>>GOOD AFTERNOON,
EVERYBODY.
REALLY NICE TO SEE SOME
OF YOU IN PERSON.
AND I'M SURE MANY, MANY
MORE ON THE WEB.
IT'S REALLY MY DISTINCT
PLEASURE TO INTRODUCE
DR. OLUFUNMILAYO OLOPADE
AS THE MARSHAL NIRENBERG
LECTURER THIS YEAR.
DR. OLOPADE IS THE
WALTER L. MARSHALL
CENTER FOR MEDICINE AND
GENETICS AND GLOBAL
HEALTH AT THE UNIVERSITY
OF CHICAGO.
SHE HAS MANY, MANY
AWARDS, TOO MANY TO LIST
THEM ALL BUT A SAMPLING
IF I MAY.
SHE'S A MEMBER OF BOTH
THE NATIONAL ACADEMY OF
SCIENCE AND THE NATIONAL
ACADEMY OF MEDICINE.
SHE HAS A FELLOW OF THE
AMERICAN ACADEMY OF ARTS
AND SCIENCES AND A
MEMBER OF THE AMERICAN
PHILOSOPHICAL SOCIETY.
AND SHE WAS AWARDED AN
McARTHUR FELLOWSHIP IN
2005.
MANY OF YOU KNOW HER
LABORATORY WAS THE FIRST
TO DESCRIBE RECURRENT
BRACOONE MUTATIONS WITH
BREAST AND OVARIAN
CANCERS.
UNDERSCORING THE NEED
FOR AT RISK WOMEN TO
RECEIVE GENETIC
COUNSELING, TESTING AND
SCREENING AT YOUNGER
AGES.
HER CURRENT WORK
CONTINUES TO FOC FOCUS ON
FAMILIAL CHANCER CANCERS
AND TUMOR PROGRESSION IN
INDIVIDUALS AND GENETIC
I NONGENETIC FACTORS
CONTRIBUTING TO TUMOR
PROGRESSION IN DIVERSE
POPULATIONS.
THE TITLE OF HER TALK
TODAY, HETEROGENEITY OF
BREAST CANCER GENOMES,
GOING BEYOND THERAPY TO
RISK ASSESSMENT AND
PRECISION HEALTHCARE.
PLEASE JOIN ME IN
WELCOMING DR. OLOPADE.
[ APPLAUSE ]
Dr. Olopade: THANK YOU VERY
MUCH FOR THAT KIND INTRODUCTION.
AND I REALLY WANT TO
THANK DR. GOSMAN FOR
EMAILING ME AND
INFORMING ME ABOUT THIS
WONDERFUL, PRESTIGIOUS
LECTURESHIP.
IT'S WONDERFUL TO
BE ABLE TO ACCEPT IT AND
TO BE ABLE TO PRESENT
PERSONALLY.
I WANT TO THANK THE
MEMBERS OF THE WOMEN OF
COLOR COMMITTEE AND
ESPECIALLY DR. DESOUSA
FOR GIVING ME MY FIRST
ZOOM TALK THIS MORNING.
I REALLY ENJOYED MEETING
EVERYONE.
OF COURSE THE HIGHLIGHT
OF MY DAY, THE YOUNG
INTERNS I HAD LUNCH
WITH, IT'S MADE IT
WORTHWHILE TO COME TO
D.C. AFTER MIDNIGHT LAST
NIGHT.
I'M STILL STANDING AND
REALLY HOPING TO
INTERACT WITH YOU.
AND I CAN'T THANK ALL OF
YOU ENOUGH FOR REALLY
ORGANIZING AND MAKING IT
EASY FOR ME TO GET HERE.
SO I THOUGHT WHAT I
WOULD DO IS JUST SHARE
MY THOUGHTS ON WHAT I
CALL DIFFERENCES AND
SIMILARITIES BETWEEN ALL
OF US, BECAUSE WE'RE ALL
FROM WHAT THE ONE HUMAN
RACE.
SO I HAVE SOME
DISCLOSURES.
AND WHAT I WANTED TO DO
IS TO ACTUALLY SHARE MY
STORY BECAUSE I KNOW
THAT A LOT OF PEOPLE
WANT TO ASK ME, HOW DID
YOU GET HERE?
INSTEAD OF SAYING IN AN
UBER, I READY REALLY
WANTED DEDICATE THIS
LECTURE TO THE MEMORY OF
MY BELOVED PARENTS.
DR. NIRENBERG, WHO IS A
GREAT MAN, GREAT
GENETICISTS, BECAUSE OF
THE WORK DR. NIRENBERG
DID WE HAVE THIS
LECTURESHIP IN HIS
HONOR.
AND HE WAS REALLY
WONDERFUL TO MEET HIS
WIFE.
IT WAS -- ON THE ZOOM
CALL THIS MORNING.
VERY KIND AND GENEROUS
WITH HER TIME TO SPEND
SOME TIME WITH ME.
SO I'M NUMBER FIVE OF
SIX CHILDREN.
AND IT'S USUALLY YOU
KNOW GROWING UP IN
AFRICA, IT'S THE FIFTH
PREGNANCY THAT IS
USUALLY MOST TREACHEROUS
FOR MOST WOMEN IN THE
GLOBAL SOUTH.
BUT MY MOTHER SURVIVED.
MY FATHER BEING A PASTOR THOUGHT
EVERYONE WAS EQUAL.
WITHIN MY OWN FAMILY I WAS
NEVER TREATED ANY DIFFERENT THAN
MY SIBLINGS
AND GREW UP IN A WONDERFUL
FAMILY.
WHEN I CAME TO THE UNITED STATES
AND STARTED THINKING ABOUT
WORKING IN BREAST CANCER, ONE OF
THE THINGS THAT WAS CLEAR WAS I
HAD THE IDEA WHEN WOMEN
PRESENTED WITH WHAT WE CALL
LOCALLY ADVANCED BREAST CANCER
BECAUSE THEY WERE IN DENIAL THAT
THEY HAD CANCER.
AND THEY CAME IN TOO LATE.
AND SO, THE CONVENTIONAL WISDOM
WAS AT THAT TIME, IGNORE IT.
HOWEVER, I WANT TO START MY TALK
ON HETEROGENEITY GOING BACK TO
THE SEMINOLE WORK BY MCGUIRE
THAT BUILDS ON THE WORK AT THE
UNIVERSE OF CHICAGO, DISCOVERING
THE ANDROGEN AND ESTROGEN WERE
RECEPTOR.
NO ONE TRAINS IN THE '90S.
YOU DIDN'T TRAIN TO BE A BREAST
CANCER RESEARCHER WITHOUT
ACTUALLY GOING TO TAKE A COST
FROM DR. HOG US WHO AT 92 WAS
TEACHING GENESIS EVEN WHEN HE
COULD NO LONGER HEAR.
WHAT WAS REALLY FUNDAMENTAL AND
WHAT IS STILL THE CASE WAS THAT
THIS PAPER ONLY HAD 145 WOMEN
WHO HAD MASTECTOMY AFTER
DIAGNOSED WITH BREAST CANCER.
IT SHOWED A SEPARATION WITH
WOMEN WITH GOOD PROGNOSIS AND
WOMEN WHO NEEDED CHEMOTHERAPY.
WE DESCRIBE BREAST CANCER IN
TERMS OF WHETHER YOU NEED
CHEMOTHERAPY OR GO WITH HORMONAL
THERAPY.
