STUDENTS. 1353 00:53:56,760 --> 00:53:59,240 SO WE TALK ABOUT THE WORLD 1354 00:53:59,240 --> 00:54:01,960 HEALTH ORGANIZATION SAYING, YOU 1355 00:54:01,960 --> 00:54:03,400 KNOW, THERE IS A RIGHT TO 1356 00:54:03,400 --> 00:54:03,880 HEALTH. 1357 00:54:03,880 --> 00:54:07,240 AND THIS WAS ALL AGREED UPON IN 1358 00:54:07,240 --> 00:54:08,920 1948. 1359 00:54:08,920 --> 00:54:12,080 AND HEALTH IS A STATE OF 1360 00:54:12,080 --> 00:54:13,760 COMPLETE PHYSICAL, HEALTH AND 1361 00:54:13,760 --> 00:54:19,120 SOCIAL WELL-BEING AND NOT MERELY 1362 00:54:19,120 --> 00:54:20,880 THE ABSENT OF DISEASE. 1363 00:54:20,880 --> 00:54:22,880 HOW ARE WE GOING TO THINK ABOUT 1364 00:54:22,880 --> 00:54:24,400 RIGHT TO HEALTH AND 1365 00:54:24,400 --> 00:54:26,040 RESPONSIBILITY SAID. 1366 00:54:26,040 --> 00:54:28,560 WHENEVER I SAY NIH, WHAT IS YOUR 1367 00:54:28,560 --> 00:54:30,160 RESPONSIBILITY FOR REDUCING 1368 00:54:30,160 --> 00:54:30,400 DISPARITY? 1369 00:54:30,400 --> 00:54:33,440 I ALWAYS SAY, WE ONLY DO 1370 00:54:33,440 --> 00:54:33,720 RESEARCH. 1371 00:54:33,720 --> 00:54:35,040 WE'RE ALL IN THE SAME ECOSYSTEM. 1372 00:54:35,040 --> 00:54:37,200 I THINK WE NEED TO BEGIN TO 1373 00:54:37,200 --> 00:54:39,240 THINK ABOUT WHAT WE NEED TO DO. 1374 00:54:39,240 --> 00:54:41,400 LET ME THANK YOU FOR THIS REALLY 1375 00:54:41,400 --> 00:54:47,040 WONDERFUL HONOR TO GIVE TO 1376 00:54:47,040 --> 00:54:47,560 REMEMBER DR. NIRENBERG. 1377 00:54:47,560 --> 00:54:51,480 IN MY MIND, WE HAVE TO STOP 1378 00:54:51,480 --> 00:54:52,880 STRATIFYING PEOPLE BASED ON 1379 00:54:52,880 --> 00:54:55,280 BLACK AND WHITE AND ALL OF 1380 00:54:55,280 --> 00:54:59,000 WHETHER THEY EXPOSED AND HAVE 1381 00:54:59,000 --> 00:55:00,800 TOXICITY AT HOME OR STRESSED 1382 00:55:00,800 --> 00:55:02,080 OUT, WHETHER THEY HAVE LOW 1383 00:55:02,080 --> 00:55:04,200 RESOURCE, NO INSURANCE, WE 1384 00:55:04,200 --> 00:55:05,720 ACTUALLY BEGIN TO THINK ABOUT 1385 00:55:05,720 --> 00:55:08,120 WHAT IS THIS PERSON, WHAT THAT 1386 00:55:08,120 --> 00:55:09,320 DNA MADE OF? 1387 00:55:09,320 --> 00:55:13,160 WHAT IS THE EPIGENOME MADE OF 1388 00:55:13,160 --> 00:55:14,920 AND THE TUMOR MICROENVIRONMENT 1389 00:55:14,920 --> 00:55:16,200 AND THEN WE CAN BEGIN TO THINK 1390 00:55:16,200 --> 00:55:19,480 ABOUT HOW WE EITHER SCREEN FOR 1391 00:55:19,480 --> 00:55:21,160 EARLY DETECTION OR BEGIN TO 1392 00:55:21,160 --> 00:55:23,600 THINK ABOUT PREVENTION OR CANCER 1393 00:55:23,600 --> 00:55:23,920 INTERCEPTION. 1394 00:55:23,920 --> 00:55:25,680 SO LET ME END BY SAYING THAT 1395 00:55:25,680 --> 00:55:29,600 THERE IS A LOT WE CAN DO NOW. 1396 00:55:29,600 --> 00:55:32,280 AND WE COULD EVEN ONCE WE KNOW 1397 00:55:32,280 --> 00:55:33,520 AND WE CAN STRATIFY, MAYBE ALL 1398 00:55:33,520 --> 00:55:35,680 WE NEED TO DO IS INTEGRATE 1399 00:55:35,680 --> 00:55:36,320 LIFESTYLE CHANGES. 