SINCE I STARTED MY CAREER IN
CHICAGO, ETHNICALLY DIVERSE
COMMUNITY, IT DOES MATTER.
WHENEVER SOMEBODY SAYS, YOU KN
KNOW, AGGRESSIVE BREAST CANCER,
BLACK WOMEN DIE AT A HIGHER RATE
THAN ANYBODY ELSE.
I BEGAN TO THINK WHAT DISEASE --
DOES IT MEAN TO HAVE AGGRESSIVE
BREAST CANCER.
AS A HEMATOLOGIST, ONCOLOGIST, I
DID A LOT OF WORK WITH JENNA
ROWLEY LOOKING AT LEUKEMIA WE
TREATED WITH CHEMOTHERAPY AND
GOT WOMEN TO BE CURED OF
LEUKEMIA.
WHENEVER I REALLY THINK ABOUT
AGGRESSIVE CANCER THAT'S HIGHLY
PROLIFERATIVE, I JOINED BREAST
CANCER THINKING MAYBE BREAST
CANCER IS LIKE LEUKEMIA AND
LYMPHOMA AND WE NEED BETTER
BIOMARKERS.
TO CUT A LONG STORY SHORT THAT'S
HOW I STARTED THINKING ABOUT
BREAST CANCER, AS IF IT WAS LIMB
PHONA -- WHO WOULD FIGURE OUT
WHAT TO DO, IT'S CLEAR MAYBE WE
SHOULD THINK A LITTLE BIT MORE
BROADLY ABOUT THE IMPORTANCE OF
SYSTEMIC THERAPY IN CURING MORE
PATIENTS WITH CANCER.
HAVING SAID THAT, MY FIRST JOB
AT THE UNIVERSITY OF CHICAGO WAS
TO DEVELOP A CANCER RISK
PLANNING.
MY MENTOR THOUGHT I COULDN'T
COMPETE WITH MY PROGRAM DIREC
DIRECTOR, DR. GULLM, DIDN'T WANT
ME TO COMPETE WITH DR. ROWLEY.
FOR THE YOUNG ONES IN THE
AUDIENCE, YOU HAVE TO DO
SOMETHING ELSE THAN YOUR MENTOR
OTHERWISE YOU ARE NOT GOING TO
SURVIVE.
MINE WAS TO START A CANCER RISK
CLINIC BECAUSE WE WERE NOW
BEGINNING TO UNDERSTAND GENES
HAD BEEN MARKED TO CHROME SEWN.
I MAPPED THE MELANOMA GENE TO
I.P. AND KING MAPPED THE RC1
GENE TO 17Q AND THE RACE WAS ON
TO FIND SUPPRESSER GENES THAT
CAUSE CANCER.
PHYSICIAN/SCIENTISTS MY JOB WAS
TO ACTUALLY FIND FAMILIES IN THE
CLINIC.
AND SO WHEN I THINK ABOUT
TRANSLATION RESEARCH, I THINK
ABOUT ASKING QUESTIONS FROM THE
CLINIC, RIGHT?
THE PART OF MY PATIENTS COMING
INTO THE CLINIC AND GOING BACK
TO THE LAB TO SAY WHAT IS IT I
CAN DO ABOUT THIS PROBLEM THAT I
FOUND IN THE CLINIC.
SO IN 1992, I WAS LIKE --
FAMILIES WERE COMING AND THEY
WANTED TO KNOW WHY DID THE
GRANDMOTHER DIE OF BREAST
CANCER, WHY DID MOTHER DIED OF
CANCER.
WE KNOW HOW TO PREEMPT AND
HOPEFULLY PREVENT CANCER IN HIGH
RISK POPULATION.
THE CANCER IS HUGE BOTH IN THE
COUNTRY AND GLOBALLY.
WE DON'T KNOW HOW TO DO BETTER.
SO FOR THOSE OF YOU WHO
GENETICISTS, THIS WAS MY
EXTENDED BLACK FAMILY IN 1992,
BEFORE THE RC1 WAS IDENTIFIED.
34-YEAR-OLD BLACK WOMEN WITH
TRIPLE NEGATIVE BREAST CANCER,
WE WERE DOING LUMPECTOMY AND
RADIATION AND CHAIRMAN --
CHEMOTHERAPY.
MY FIRST CONSULTATION SHE
BROUGHT A PEDIGREE, FIVE
GENERATIONS OF WOMEN AND MEN IN
THIS FAMILY WHO HAD HAD CANCER.
CAME FROM THE SOUTH.
IF YOU KNOW, THE ORIGINS OF A
LOT OF AFRICAN AMERICANS DURING
SLAVE TRADE, JIM CROW, REALLY
HELD ONTO THEIR FAMILY HISTORY.
THEY ALREADY HAD THE PEDIGREE
DRAWN AND WANTED TO PARTICIPATE
IN RESEARCH.
AND I'VE KEPT ENGAGING THEM WITH
FAMILY UNION.
AND WE GOT LINKED THE FAMILY TO
CHROMOSOME 17.
WE IDENTIFIED THE BRCA1 MUTATION
AND MULTIPLE FAMILY MEMBER SAID.
HAVING SURVIVED BREAST CANCER,
WE NEEDED TO HELP THEM NOT DIE
FROM OVARIAN CANCER.
BECAUSE IT DAMAGED HER HEART,
SHE COULD ACTUALLY NOT GET THE
RISKING REDUCE OOPHORECTOMY SHE
NEEDED.
ONCE YOU HAVE TOXICITY FROM YOUR
TREATMENT AND DON'T HAVE A JOB,
NO INSURANCE, THE ONLY PLACE YOU
CAN GET CARE IN CHICAGO WAS COOK
COUNTY HOSPITAL IN CHICAGO.
WHICH IS WHERE I STARTED.
I LINKED HER UP WITH MY
COLLEAGUES THERE.
SHE REALLY WAS THE PERFECT FACE
OF EVERY YOUNG BLACK WOMEN DYING
PREMATURELY IN CHICAGO, BECAUSE
OF THE WAY THE CITY IS ORGANIZED
AND SHE PARTICIPATED IN RESEARCH
AND REALLY GAVE ME CONFIDENCE
THAT IN FACT IF WE PERSONALIZE
CARE MAYBE WE'LL DO BETTER.
THE FIRST STORY I HAD IN TERMS
OF TALKING ABOUT PERSONALIZED
MEDICINE WHEN MY THEN NEIGHBOR,
PRESIDENT OBAMA, REALLY WANT WAD
MME TO ADVISE HIS STAFF ABOUT
PERSONALIZED MEDICINE.
THE IDEA CAN WE STOP TALKING
ABOUT BLACK AND WHITE AND THINK
ABOUT WHAT PRECISION MEDICINE
WOULD LOOK LIKE IF EVERYONE WAS
TREATED LIKE A HUMAN BEING.
WE BECAME FRIENDS AND SHE GOT
THE MEDAL OF SCIENCE.
BUT I STARTED THINKING ABOUT
GETTING TO THE ROOT OF BREAST
CANCER THROUGH HETEROGENEITY BY
STUDYING BLACK WOMEN CRISIS THE
AFRICAN DIASPORA.
BLACK IS DEFINED ON A SOCIAL
CONSTRUCT.
BY THE TIME I STARTED THINKING
ABOUT GENETICS, IT WAS HARD TO
HAVE CONVERSATIONS WITH
COMMUNITIES BECAUSE EVERYONE WAS
VERY SURE IT'S BECAUSE OF THE
SOCIAL, OVER 10 MILLION AFRICANS
IN TRANSATLANTIC TRADE SLAVE.
THE FACT THE MAJORITY OF WOMEN
IN THE U.S., CARIBBEAN, AND HERE
IS THIS LITTLE AREA IN BRAZIL
WHERE THE AFRICAN DESCENT AND
SLAVES ACTUALLY PRESERVED THEIR
CULTURE AND ACROSS CUBA AND
ACROSS THE CARIBBEAN YOU WILL
HEAR THEM TALK ABOUT
APHROCARIBBEAN.
I KNOW THEY WERE LONG-LOST
RELATIVES BECAUSE OF THE STRONG
CULTURE.
ACROSS LATIN AMERICA, YOU WILL
SEE GENETICISTS TALK ABOUT
DIFFERENT LEVELS OF GENETIC
MIXTURE.
SO EVEN THOUGH YOU MAY HAVE, YOU
KNOW, 50% AFRICAN ANCESTRY, YOU
MAY HAVE BLOND, YOU MAY HAVE
BLOND EYE, I MEAN, BLOND HAIR,
BLUE EYES AND DARK SKIN BECAUSE
DEPENDING ON HOW MUCH AFRICAN
MIXTURE YOU HAVE.
AND SO IN BRAZIL, THEY DON'T
WANT TO TALK ABOUT WHETHER YOU
ARE BLACK OR NOT.
HOWEVER, THERE ARE SOME PARTS
WHERE THERE IS LITTLE MIXTURE
BECAUSE OF THE AFRICAN DESCENT
DIDN'T MAKE IT AND THIS PAPER
THAT WAS PUBLISHED BY 23ANDME
MADE ON PEOPLE WHO ACTUALLY WENT
TO GET TESTED.
YOU KNOW, TO AND THEY WANTED TO
KNOW THE ANCESTRY.
YOU KNOW ANCESTRY.COM, SO MANY
PEOPLE ARE TRYING TO CONNECT
WITH THEIR ROOTS.
WAS REALLY PROBLEMATIC FOR ME
BECAUSE IT SHOWED THE SUFFERING
THAT BLACK PEOPLE HAD COMING TO
THE NEW, TO AMERICA.
AND SO EVERY TIME YOU HEAR BLACK
WOMEN HAVE THE HIGHEST DEATH
RATE FROM BREAST CANCER, YOU
KNOW, UNDERSTUDIED AND
UNDERSERVED, IT REALLY MAKES ME
WONDER WHETHER IN FACT THIS
SEGREGATION AND THE RACISM AND
OF COURSE ACROSS THE GLOBAL
SOUTH, THE COLONIALISM THAT'S
PREVENTING US FROM DOING WHAT WE
NEED TO DO.
THAT'S WHY I STARTED ASKING THE
QUESTION, BECAUSE CHUCK PERU
FROM NORTH CAROLINA, YOU CAN SEE
IN THE DEEP SOUTH MAJORITY OF
THE WOMEN, I WILL CALL THEM,
THEY HAVE ABOUT THE SAME GENETIC
ARCHITECTURE AS WOMEN IN AFRICA
VERY LITTLE -- I CALL THEM
INDIGENOUS AFRICANS LIVING IN
NORTH CAROLINA AND IN THE DEEP
SOUTH.
IF THAT'S THE CASE, HOW DO WE
THEN DO, YOU KNOW, COMPARATIVE
ANALYSIS?
WE STARTED THINKING ABOUT
ESTABLISHING THE NIGERIAN BREAST
CANCER STUDY.
AND THEN WE PUBLISHED NOW
LOOKING AT THE CANCER GENOME ADD
CLASS AND THE MORE WE'RE ABLE TO
ACTUALLY LOOK AT MUTATIONS,
MUTATION NOW IN MY LAB, WE'RE
DOING WHOLE GENOME SEQUENCING,
TRYING TO UNDERSTAND
INTERACTIOACTIONS BETWEEN GERM E
AND SEMATIC MUTATIONS.
ALLOWING US TO THINK ABOUT
ANCESTRY POPULATIONS AND GENOMIC
AND EVOLUTIONARY TRAJECTORY OF
BREAST CANCER.
THE REASON IT'S IMPORTANT IS
BECAUSE, YOU KNOW, WE ALL CAME
OUT OF AFRICA.
AND YOU KNOW, IF YOU USE
MITOCHONDRIA DNA YOU CAN TRACK
YOUR LINEAGE, I DIDN'T NEED
MITOCHONDRIA OR DNA GROWING UP
IN AFRICA.
I SAW THE HISTORY AND WHAT I WAS
TOLD IS LIFE BEGAN AND NOW
SCIENCE ACCEPTED OR PROVEN THAT
IN FACT WE ALL CAME OUT OF
AFRICA.
AS WE'VE COME OUT WE'VE HAD THE
DIVERGENCE.
WHEN I KNOW HERE'S THE BASIC
GENETIC ARCHITECTURE ACROSS
AFRICA, HOW ABOUT THE
REPRODUCTIVE PATTERNS?
MY MOTHER HAD SIX CHILDREN.
IN ONE GENERATION, WE'RE HAVING
FEWER AND FEWER CHILDREN.
SO WHAT'S THE DIFFERENCE IN
TERMS OF THE REPRODUCTIVE
PATTERNS OF THE AVERAGE AFRICAN
WOMEN.
CAN I COMPARE THAT TO THE
AVERAGE AFRICAN AMERICANS OR
WHITE WOMEN IN THE LITERATURE.
WE FOUND AFRICAN WOMEN HAVE LOTS
OF CHILDREN.
AND THEY HAVE LATER AGE, AND
HIGH LEVELS OF BREASTFEEDING.
THE HIGH LEVELS OF
BREASTFEEDING, ALL OF THOSE
THINGS ARE SUPPOSED TO BE
PROTECTIVE, WHY DO THEY GET
BREAST CANCER?
WE OF COURSE LOOKED AT THE
POPULATION STRUCTURE AND FOUND
THAT IN FACT MANY OF THESE WOMEN
DIE IN CHILD BIRTH FROM, YOU
KNOW, DIARRHEAL DISEASES, THINGS
THAT WILL NOT KILL YOU IN
AMERICA.
THE POPULATIONS THAT WE'RE
STUDYING IS ACTUALLY REALLY IN
ROOT FOR YOUNG ONSET BREAST
CANCER.
AND THAT'S WHAT WE HEAR ABOUT
THAT BLACK WOMEN IN THE U.S.
HAVE OVERREPRESENTED OF EARLY
ONSET BREAST CANCER.
THE AVERAGE AGE STUDIES IN
NIGERIAN AND CAMAROON AND THAT'S
REPLICATED IN AFRICAN COUNTRIES
FOR POPULATIONS OF EUROPEAN
ANCESTRY HERE AND IN EUROPE.
AND HIGHER RISK OF AGGRESSIVE ER
NEGATIVE BREAST CANCER.
BECAUSE, YOU KNOW, EVERYONE SAYS
WHEN I WAS A MEDICAL SCHOOL,
COMMON THINGS ARE COMMONLY.
IF YOU HAVE A LUMP IN YOUR
BREAST, THEY WILL THINK IT'S
TUBERCULOSIS OR A ABSCESS.