1400 00:55:36,320 --> 00:55:38,400 IF YOU ARE GOING TO, IF YOU HAVE 1401 00:55:38,400 --> 00:55:45,720 A BRCA1 -- BCCA2 MUTATION AND IT 1402 00:55:45,720 --> 00:55:49,000 WILL INCREASE YOUR RISK OF 1403 00:55:49,000 --> 00:55:51,360 PANCREATIC CANCER, MAYBE YOU 1404 00:55:51,360 --> 00:55:55,040 WOULDN'T SPOKE -- SMOKE. 1405 00:55:55,040 --> 00:55:58,040 I'M GRATEFUL TO WORK IN CHICAGO. 1406 00:55:58,040 --> 00:55:59,240 THE WOMEN'S BASKETBALL LEAGUE 1407 00:55:59,240 --> 00:56:01,600 LAST YEAR, THAT BROUGHT A LOT OF 1408 00:56:01,600 --> 00:56:02,480 JOY FOR US. 1409 00:56:02,480 --> 00:56:04,040 WE GO OUT AND HANG OUT IN THE 1410 00:56:04,040 --> 00:56:05,440 CITY THAT NEVER SLEEPS. 1411 00:56:05,440 --> 00:56:06,920 THIS IS MY TEAM. 1412 00:56:06,920 --> 00:56:10,640 WE HAVE A REALLY DIVERSE TEAM IN 1413 00:56:10,640 --> 00:56:11,080 OUR BREAST PROGRAM. 1414 00:56:11,080 --> 00:56:12,360 I HAVE TO GIVE A SHOUT-OUT TO 1415 00:56:12,360 --> 00:56:15,480 THE NCI CENTER TO REDUCE CANCER 1416 00:56:15,480 --> 00:56:18,720 HEALTH DISPARITIES FOR GETTING A 1417 00:56:18,720 --> 00:56:20,600 P20 OUT THAT ALLOWED US TO DO 1418 00:56:20,600 --> 00:56:21,640 THIS WORK. 1419 00:56:21,640 --> 00:56:23,840 AND OF COURSE, THESE ARE MY 1420 00:56:23,840 --> 00:56:27,480 COLLEAGUES IN NIGERIA. 1421 00:56:27,480 --> 00:56:29,240 THEY ARE REALLY LOOKING TO 1422 00:56:29,240 --> 00:56:33,600 BE PART OF A GLOBAL COMMUNITY. 1423 00:56:33,600 --> 00:56:35,640 WHEN WE LAUNCHED FIRST CLINICAL 1424 00:56:35,640 --> 00:56:37,560 TRIAL, THIS WAS ALL OF THEM. 1425 00:56:37,560 --> 00:56:39,400 YOUNG, OLD, SAYING WE CAN DO 1426 00:56:39,400 --> 00:56:41,480 THIS AND WE MUST DO THIS. 1427 00:56:41,480 --> 00:56:45,520 SO I REALLY WANTED TO THANK THE 1428 00:56:45,520 --> 00:56:46,880 INVESTIGATORS FOR MOVING US 1429 00:56:46,880 --> 00:56:49,480 FORWARD WITH OUR CLINICAL 1430 00:56:49,480 --> 00:56:49,720 TRIALS. 1431 00:56:49,720 --> 00:56:51,760 THANK YOU. 1432 00:56:51,760 --> 00:56:56,400 [ APPLAUSE ] 1433 00:56:56,400 --> 00:56:57,840 >>HANK YOU FOR A WONDERFUL 1434 00:56:57,840 --> 00:56:58,760 TALK. 1435 00:56:58,760 --> 00:57:01,280 I THINK SO MANY LESSONS LEARNED 1436 00:57:01,280 --> 00:57:02,600 CAN BE APPLIED TO OTHER CANCERS 1437 00:57:02,600 --> 00:57:03,960 WE'RE NOT DOING WELL LIKE ORAL 1438 00:57:03,960 --> 00:57:04,080 CANCER. 1439 00:57:04,080 --> 00:57:09,000 I WANTED TO ASK AS YOU MOVE FROM 1440 00:57:09,000 --> 00:57:09,560 STRATIFICATION, DO YOU THINK 1441 00:57:09,560 --> 00:57:11,640 THAT THOSE OTHER THINGS THAT WE 1442 00:57:11,640 --> 00:57:14,440 ARE TYPICALLY LOOKING AT CAN 1443 00:57:14,440 --> 00:57:16,320 ACTUALLY EMBODIED WHEN YOU LOOK 1444 00:57:16,320 --> 00:57:18,560 AT THE EPIGENOME. 