THEY WILL HAVE MASTITIS AFTER
BIRTH.
WHEN THEY INTERVIEW WOMEN
WAITING TO BE DIAGNOSED AFTER
ADVANCED CANCER, THEY WILL SAY
NO, THEY SHOWED UP TO THE
COMMUNITY HEALTH WORKSER OR
DISPENSARY, IT'S THE DELAY THAT
LED TO MORE OVERALL OUTCOMES.
WE FOUND THE SAME IN CHICAGO.
CHICAGO WOMEN WILL GET, YOU
KNOW, OUTREACH TO THEIR -- AND
YOU FIND CANCER ON THE CHURCH ON
THE SOUTH SIDE OF CHICAGO.
THERE ARE NO DOCTORS TO TAKE
CARE OF THIS PATIENT BECAUSE
THERE IS NO HEALTHCARE.
AND SO IT'S NOT THAT THEY ARE
NOT FEELING THE LUMP.
THEY FEEL THE LUMP, THEY DON'T
WANT TO ACCEPT THEM INTO THE
HEALTH SYSTEM.
FAST FORWARD, THIS PAPER WAS
PUBLISHED FROM THE NCI.
AND I REALLY ENJOYED READING IT
BECAUSE NOW WE HAD THE ABILITY
TO LOOK AT THOUSANDS OF GENE
EXPRESSION PROFILING.
AND THIS PAPER PUBLISHED BY
JEFF'S GROUP WAS REALLY PRECISE.
THERE WERE NOT A LOT OF THE
TUMORS.
BRCA1 CARRIER, SPORADIC CARRIER,
SPORADIC BREAST TUMORS AND
BRCA1.
THEY USED THE TECHNOLOGY FOR THE
FIRST TIME AND SHOWED THERE IS A
CLEAR DISTINCTION BETWEEN BRCA1
MUTATION CARRIERS AND BRCA2.
THEY SHOWED THAT IN FACT FOR
THAT ONE TUMOR THAT WAS
MISCLASSIFIED IT WAS BECAUSE
THAT BRCA1 WAS METHYLATED IN THE
TUMOR OF THIS PATIENT.
YOU CAN EITHER MUTATE TO GET
THIS PATTERN OF GENE EXPRESSION
OR METHYLATE.
FOR THOSE OF YOU WHO DO CANCER
BIOLOGY, THAT'S A GOOD WAY TO
TURN GENES ON AND OFF.
YOU CAN TURN THAT ON AND OFF
BASED ON ENVIRONMENTAL EXPOSURE.
WE GOT REALLY INTERESTED IN
TRYING TO FIGURE OUT WHAT'S
GOING ON.
AND THAT'S WHEN WE HAVING FOUND
MY EXTENDED AFRICAN AMERICAN
FAMILIES WITH BRCA1 MUTATION, I
WANTED TO ACTUALLY LOOK AT THE
PREVALENCE OF BRCA1 MUTATION AS
A WAY TO UNDERSTAND AGGRESSIVE
ER NEGATIVE BREAST CANCER.
AND SO FINALLY, WE WERE ABLE TO
DO THE EXPERIMENT.
AND THIS IS AN IMAGE ON THE
INTERNET.
WE HAD ASSEMBLED CASES AND
CONTROLS IN NIGERIA.
ONCE GENOMIC TESTING WAS MUCH
CHEAPER.
WE WANTED TO DO A THOUSAND CASE
AND A THOUSAND CONTROLS.
AND CONSECUTIVE CASES, YOU CAN
SEE THIS WOMEN THE AVERAGE AGE
IS UNDER 50.
AND WE HAD A MUTATION DETECTION
RATE OF ABOUT 14.5%.
SO ONE IN 8 EIGHT OF THE WOMEN
HAD MUTATIONS IN BRCA1, BRCA2.
WE SAW THE FREQUENCY.
LET'S GO TO CAMAROON AND
ACANADA.
SAME THING.
WE UGANDA.
THIS WAS MORE OF A FAMILY BASED,
YOUNG WOMEN AND HAVING HIGH RA
RATES OF BRCA1 AND BRCA2 AND
[INDISCERNIBLE] 2.
THIS IS HIGHLY -- MUTATION WHICH
MEANS YOU HAVE A 50% CHANCE OF
PASSING IT ONTO YOUR CHILDREN.
AND OF COURSE, IF YOU ARE
GETTING THIS MUTATION AT 40 OR
EVEN YOUNGER THAN 40, THERE IS
NO STRATEGY FOR SCREENING FOR
THIS MUTATION BECAUSE WE ASK
EVERY WOMEN TO GO GET SCREENED,
THAT'S AT AGE 40.
IN SOME COUNTRIES, AGE 50.
AND NOBODY EVEN IS THINKING
ABOUT HOW ABOUT THOSE
INDIVIDUALS WHO ARE AT RISK OF
HAVING BRCA1 MUTATION.
SO SHORTLY AFTER WE PUBLISHED
THIS IN 2 28 -- 2018, TWO PAPERS
PUBLISHED BACK TO BACK IN THE
NEW ENGLAND JOURNAL LAST YEAR
LOOKING AT A COHORT OF AFRICAN
AMERICANS AND THEN THE CARRIER
COHORT, 32 THOUSAND CASES IN
WHITE WOMEN AND 32 THOUSAND
CONTROLS.
THIS IS WHY I TALK ABOUT, IT'S
NOT THE POWER OR THE NUMBERS
THAT MATTER.
IF A SIGNAL IS HE YOU DON'T NEED
32 THOUSAND CASES AND CONTROLS
TO ACTUALLY GET THE SIGNAL YOU
WANT.
THIS IS ALMOST 15 YEARS OLDER
THAN OUR COHORT.
THE AFRICAN AMERICAN AGE IS SORT
OF IN BETWEEN.
EVEN THE AFRICAN AMERICANS YOU
CAN SEE THEY HAVE A MUCH HIGHER
RATE COMPARED TO THE OLDER WHITE
WOMEN.
AND SO WHENEVER WE TALK ABOUT
WHO NEEDS TO HAVE ACCESS TO
GENETIC TESTING, A LOT OF
ACTIVITIES AND THERE IS, YOU
KNOW, THE FIRST PAPERS THAT CAME
OUT WAS THE STUDY BY JEFF,
LOOKING AT IN SYNAGOGUES IN
WASHINGTON D.C., 5000 ASCONASY
JEWISH MEN AND WOMEN, SHOWING
THEY HAD A ONE AND 40 CHANCE OF
HAVING A BRCA1 MUTATION.
I KEPT SAYING THIS IS ALSO MORE
PREVALENT IN THOSE POPULATIONS
AND WE NEED TO REALLY STUDY IT.
SO NOW THAT WE KNOW THAT A
SIGNIFICANT FRACTION OF WOMEN
WHO ARE COMING IN HAVE MUTATIONS
AND WE'VE ALSO DONE THE STUDY IN
OUR PRACTICE IN CHICAGO.
WHAT ELSE CAN WE DO TO
UNDERSTAND ETIOLOGY OF BREAST
CANCER, EVEN WITH A MUTATION
DETECTION REALITY OF 15 -- RATE
OF 15%, 85% UNEXPLAINED.
THAT'S WHERE NOW WE HAVE THE
ABILITY TO NOT ONLY SEQUENCE THE
GENE LINE BUT SEMATIC SEQUENCING
TO TRY AND UNDERSTAND MUTE
GENESIS AND CANCER DEVELOPMENT.
WHEN I EXPOSED TO ULTRA VIOLET
LIGHT THERE IS A MUTATION YOU
HAVE.
THERE IS A SEQUENCE GIVEN US
INSIGHT INTO THINGS WE MAY B
MAY BE ABLE TO PLOD DOWN IN
TERMS OF RISK FACTORS, WHAT IS
GENETIC AND WHAT IS ENVIRONMENT
THERE.
SO THIS THEN LED US TO LOOK AT
EXOME SEQUENCING, LOOKING AT TWO
NIGERIAN WOMEN AND COMPARING TO
TUMORS FROM THE CANCER GENOME
ADD CLASS.
THIS STUDY HAD 74 NIGERIAN WOMEN
AND 88 BLACKS AND ABOUT 284
[INDISCERNIBLE] THAT COULD DO
COMPARATIVE ANALYSIS.
NOW, THIS STUDY OF COURSE WAS
UNDERPOWERED TO SEE WHAT WAS
GOING ON.
BUT AT LEAST GIVE US SOME
INSIGHT.
AND WE'VE KNOWN THAT P52
MUTATIONS AND [INDISCERNIBLE]
MUTATIONS TEND TO BE THE
PREVALENCE TEND TO BE DIFFERENT
IN AFRICAN ANCESTRY GROUPS.
CDH1 AND THE AFRICAN ANCESTRY
GROUP HAD MORE FREQUENT
VARIATIONS AND WHAT WAS REALLY
INTERESTING WAS THAT THE
ACTIVITY OF THE COMBINATION
DEFICIENCY MUTATION SIGNATURE
WAS ACTUALLY QUITE HIGH IN THE
BLACK AND THE U.S. AND AFRICAN
NIGERIANS.
SO YOU CAN SEE THE CLUSTERING
WHERE THE SIGNATURE IS MORE AND
BCA IS OVER HERE AND YOU CAN SEE
THE P53 AND C1 AND 2 CLUSTERING
SEPARATELY.
SO THEN ABOUT THE TIME THAT WE
WERE DOING THE EXOME SEQUENCE
AND DOING OUR WORK, MY HUSBAND
IS A PULL MONNOLOGIST AND
STUDIED ASTHMA AND AIR
POLLUTION.
THERE IS ALWAYS A HYPOTHESIS WHY
BLACKS ARE DYING AT A HIGHER
RATE.
IN CHICAGO, THE BLACKS HAD THE
HIGHEST DEATH RATE FROM ASTHMA.
AND I SAY BLACKS HAVE THE
HIGHEST DEATH RATE FROM BREAST
CANCER.
WE THEN STARTED THINKING, WELL
MAYBE WE SHOULD STUDY ASTHMA AND
BREAST CANCER ACROSS THE AFRICAN
DIASPORA.
THIS PAPER ACTUALLY REALLY WAS A
CONSORTIUM EFFORT LOOKING AT
AFRICAN ANCESTRY POPULATIONS,
7000 ASTHMA CASES AND MORE THAN
7500 CONTROLS.
AND WHAT WAS CLEAR, SO THIS IS
CHICAGO IN A REALLY NICE
BEAUTIFUL -- THERE IS A REASON
WHY I STAYED IN CHICAGO.
RIGHT?
BECAUSE I QUICKLY FORGET ABOUT
THE COLD BITTER WINTERS.
THIS PAPER REALLY SAID, YOU
KNOW, WHEN YOU DO GENOME
SEQUENCING OF 910 AFRICAN
INDIVIDUALS, WE FOUND THAT
NEARLY 296 MILLION BASES WERE
MISSING FROM THE REFERENCED
GENOME.
THAT'S 10% THAT WAS MISSING.
UNTIL YOU SEQUENCE IT, UNTIL YOU
STUDY IT, YOU DON'T KNOW
ANYTHING ABOUT IT.
THAT'S WHAT WE'RE FINDING.
WE THEN LOOKED AT SO WE HAVE
ONGOING NOW SEQUENCING, OLD
GENOME OF TUMOR PAIRS FROM
NIGERIAN TO REALLY GET A DEEPER
KNOWLEDGE OF GENOMIC ABRISIONS.
IF YOU ARE NOT IN GENOMICS, THIS
MAY NOT BE AN IMAGE THAT YOU CAN
UNDERSTAND.
BUT YOU KNOW, I SEE NOW THAT
[INDISCERNIBLE] IGNITION IS ALL
YOU NEED TO BECOME A COMPETITION
AT BIOLOGY.
SINGLE BASED SUBSTITUTION, THE
HR NATURE THAT WE COULD GENERATE
USING EXOMES, THAT GETS YOU
SOMETHING.
RIGHT?
BUT IT DOESN'T QUITE GET YOU THE
WHOLE STORY BECAUSE WE ALSO KNOW
THERE IS DOUBLE BASE
SUBSTITUTION, AND SHOWED HIGHER
ACTIVITY IN NIGERIAN TUMORS.
AND THEN WHEN YOU LOOK FOR
INDULLS, THEN YOU ARE ALSO NOW
SEEING DIFFERENCES THAT YOU
WOULDN'T HAVE SEEN IF YOU HADN'T
DONE THE GENOME.
SO BY REALLY DOING COMPARATIVE
ANALYSIS ACROSS BLACKS IN THE
U.S., NIGERIANS AND WHITE, WE
BEGAN TO SEE THE PROPORTION OF
THESE DIFFERENT MUTATION
SIGNATURE.
AND THE [INDISCERNIBLE] OF
COURSE HAD UNDERREPRESENTATION
OF AFRIC AFRICAN AMERICANS.
WITH EVERY DATA SET YOU LOOK AT,
IT'S AN INCOMPLETE STORY.
A STORY IS EVOLVING.
I HOPE I WILL CONTINUE TO
GENERATE MORE DATA.
SO THEN, MY STUDENTS, WE THEN
SORT OF WANTED TO KNOWT NOW THAT
WE CAN CATEGORIZE THE TUMORS
USING SIGNATURE, STRUCTURE
VARIANTS, WHAT PROPORTION OF
THE TUMORS COULD WE CATEGORIZE
AS DEFINITELY DUE TO HUHMOLOGOUS
DEFICIENCY, AND HOW MANY MIGHT
BE DRIVEN BY BRCA1 OR BRCA2 OR
SOME OTHER GENES THAT WE REALLY
HADN'T HAD THE ABILITY TO
IDENTIFY.
THIS IS THE CRITICAL PAGE HERE.
YOU CAN SEE THIS IS THE NIGERIAN
COHORT TO THE EXTREME HERE.
THE BLACKS IN BETWEEN AND THEN
WHITE.
AND WE WERE ABLE TO SHOW LOTS OF
BRCA1 AND BRCA2 SIGNATURE.
CLEARLY 34% OF OUR SAMPLES WERE
CLASSIFIES AS THE HOMOLOGOUS
REPAIRED DEFICIENCY.
THIS HAS CLINICAL IMPLICATIONS.
WE HAVE FOUR OR FIVE POP
INHIBITORS, MAKING A DIFFERENCE
IN THE CLINIC BECAUSE YOU CAN
TAKE AN ORAL NEEDLE IF YOU ARE
BRCA1 MUTATION, YOU CAN TAKE IT,
A NEEDLE IF YOU RECOLLECT BRC2
MUTATION BECAUSE THE STUDIES ARE
DONE.