1445 00:57:18,560 --> 00:57:20,480 FOR INSTANCE, RESPONSES TO THE 1446 00:57:20,480 --> 00:57:22,080 STRESSFUL OTHER ENVIRONMENTAL 1447 00:57:22,080 --> 00:57:24,920 FACTORS THAT RESULTED IN THE 1448 00:57:24,920 --> 00:57:26,680 SHIFT, WHICH YOU SEE IN A 1449 00:57:26,680 --> 00:57:28,320 PERSON'S DNA IS ENOUGH? 1450 00:57:28,320 --> 00:57:28,880 RIGHT? 1451 00:57:28,880 --> 00:57:31,680 MAYBE WE DON'T NEED TO 1452 00:57:31,680 --> 00:57:34,880 BE LOOKING SO MUCH AT WHERE A 1453 00:57:34,880 --> 00:57:36,440 PERSON LIVES AND ALL OF THAT 1454 00:57:36,440 --> 00:57:38,480 STUFF, NOT SAYING IT'S NOT 1455 00:57:38,480 --> 00:57:39,160 IMPORTANT. 1456 00:57:39,160 --> 00:57:41,280 BUT MAYBE IT'S ALREADY RECORDED 1457 00:57:41,280 --> 00:57:43,680 WITHIN THE CONTEXT OF THE 1458 00:57:43,680 --> 00:57:45,160 PERSON'S NUCLEIC ACID. 1459 00:57:45,160 --> 00:57:46,840 >> 1460 00:57:46,840 --> 00:57:47,320 Dr. Olopade: YEAH. 1461 00:57:47,320 --> 00:57:51,560 I THINK THE 1462 00:57:51,560 --> 00:57:52,680 ANTHROPOLOGIST WILL SAY 1463 00:57:52,680 --> 00:57:54,160 YOU ARE MORE THAN YOUR 1464 00:57:54,160 --> 00:57:54,560 DNA, RIGHT? 1465 00:57:54,560 --> 00:57:58,640 >> I'M A BIOLOGIST AND A 1466 00:57:58,640 --> 00:58:00,200 GENETICISTS, EVERYTHING 1467 00:58:00,200 --> 00:58:00,720 WALKS DOWNSTREAM THROUGH 1468 00:58:00,720 --> 00:58:01,520 THE GENES. 1469 00:58:01,520 --> 00:58:02,400 I CAN MEASURE THAT, 1470 00:58:02,400 --> 00:58:03,760 RIGHT? 1471 00:58:03,760 --> 00:58:05,920 AND THEN THE SOCIETAL 1472 00:58:05,920 --> 00:58:09,440 FACTORS, WE KNOW THAT. 1473 00:58:09,440 --> 00:58:11,280 NIH HAS BEEN TALKING 1474 00:58:11,280 --> 00:58:11,600 ABOUT RACISM. 1475 00:58:11,600 --> 00:58:13,800 EVERYBODY SAYING LET'S 1476 00:58:13,800 --> 00:58:14,280 MEASURE MEASURE THAT. 1477 00:58:14,280 --> 00:58:16,680 I MEASURED THAT FOR 30 1478 00:58:16,680 --> 00:58:17,200 YEARS, PRACTICING ON THE 1479 00:58:17,200 --> 00:58:19,920 SOUTH SIDE OF CHICAGO. 1480 00:58:19,920 --> 00:58:21,120 I WANT TO GIVE THEM THE 1481 00:58:21,120 --> 00:58:22,480 RIGHT DRUGS AT THE RIGHT 1482 00:58:22,480 --> 00:58:22,720 TIME. 1483 00:58:22,720 --> 00:58:24,320 I THINK WE HAVE THE 1484 00:58:24,320 --> 00:58:24,840 TOOLS TO DO THAT BY 1485 00:58:24,840 --> 00:58:26,080 FOCUSING ON THE PATIENT 1486 00:58:26,080 --> 00:58:26,960 AND GETTING THE CARE TO 1487 00:58:26,960 --> 00:58:27,520 THEM. 1488 00:58:27,520 --> 00:58:29,160 AND I THINK COVID HAS 1489 00:58:29,160 --> 00:58:30,920 SHOWED US NOW, RIGHT, 1490 00:58:30,920 --> 00:58:33,600 THAT IF WE VACCINATE WE 1491 00:58:33,600 --> 00:58:35,720 CAN BE IN THIS TOGETHER 1492 00:58:35,720 --> 00:58:41,680 IN SOLID AREA ATE. 1493 00:58:41,680 --> 00:58:44,360 IF WE'RE SEGREGATED 1494 00:58:44,360 --> 00:58:45,520 WE'LL SPEND MONEY 1495 00:58:45,520 --> 00:58:48,400 TREATING ADVANCED 1496 00:58:48,400 --> 00:58:49,000 CANCER. 