THE QUESTION IS WHEN WILL THE
DRUGS ACTUALLY REACH UNDERSERVED
POPULATIONS WHO HAVE AN
ENRICHMENT OF HRD IN THEIR
TUMORS.
THESE ARE REASONS WHO -- WHY
WHEN WE SAY SOMEBODY HAS AN
AGGRESSIVE TUMOR, THE QUESTION
IS WE HAVE THE RIGHT DRUG FOR
THE RIGHT PATIENT AT THE RIGHT
TIME.
THE STORY CONTINUES BECAUSE
WHAT WE THEN WANTED TO DO WAS TO
NOW LOOK AT ONCE YOU ARE ABLE TO
DO WHOLE GENOME SEQUENCING YOU
CAN ACTUALLY NOW LOOK AT THE
EVOLUTIONARY TRAJECTORY OF
DIFFERENT MUTATIONS AND
DIFFERENT COPY CHANGES.
SO HERE YOU SEE LOSSES AS IN
GREEN AND THEN YOU SEE GENE
AMPLIFICATION AND HERE YOU SEE
WHOLE GENOME DUPLICATION.
WHEN YOU SEE THOSE CHROMOSOMAL
CHANGES, THEY ARE GOING TO MAKE
YOUR TUMOR UNDER THE MICROSCOPE
TO HAVE HIGRADE.
IF YOU ASK ANY PATHOLOGIST, IN
FACT ONE OF THE THINGS I WAS A
MY LAB, HAVING LOOKED AT LOTS
AND LOTS OF BREAST CANCER IN
NORWAY, AND HE SAYS, YOU KNOW,
THE BREAST CANCERS I'M SEEING IN
MY PATIENT IN NIGERIA DON'T LOOK
LIKE THE BREAST CANCERRESS I'M
LOOKING AT IN THE NORWEGIAN
WOMEN.
SOMEONE SOLD HIM TO WORK WITH
ME.
WE LOOKED AT LOCAL MORPHOLOGY.
AND CLEARLY THE TUMORS WOULD
ALWAYS BE CLASSIFIED AS HIGH
GRADE.
WE SAW THE PATIENTS HAVE
MUTATIONS.
AND IN THIS COHORT, THE PATIENTS
WHO HAD [INDISCERNIBLE]
MUTATIONS AS AN EARLY EVENT THAT
PROPELLING THE CANCER WERE 10
YEARS YOUNGER THAN PATIENTS WHO
DIDN'T HAVE THE [INDISCERNIBLE]
MUTATION.
IF YOU HAVE EARLY B53 MUTATIONS
YOU WILL HAVE MORE GENOMIC
INSTABILITIES.
THESE WERE GIVING HINTS WHY THE
EVOLUTIONARY TRAJECTORY OF THE
CANCER MAYBE LETHAL.
LET'S TALK ABOUT SCREEN SCREENIR
BREAST CANCER.
DO YOU SCREEN EVERY TWO YEARS OR
SIX MONTHS?
IF YOUR CANCER HAS AN
ACCELERATED TRAJECTORY.
SO THIS PAPER AND DEBATES ABOUT
SCREENING HAS ALWAYS BEEN ABOUT
WE'RE DOING OVERDOSE.
IF YOU ASK THE AVERAGE BLACK
WOMEN, NO, YOU ARE TELLING US
OUR CANCERS ARE AGGRESSIVE AND
YOU ARE TELLING US DON'T SCREEN
OR SCREEN EVERY TWO YEARS.
WHAT SHOULD WE DO?
SO THAT'S WHY IT'S REALLY THE
CASE THAT WE DON'T HAVE THE
RIGHT SCREENING TOOLS.
AND WE REALLY NEED TO THINK
ABOUT THE HETEROGENOUS
POPULATION IN THE U.S. THAT ARE
NOT GOING TO GET THE SLOW
GROWING DCI WE'RE OVERDIAGNOSING
AND GOING TO HAVE AN ACCELERATED
EVOLUTION OF THEIR BREAST
CANCER.
BECAUSE ALL THE TIMES THAT WE'VE
BEEN SCREENING, YOU CAN SEE THE
PROPORTION OF PATIENTS WHO HAVE
PRESENTED WITH DE NOVO
METASTATIC BREAST CANCER HAS NOT
DECLINED.
SO WHY IS THAT THE CASE?
NOW I THINK WHAT WE ARE THINKING
ABOUT IS WHETHER WE CAN BUILD
BETTER MODELS FOR RISK
ASSESSMENT.
THIS IS WHERE YOU KNOW, GENETIC
CYSTS LOOKING AT STUDIES TALKING
ABOUT HERITABILITY, HOW BREAST
CANCER IS INHERITED.
I USE THE EXAMPLE OF N.B.A.
BASKETBALLERS.
THEY ARE TALL, THEY GET TO BE
BE 7 FEET, FIVE INCHES, HOW DO
THEY GET TO BE THAT TALL?
LIKE WINNING THE LOTTERY BASED
ON HOW YOUR GEN GENES ARE STRAM.
WE'RE TRYING TO LOOK AT WHAT
MODEL WILL BEST TELL US THE
RISKING IN DIFFERENT
POPULATIONS.
WHETHER A STUDY ACTUALLY SAYS WE
FOUND LOCALS THAT IS
[INDISCERNIBLE] WITH BREAST
CANCER RISK, IF WE TRY TO
REPLICATE THAT IN A AFRICAN
ANCESTRY COHORT, WE GET WHAT WE
CALL THE FLIP-FLOP PHENOMENON
BECAUSE OF THE SHORT L.D. OF
AFRICAN POPULATIONS.
SO IT MAY BE A PROTECTIVE ALLELE
IN ONE POPULATION, AND A RISK
ALLELE IN THE OTHER.
HISPANIC HAVE AN ALLELE THAT
ACTUALLY VERY PROTECTIVE AGAINST
BREAST CANCER.
AND THAT'S WHY HISPANICS HAVE A
LOWER RISK OF BREAST CANCER,
ESPECIALLY IF THEY HAVE THAT
NATIVE AMERICAN ALLELE THAT IS
PROTECTIVE.
SO THE THERE IS A LOT THAT WE CN
LEARN FROM DIFFERENT POPULATIONS
BECAUSE OUR CHROMOSOMES ARE
SCRAMBLED DIFFERENTLY.
SO A GROUP HAS BEEN REALLY
WORKING WITH THE AFRICAN
ANCESTRY BREAST CANCER GENETIC
CONSORTIUM.
I'M NOT GOING THROUGH IT IN THE
INTEREST OF TIME.
PULLING DATA AND TRYING TO SEE
WHETHER WE CAN ACTUALLY DO
BETTER BY BEGINNING TO
UNDERSTAND THAT ER POSITIVE
BREAST CANCER IS DIFFERENT FROM
ER NEGATIVE BREAST CANCER.
AND TRYING TO, YOU CAN SEE FOR
ROOT CONSORTIUM, THE AVERAGE ACT
IS YOUNGER, THE -- AGE, GHANA,
MORE THAN 2000 BREAST CANCER
CASES, ALSO YOUNGON SET.
WHEN WE LOOK AT THE YOUNG ONSET
CASES, MAYBE WE'LL HAVE BETTER
TOOLS.