1497 00:58:49,000 --> 00:58:50,920 AND THEN GET BETTER WITH 1498 00:58:50,920 --> 00:58:52,920 THAT TREATMENT. 1499 00:58:52,920 --> 00:58:57,600 >> I DO HAVE A QUESTION. 1500 00:58:57,600 --> 00:58:59,480 THANK YOU FOR THIS 1501 00:58:59,480 --> 00:58:59,880 ENLIGHTING LECTURE. 1502 00:58:59,880 --> 00:59:04,200 ARE THE RESULTS OF YOUR 1503 00:59:04,200 --> 00:59:05,320 EXTRAORDINARY WORK WELL 1504 00:59:05,320 --> 00:59:06,200 KNOWN IN THE MEDICAL 1505 00:59:06,200 --> 00:59:06,760 COMMUNITY? 1506 00:59:06,760 --> 00:59:11,400 WHERE IS THE BEST PLACE 1507 00:59:11,400 --> 00:59:12,400 TO HAVE BREAST CANCER IF 1508 00:59:12,400 --> 00:59:12,840 YOU HAVE AN AFRICAN 1509 00:59:12,840 --> 00:59:14,880 AMERICAN WOMEN AND WHERE 1510 00:59:14,880 --> 00:59:15,920 IS THE WORST PLACE? 1511 00:59:15,920 --> 00:59:17,440 Dr. Olopade: I'M A SCHOLAR, AND 1512 00:59:17,440 --> 00:59:20,240 IT'S NICE THAT NOW WE CAN 1513 00:59:20,240 --> 00:59:23,560 ACTUALLY GET GEOGRAPHIC, WE CAN 1514 00:59:23,560 --> 00:59:25,960 MEASURE WHO IS GETTING BREAST 1515 00:59:25,960 --> 00:59:27,680 CANCER BY ZIP CODE, RIGHT? 1516 00:59:27,680 --> 00:59:28,360 SO ONE OF THE WORST 1517 00:59:28,360 --> 00:59:31,000 PLACES IS THE ZIP CODE 1518 00:59:31,000 --> 00:59:32,480 WHERE I LIVE ON THE 1519 00:59:32,480 --> 00:59:33,520 SOUTH SIDE OF CHICAGO. 1520 00:59:33,520 --> 00:59:36,080 YOU CAN SEE IN THE SOUTH 1521 00:59:36,080 --> 00:59:38,760 AND WHERE RURAL AMERICA. 1522 00:59:38,760 --> 00:59:41,120 SO BY ACTUALLY REPORTING 1523 00:59:41,120 --> 00:59:43,080 ON WHERE PEOPLE ARE, 1524 00:59:43,080 --> 00:59:44,080 WE'RE SEEING THE 1525 00:59:44,080 --> 00:59:44,720 PATTERNS AND WE'RE 1526 00:59:44,720 --> 00:59:46,000 SEEING THE PATTERN OF 1527 00:59:46,000 --> 00:59:46,960 THE SEGREGATION. 1528 00:59:46,960 --> 00:59:51,440 SO WHEN WE AND STUDENTS 1529 00:59:51,440 --> 00:59:51,840 ASKED FAMILY CARE 1530 00:59:51,840 --> 00:59:53,120 PHYSICIANS ON THE SOUTH 1531 00:59:53,120 --> 00:59:54,280 SIDE IF A WOMEN SHOWED 1532 00:59:54,280 --> 00:59:56,200 UP WITH A LUMP ON THE 1533 00:59:56,200 --> 00:59:58,360 SOUTH SIDE OF CHICAGO, 1534 00:59:58,360 --> 00:59:59,360 WHERE WOULD YOU SHOW 1535 00:59:59,360 --> 01:00:01,720 THEM TO GET A MAMMOGRAM? 1536 01:00:01,720 --> 01:00:03,880 THEY DON'T KNOW BECAUSE 1537 01:00:03,880 --> 01:00:06,800 THEY ARE NOT DOCTORS 1538 01:00:06,800 --> 01:00:07,160 THAT DO QUALITY 1539 01:00:07,160 --> 01:00:07,880 MAMMOGRAPH IN THE 1540 01:00:07,880 --> 01:00:08,840 NEIGHBORHOOD. 1541 01:00:08,840 --> 01:00:10,120 TAKE THREE BOSSES AND GO 1542 01:00:10,120 --> 01:00:11,240 TO COUNTY HOSPITAL. 1543 01:00:11,240 --> 01:00:13,960 HOW WILL THEY DO THAT ON 1544 01:00:13,960 --> 01:00:16,320 A COLD, YOU KNOW, WINTER 1545 01:00:16,320 --> 01:00:16,680 DAY IN CHICAGO. 1546 01:00:16,680 --> 01:00:18,960 SO I THINK, YOU KNOW, I 1547 01:00:18,960 --> 01:00:20,120 WAS AT LUNCH I WAS 1548 01:00:20,120 --> 01:00:21,560 SAYING WE MADE SOME 1549 01:00:21,560 --> 01:00:22,160 PROGRESS. 1550 01:00:22,160 --> 01:00:23,640 WHEN I GOT TO CHICAGO, 1551 01:00:23,640 --> 01:00:25,520 THE ONLY HOSPITAL WAS 1552 01:00:25,520 --> 01:00:27,400 COOK COUNTY HOSPITAL. 1553 01:00:27,400 --> 01:00:28,240 AND WOMEN WOULD WAIT AND 1554 01:00:28,240 --> 01:00:29,720 WAIT AND WAIT. 1555 01:00:29,720 --> 01:00:31,360 IT'S ALMOST LIKE IN 1556 01:00:31,360 --> 01:00:32,200 GLOBAL HEALTH SECS, THIS 1557 01:00:32,200 --> 01:00:33,640 IS IN AMERICA. 1558 01:00:33,640 --> 01:00:35,480 I THINK THERE IS A LOT 1559 01:00:35,480 --> 01:00:38,880 WE CAN DO TO PROMOTE 1560 01:00:38,880 --> 01:00:40,080 EQUITY AND EQUITABLE 1561 01:00:40,080 --> 01:00:40,440 DISTRIBUTION OF 1562 01:00:40,440 --> 01:00:43,280 RESOURCES TO SAVE LIVES. 1563 01:00:43,280 --> 01:00:45,000 >> THAT WAS A LOVELY 1564 01:00:45,000 --> 01:00:45,640 TALK. 1565 01:00:45,640 --> 01:00:46,920 THE QUESTION I HAD I 1566 01:00:46,920 --> 01:00:48,520 GUESS IS ARE YOU GETTING 1567 01:00:48,520 --> 01:00:51,400 CLUES FROM THE POLYGENIC 1568 01:00:51,400 --> 01:00:52,720 TRADES AND GENETIC 1569 01:00:52,720 --> 01:00:53,760 TRADES HOW TO MOVE 1570 01:00:53,760 --> 01:00:55,360 TOWARDS NOT JUST 1571 01:00:55,360 --> 01:01:00,800 SCREENING AND SURGIC 1572 01:01:00,800 --> 01:01:04,600 SURGICAL -- PROPHYLACTIC 1573 01:01:04,600 --> 01:01:05,480 SURGERIES, MORE COMMON 1574 01:01:05,480 --> 01:01:06,800 IN THE AFRICAN AMERICAN. 1575 01:01:06,800 --> 01:01:10,680 >> I SENT A NARROW ONE 1576 01:01:10,680 --> 01:01:11,840 IN FEBRUARY. 1577 01:01:11,840 --> 01:01:13,480 IF IT'S FUNDED THAT'S 1578 01:01:13,480 --> 01:01:14,800 THE STUDY WE WANT TO DO 1579 01:01:14,800 --> 01:01:17,560 IS BEGIN TO APPLY THIS. 1580 01:01:17,560 --> 01:01:19,520 WE KNOW IT'S NOT 1581 01:01:19,520 --> 01:01:19,720 PERFECT. 1582 01:01:19,720 --> 01:01:20,640 IT'S NOT READY FOR PRIME 1583 01:01:20,640 --> 01:01:20,840 TIME. 1584 01:01:20,840 --> 01:01:23,040 BUT IF WE CAN GET A 1585 01:01:23,040 --> 01:01:23,640 COHORT OF WOMEN THAT 1586 01:01:23,640 --> 01:01:25,800 WILL REALLY WANT TO HAVE 1587 01:01:25,800 --> 01:01:28,040 THE TEST DONE AND THEN 1588 01:01:28,040 --> 01:01:30,320 FOLLOW THEM OVER TIME WE 1589 01:01:30,320 --> 01:01:31,920 WILL LEARN A LOT FROM 1590 01:01:31,920 --> 01:01:32,120 THEM. 1591 01:01:32,120 --> 01:01:35,040 WE HAVE TO MAKE SURE THE 1592 01:01:35,040 --> 01:01:35,960 STUDIES ARE 1593 01:01:35,960 --> 01:01:36,360 PATIENT-CENTERED. 