THAT IS SHOWN WITH THE CROSS
ANCESTRY IDENTIFYING SIX BREAST
CANCER IN AFRICAN AND EUROPEAN
ANCESTRY WOMEN.
THIS HAS BEEN PUBLISHED.
BUT THE POINT THAT WE'RE TRYING
TO MAKE IS THAT BREAST CANCER IS
NOT ONE DOES, IT'S HETEROGENOUS.
IF YOU DEFINE THE PHENOTYPE
ADEQUATELY, YOU MAY BEGIN TO
MAKE PROGRESS.
IF YOU CAN GET, YOU KNOW,
ADDITIONAL LUSIGH, WOULD IT THEN
BE POSSIBLE FOR US TO CREATE A
POLYGENIC MODEL FOR
INHERITABILITY.
FOR THOSE OF YOU WHO ARE NOT
GENETICISTS, THIS IS WHITE --
WHITE -- QUITE CLEAR.
IT'S CONTRIBUTED -- CONTRIBUTED
CONTRIBUTED — DISTRIBUTED IN A
BELL CURVE.
IF WE CAN GET A SET OF MARKERS
THAT WOULD ALLOW US TO DO
POPULATION STRATIFICATION, THEN
PEOPLE AT THIS EXTREME RACE WE
CAN FIND THEM.
PEOPLE AT LOWER RISK MAYBE THEY
DON'T NEED TO SCREEN AS OFTEN.
THAT'S SORT OF WHERE THAT
COMMENT IS COMING FROM.
YOU CAN SEE THERE IS A VERY NICE
PRS CORE THAT IS BEING GENERATED
WITH 94 THOUSAND EUROPEAN
ANCESTRY CASES AND CONTROLS.
AND YOU KNOW, IT'S PERFORMING
MODERATELY WELL, IT'S BEEN
REPLICATED IN HISPANICS,
REPLICAREPLICATED IN SOUTHEAST ,
FOR THE AFRICAN GROUP, IT'S A
FLIP OF THE COIN.
WE HAVE WORK TO DO TO CONTINUE
TO DO THIS.
THE REASON IS ALREADY IF WE WANT
TO USE THIS, I I IT MAY HELP
EXACERBATE HEALTH DISPARAGES.
WHAT WE'RE SEEING WITH THE
GENOME SEQUENCING, WE'RE REALLY
TOUCHING THE TIP OF THE ICEBERG.
THE HETEROGENEITY ON THE AFRICAN
CONTINENT, O ON THE AFRICAN
GENOME, HAS NOT BEEN STUDIED
BECAUSE THIS IS THE FOUNDATION,
THE SUBSET IS EUROPEAN AND A
SUBSET IS ASIAN.
AND THIS IS WHAT IS PRESENT IN
DATABASE.
VERY FEW FROM AFRICAN ANCESTRY
POPULATIONS.
IN TRYING TO SEE HOW THAT MODEL
WORKS, THIS IS BEEN PUBLISHED
NOW BY MUNCIE AND THE GROUP
REALLY TRYING TO SEE WHETHER WE
CAN GET IT PRS CORE THAT
FUNCTION WELL.
AND YOU CAN SEE THAT IT
FUNCTIONS WELL IN SEPARATING
HIGH RISK POPULATIONS FROM LOW
RISK.
BUT IN AFRICAN ANCESTRY GROUP,
IT'S NOT WORKING AS WELL.
WHEN YOU LOOK AT HOWEVER FOR ER
NEGATIVE BREAST CANCER, YOU CAN
SEE THE SAME ANALYSIS IS, YOU
HAVE BETTER SEPARATION OF THE
HIGHEST RISK CATEGORY FROM THE
LOWER RISK CATEGORY IN AFRICAN
AMERICANS FOR ER NEGATIVE BUT
IT'S NOT AS GREAT WITH EUROPEAN
ANCESTRY GROUP.
THAT'S BECAUSE THE PREDOMINANT
TYPE OF BREAST CANCER THAT YOU
SEE IN EUROPEAN ANCESTRY WOMEN
IS A RECEPTOR POSITIVE AND GROWS
VERY SLOWLY.
THIS IS GIVING US HOPE WE CAN
REALLY BEGIN TO THINK ABOUT
THIS.
SO LET ME THEN SWITCH TO, SO NOW
IF YOU HAVE, YOU ARE HIGH RISK
AND WE'VE DONE RISK
STRATIFICATION, WHAT IS A
CLINICAL IMPLICATION OF THAT?
WELL THE CLINICAL IMPLICATION,
IF YOU HAVE A BRCA1 MUTATION,
YOU WOULDN'T HAVE YOUR BREAST
CANCER DIAGNOSED EARLY.
IT DOESN'T MATTER THE AGE.
YOU HAVE DENSE BREASTS, THE
CANCER IS LOCKED IN THERE.
YOU NOW NEED TO DO MRI.
WE HAVE THE IDEA IN 2004 BECAUSE
OF COURSE, YOU KNOW, I PRACTICED
ON THE SOUTH SIDE OF CHICAGO.
IF YOU GO AND TELL AN AFRICAN
AMERICAN WOMEN, YOU KNOW YOU
HAVE A HIGH RISK, TAKE BOTH
BREASTS OFF.
THEY ARE GOING TO LOOK AT YOU
AND SAY, WHAT?
THERE IS NOTHING WRONG WITH ME,
WHY WOULD I TAKE MY BREAST OFF.
WE HAD TO FIGURE OUT A BEST WAY
TO SUPPORT THESE WOMEN, AND THEN
LEARN FROM THEM.
THAT'S HOW WE WERE ABLE TO LEARN
IN FACT WHEN YOU DO MRI EVERY
SIX MONTHS KNOWING THE
TRAJECTORY OF THE CANCER, YOU
ARE GOING TO PICKUP CANCER.
THE PAPER THAT IS ALREADY
PUBLISHED AND THE COMMENTS ON IT
IS MOST MRI BREAST SCREENING IN
BRCA1 MUTATION CARRIER.
WITHIN SIX MONTHS THEY HAD RAPID
PROGRESSION OF CANCER.
IN THE STUDY THE AVERAGE TUMOR
STAYS THAT WE DETECTED WAS
6-MILLIMETER.
AND EVERYONE HAD THE CANCER
DIAGNOSED ONE CENTIMETER AND NO
NEGATIVE.
IF YOU CAN DOWN STATE THE
AGGRESSIVE ER NEGATIVE BREAST
CANCER IN ALL POPULATIONS YOU
WILL SAVE MORE LIVES.
THE QUESTION IS, USE MRI FOR
EVERYBODY OR THINK A LITTLE BIT
OUTSIDE THE BOX AND DO SOMETHING
ELSE?
SO THAT'S WHY WE ARE
COLLABORATING WITH LAURA ESMAN
AND DOING THE WISDOM STUDY.
WOMEN INFORM TO SCREEN BASED ON
MEASURES OF RISK.
THIS STUDY IS RECRUITING ALL
ACROSS THE COUNTRY.
AND I'M HOPING THAT I'VE JOINED
IT, THAT MORE WOMEN WILL JOIN SO
WE CAN LEARN AND BE ABLE TO
FIND HIGH-RISK PATIENTS BEFORE
THEY GET CANCER.
FOR NOW, WE'RE LEFT WITH REALLY
THINKING ABOUT TREATMENT.