1594 01:01:36,360 --> 01:01:41,680 WE WERE TALKING ABOUT 1595 01:01:41,680 --> 01:01:43,720 MULTIDETECTION, LIQUID 1596 01:01:43,720 --> 01:01:46,360 BIOFEED AND ANALYZE THE 1597 01:01:46,360 --> 01:01:47,800 EARLY DETECTION RESOURCE 1598 01:01:47,800 --> 01:01:49,360 NETWORK IS TRYING TO 1599 01:01:49,360 --> 01:01:50,320 BRING INTO POPULATION 1600 01:01:50,320 --> 01:01:50,600 SCREENING. 1601 01:01:50,600 --> 01:01:51,680 THERE IS A LOT OF 1602 01:01:51,680 --> 01:01:52,000 OPPORTUNITIES. 1603 01:01:52,000 --> 01:01:54,360 BUT WE HAVE TO MAKE SURE 1604 01:01:54,360 --> 01:01:57,440 IT'S INCLUSIVE AND WE GO 1605 01:01:57,440 --> 01:01:59,960 OUT INSTEAD OF HAVING 1606 01:01:59,960 --> 01:02:08,760 EVERYBODY COME INTO US. 1607 01:02:08,760 --> 01:02:12,160 >> THE VIDEO -- 1608 01:02:12,160 --> 01:02:14,160 >> I THANK YOU FROM MY 1609 01:02:14,160 --> 01:02:17,080 HEART FOR MODELING FOR 1610 01:02:17,080 --> 01:02:17,840 US HOW DISCOVERY SCIENCE 1611 01:02:17,840 --> 01:02:19,080 CAN BE EXTENDED FOR THE 1612 01:02:19,080 --> 01:02:20,760 BENEFIT OF HUMANITY. 1613 01:02:20,760 --> 01:02:22,080 AND HOW IMPORTANT THE 1614 01:02:22,080 --> 01:02:22,880 GLOBAL COMMUNITY IS FOR 1615 01:02:22,880 --> 01:02:25,520 US TO LEARN FROM. 1616 01:02:25,520 --> 01:02:27,040 AND I COULDN'T THINK OF 1617 01:02:27,040 --> 01:02:28,480 A BETTER EXAMPLE. 1618 01:02:28,480 --> 01:02:31,200 MY QUESTION IS A LITTLE 1619 01:02:31,200 --> 01:02:33,160 BIT CURING MY OWN FUZZY 1620 01:02:33,160 --> 01:02:34,120 STATE. 1621 01:02:34,120 --> 01:02:35,160 THE GENETIC 1622 01:02:35,160 --> 01:02:36,320 HETEROGENEITY YOU 1623 01:02:36,320 --> 01:02:37,960 DESCRIBED FOR BREAST 1624 01:02:37,960 --> 01:02:39,560 CANCER RELATE TO THE 1625 01:02:39,560 --> 01:02:40,760 PHENOTYPIC PRESENTATION 1626 01:02:40,760 --> 01:02:41,800 OF [INDISCERNIBLE] 1627 01:02:41,800 --> 01:02:42,320 VERSUS ASTHMA. 1628 01:02:42,320 --> 01:02:44,960 I WASN'T SURE AS TO HOW. 1629 01:02:44,960 --> 01:02:47,200 I KNOW THERE ARE 1630 01:02:47,200 --> 01:02:47,720 DIFFERENT PROGNOSIS FOR 1631 01:02:47,720 --> 01:02:50,200 EACH SITE, RIGHT? 1632 01:02:50,200 --> 01:02:51,320 SITE SPECIFIC. 1633 01:02:51,320 --> 01:02:52,080 Dr. Olopade: YEAH, THAT'S A 1634 01:02:52,080 --> 01:02:53,520 GREAT QUESTION. 1635 01:02:53,520 --> 01:02:57,720 SO WE'VE LOOKED AT 1636 01:02:57,720 --> 01:02:58,720 GLOBULAR BREAST CANCER 1637 01:02:58,720 --> 01:02:59,520 FOR EXAMPLE IS MORE 1638 01:02:59,520 --> 01:03:02,720 LIKELY TO HAVE CGH1 1639 01:03:02,720 --> 01:03:03,520 MUTATION, THAT'S MUCH 1640 01:03:03,520 --> 01:03:05,040 MORE COMMON IN OLDER 1641 01:03:05,040 --> 01:03:06,200 WHITE WOMEN. 1642 01:03:06,200 --> 01:03:07,800 AND FOR OUR COHORT WE 1643 01:03:07,800 --> 01:03:08,920 WERE LOOKING AT, WE 1644 01:03:08,920 --> 01:03:12,400 DIDN'T SEE A LOT OF 1645 01:03:12,400 --> 01:03:13,400 LOBLER BREAST CANCER. 1646 01:03:13,400 --> 01:03:14,560 WE ALWAYS, YOU KNOW IN 1647 01:03:14,560 --> 01:03:17,040 THE PAST WE WENT FROM 1648 01:03:17,040 --> 01:03:18,840 PATHOLOGY TO THEN 1649 01:03:18,840 --> 01:03:19,280 CLINICAL ASSOCIATION. 1650 01:03:19,280 --> 01:03:23,000 BUT NOW WE'RE GOING FROM 1651 01:03:23,000 --> 01:03:25,160 GENOTYPES TO SAY WHAT DO 1652 01:03:25,160 --> 01:03:27,240 I NEED, IT DOESN'T 1653 01:03:27,240 --> 01:03:29,200 MATTER WHETHER YOU HAVE 1654 01:03:29,200 --> 01:03:30,800 LOBLER OR DOCTOR, DO I 1655 01:03:30,800 --> 01:03:31,920 HAVE THE RIGHT DRUG TO 1656 01:03:31,920 --> 01:03:33,120 TREAT YOU. 1657 01:03:33,120 --> 01:03:35,120 EVEN STAGE IF YOU HAVE 1658 01:03:35,120 --> 01:03:37,440 EFFECTIVE THERAPIES, IT 1659 01:03:37,440 --> 01:03:39,080 DOESN'T MATTER WHETHER 1660 01:03:39,080 --> 01:03:40,000 YOU HAVE DIAGNOSED AT 1661 01:03:40,000 --> 01:03:40,960 STAGE TWO OR THREE, AS 1662 01:03:40,960 --> 01:03:42,680 LONG AS YOU HAVE THE 1663 01:03:42,680 --> 01:03:45,600 RIGHT BIOMARKER AND 1664 01:03:45,600 --> 01:03:46,600 THOSE TUMORS MELT AWAY. 1665 01:03:46,600 --> 01:03:50,440 I THINK NOW IN THE 1666 01:03:50,440 --> 01:03:50,960 BREAST CANCER COMMUNITY, 1667 01:03:50,960 --> 01:03:53,240 EVERYONE HAS ACCEPTED 1668 01:03:53,240 --> 01:03:57,520 THAT WE SHOULD BE DOING 1669 01:03:57,520 --> 01:04:00,080 GENOMIC ASSAYS FOR RISK 1670 01:04:00,080 --> 01:04:00,440 STRATIFICATION. 1671 01:04:00,440 --> 01:04:02,000 IF BLACK WOMEN HAVE 1672 01:04:02,000 --> 01:04:04,480 AGGRESSIVE HIGH GRADE 1673 01:04:04,480 --> 01:04:06,520 TUMORS, PLEASE GIVE THEM 1674 01:04:06,520 --> 01:04:07,040 CHEMOTHERAPY BECAUSE WE 1675 01:04:07,040 --> 01:04:08,160 HAVE THE DATA I DIDN'T 1676 01:04:08,160 --> 01:04:09,840 GET TO PRESENT. 1677 01:04:09,840 --> 01:04:11,240 THEY ACTUALLY RESPOND 1678 01:04:11,240 --> 01:04:13,160 BECAUSE A TUMOR ARE 1679 01:04:13,160 --> 01:04:14,960 HIGHLY PROLIFERATIVE AND 1680 01:04:14,960 --> 01:04:17,600 NOT GIVING OPTIMAL 1681 01:04:17,600 --> 01:04:19,880 TREATMENT OR GIVING 1682 01:04:19,880 --> 01:04:23,240 TREATMENT THAT WILL 1683 01:04:23,240 --> 01:04:23,680 CAUSE MORE DAMAGE TO 1684 01:04:23,680 --> 01:04:25,040 THEM THAT MAKING THE 1685 01:04:25,040 --> 01:04:25,920 PATIENT NOT DO WELL. 1686 01:04:25,920 --> 01:04:27,880 WE LOOK AT THE DATA. 1687 01:04:27,880 --> 01:04:29,480 ONCE THEY GET INTO US, 1688 01:04:29,480 --> 01:04:31,160 THEY GET TREATMENT, 1689 01:04:31,160 --> 01:04:33,240 EVERYTHING IS THE SAME. 1690 01:04:33,240 --> 01:04:35,880 THEY DO WELL. 1691 01:04:35,880 --> 01:04:38,320 BUT IT'S FIRST GET THE 1692 01:04:38,320 --> 01:04:39,120 GENOMIC ASSAY AND THEN 1693 01:04:39,120 --> 01:04:41,920 GET THEM INTO THE 1694 01:04:41,920 --> 01:04:43,040 CLINICAL TRIAL. 1695 01:04:43,040 --> 01:04:44,560 THAT'S WHY I THINK THAT 1696 01:04:44,560 --> 01:04:46,840 EARLY ADOPTION OF 1697 01:04:46,840 --> 01:04:48,240 TECHNOLOGY OF COURSE 1698 01:04:48,240 --> 01:04:50,480 GETS A LOT OF PEOPLE TO 1699 01:04:50,480 --> 01:04:51,960 PROVIDE THE CANCER THAT 1700 01:04:51,960 --> 01:04:53,200 THEY MAY NOT HAVE 1701 01:04:53,200 --> 01:04:54,320 SURVIVED. 1702 01:04:54,320 --> 01:04:55,320 UNDERSERVED POPULATIONS 1703 01:04:55,320 --> 01:04:57,400 ARE THE LAST TO GET 1704 01:04:57,400 --> 01:04:59,160 ANYTHING THAT WE BRING 1705 01:04:59,160 --> 01:05:00,240 OUT IN AMERICA. 1706 01:05:00,240 --> 01:05:02,560 AND THEN WE BLAME THEM 1707 01:05:02,560 --> 01:05:04,080 THAT THEY DIDN'T WANT TO 1708 01:05:04,080 --> 01:05:05,640 ACCEPT IT WHEN IT'S 1709 01:05:05,640 --> 01:05:06,280 IMPOSSIBLE. 1710 01:05:06,280 --> 01:05:08,160 THE SYSTEMIC BARRIER TO 1711 01:05:08,160 --> 01:05:09,600 COMING TO GET INTO A 1712 01:05:09,600 --> 01:05:10,800 CLINICAL TRIAL IS 1713 01:05:10,800 --> 01:05:11,240 IMPOSSIBLE. 1714 01:05:11,240 --> 01:05:13,480 SO I'M HOPING THAT WITH 1715 01:05:13,480 --> 01:05:15,720 THIS PANDEMIC THAT WE 1716 01:05:15,720 --> 01:05:16,960 HAVE DISTRIBUTED 1717 01:05:16,960 --> 01:05:18,360 RESPONSIBILITIES AND 1718 01:05:18,360 --> 01:05:19,360 THAT WE CAN MEET 1719 01:05:19,360 --> 01:05:21,840 PATIENTS WHERE THEY ARE. 1720 01:05:21,840 --> 01:05:25,200 AND FIGURE OUT HOW TO DO 1721 01:05:25,200 --> 01:05:28,520 BETTER CLINICAL TRIALS, 1722 01:05:28,520 --> 01:05:29,200 BETTER PRAGMATIC STUDIES 1723 01:05:29,200 --> 01:05:30,920 AND LEARN FROM EVERY 1724 01:05:30,920 --> 01:05:31,400 PATIENT. 1725 01:05:31,400 --> 01:05:32,600 THAT'S I THINK IS WHAT 1726 01:05:32,600 --> 01:05:34,240 PATIENTS ARE LOOKING 1727 01:05:34,240 --> 01:05:36,480 FOR, TO BE TREATED EQU 1728 01:05:36,480 --> 01:05:36,720 EQUALLY. 1729 01:05:36,720 --> 01:05:39,720 >> THANK YOU. 1730 01:05:39,720 --> 01:05:43,120 >> OKAY. [OFF MIC] 1731 01:05:43,120 --> 01:05:43,920 MAYBE YOU AND I CAN HAVE 1732 01:05:43,920 --> 01:05:44,560 A FURTHER DISCUSSION. 1733 01:05:44,560 --> 01:05:45,520 THE TIME IS UP. 1734 01:05:45,520 --> 01:05:48,000 I JUST WANT TO THANK FOR 1735 01:05:48,000 --> 01:05:50,040 AN INCREDIBLE, 1736 01:05:50,040 --> 01:05:50,480 EYE-OPENING LECTURE. 1737 01:05:50,480 --> 01:05:53,880 REALLY APPRECIATE IT. 1738 01:05:53,880 --> 01:05:56,200 AND THE AUDIENCE HERE IS 1739 01:05:56,200 --> 01:05:57,440 NOT LARGE ON PURPOSE BUT 1740 01:05:57,440 --> 01:05:58,800 VERY RESPONSIVE I WOULD 1741 01:05:58,800 --> 01:05:59,000 SAY. 1742 01:05:59,000 --> 01:06:00,000 AND THANK YOU TO 1743 01:06:00,000 --> 01:06:00,360 EVERYONE WHO IS 1744 01:06:00,360 --> 00:00:00,000 LISTENING IN AS WELL.