BECAUSE WE TEST MOSTLY WHEN
PEOPLE SHOW UP HAVING BEEN
DIAGNOSED WITH BREAST CANCER.
SO THIS WAS AN EDITORIAL I
PUBLISHED IN 1996.
AND I ASKED RITA, WHO WAS MY
FELLOW AT THAT TIME TO THINK
ABOUT IF YOU ACTUALLY LOOK AT
THIS PAPER, THEY HAD ONLY JUST
43 WOMEN WITH [INDISCERNIBLE]
MUTATIONS WHO HAD OVARIAN
CANCER.
AND THEY TREATED THEM WITH STIFF
PLATINUM.
YOU CAN SEE THE SEPARATION
BETWEEN WOMEN DOING WELL IF THEY
HAD THE GERM LINE MUTATION AND
THEN THE OTHER COHORT THAT DID
NOT HAVE A GERM LINE MUTATION.
AND THIS WAS REALLY WHERE IT WAS
VERY CLEAR THAT YOUR GERM LINE
GENETICS ACTUALLY CAN DETERMINE
YOUR RESPONSE TO TREATMENT.
RIGHT?
SO IT'S NOT JUST ABOUT THE TUMOR
ALONE, IT'S ABOUT WHAT IS
DRIVING THE EVOLUTIONARY
TRAJECTORY.
AND SO IN 1996, I THOUGHT
GENETICS IN CLINICAL CANCER
CARE, THE FUTURE IS NOW! WELL,
WAS I WRONG BECAUSE NO ONE WAS
PREPARED TO ACTUALLY THINK ABOUT
HOW TO GET WOMEN TESTED AND HOW
TO PERSONALIZE THERAPY.
SO FAST FORWARD, WE STARTED A
PROSPECTIVE COHORT OF PATIENTS.
AND THAT CAME IN THROUGH MY
CLINIC BECAUSE WE REALLY WANTED
TO KNOW HOW PEOPLE WERE DOING.
BECAUSE WE'RE ON THE SOUTH SIDE
OF CHICAGO, WE'VE NOW HAD MORE
THAN 4000 WOMEN, ABOUT 40% OF
OUR PATIENTS ARE BLACK.
AND WITH A MEDIAN FOLLOW-UP OF
ABOUT 5.4 YEARS.
WE WANTED TO KNOW WHAT IS THE
CHARACTERISTICS OF WOMEN WHO
SHOW UP AT OUR DOOR.
AND SO CONTRARY TO WHAT I SHOWED
WHERE IN THE CASE CONTROL
COHORT, THE WHITE WOMEN WERE
OLDER, HERE THE BLACK WOMEN
ACTUALLY ARE OLDER BECAUSE WE
PRACTICED IN A PRIVATE HOSPITAL.
THEY HAVE INSURANCE, THEY HAVE
MEDICARE, AND THAT'S HOW THEY
GET IN.
RIGHT?
AND IF YOU LOOK AT THIS TYPES OF
BREAST CANCER, ALWAYS IN EVERY
CASE, BLACK WOMEN TEND TO HAVE
MORE TRIPLE NEGATIVE BREAST
CANCER.
AND BECAUSE THIS WOMEN NOW HAVE
BEEN FOLLOWED FOR A VERY LONG
TIME, WE WANTED TO KNOW WHAT WAS
THE OUTCOME, ESPECIALLY IF WE
TREATED THEM WITH NEW
CHEMOTHERAPY.
[INDISCERNIBLE] CHEMOTHERAPY
MEANS WE CAN GIVE YOU
CHEMOTHERAPY AND THEN LOOK AT
WHAT IS YOUR RESPONSE?
RIGHT?
BEFORE TAKING THE TUMOR OUT.
AND THIS IS WHAT WE FOUND.
PATIENTS OF COURSE BLACK
PATIENTS HAD MORE C COMORMIB
BIBTIES.
MORBIDITY.
IN MORE DELAY INITIATING
CHEMOTHERAPY.
AND OF COURSE IN TERMS OF
PRIMARY CARE INSURANCE, MOST OF
THE PATIENTS MORE BLACK WOMEN
WERE ON MEDICAID COMPARED TO
PRIVATE INSURANCE.
BECAUSE ANYONE WHO, IN FACT, WE
DID STUDIED THE FARTHER YOU
LIVED TO US, THE BETTER YOUR
CANCER OUTCOMES.
THE PEOPLE IN THE NEIGHBORHOOD
WHO CAN'T COME BECAUSE WE HAVE A
PRIVATE HOSPITAL WITH THE WORST
OUTCOME.
IS THAT RELATE TODAY THE
DISTANCE OR RELATED TO THE
SOCIOECONOMIC STATUS?
THOSE ARE SOME OF THE THINGS
WHEN YOU DO STUDIES, YOU HAVE TO
[INDISCERNIBLE] IN THE CONTEXT
OF WHERE YOU ARE PRACTICING.
THIS WHAT WE FOUND.
IF YOU GET A CR, THERE IS NO
DIFFERENCE BETWEEN BLACK AND
WHITE IN TERMS OF LONG TERM
DOING WELL.
AND THEN, PATIENTS WITHOUT PCR
BETWEEN BLACK AND WHITE, BLACKS
ARE NOT DOING AS WELL IF THEY
DON'T GET A CR.
WE LOOKED AT RECURRENCE FREE
SURVIVAL.
YOU GET OPTIMAL THERAPY.
IT DOESN'T MATTER HOW YOU GET TO
POD CR, IF YOU CAN GET THERE,
YOU WILL HAVE BETTER LONG-TERM
SURVIVAL.
IF QUESTION IS WHY YOU ARE NOT
GETTING PAT CR.
THE STUDY WAS POSSIBLE BECAUSE
WE GOT A CANCER HEALTH
DISPARITIES PLANNING GRANT.
AND WE LOOKED AT OVERALL YOU CAN
SAY WELL, MAYBE THE PCR AGE IS
NOT SO BAD.
HERE IS WHERE WE WERE FLOORED.
TWO POSITIVE BREAST CANCER.
THIS IS NOW THE MOST TREATABLE
BREAST CANCER.
AND YES, THEY HAVE THE WORST PCR
READ, RIGHT?
TRIPLE NEGATIVE BREAST CANCER
ARE NOT SO HIGH.
AND THEN WE ASKED THE QUESTION,
WHAT IS THE REASON WHY THIS IS
OCCURRING.
WE WERE ABLE TO NOW GO BACK AND
DO PANEL SEQUENCE IN THE TUMOR.
IS THE EVOLUTIONARY TRAJECTORY?
LOOKING AT 186 OF THIS SUBSET WE
WERE ABLE TO SEQUENCE, WE WERE
REALLY INTERESTED IN THE
DISTRIBUTION OF THE PATIENT.
AND WE'RE LEARNING BECAUSE THIS
EXPERIMENT IS VERY EXPENSIVE AND
YOU CAN DO SHORT COST BY DOING
PANEL SEQUENCING OR WHOLE GENOME
SEQUENCING TO FIGURE OUT WHAT IS
GOING ON.
IN THE FIRST PAIRS OF SAMPLES WE
DID, WELL, WHEN YOU DO ADVAN
THERAPY, THE TUMOR CHANGES
CHARACTERISTICS.
RIGHT?
YOU KNOW, THE TUMOR MUTATION --
SEVEN REDUCED.
FIVE INCREASES.
ONE STAYED THE SAME.
TWO POSITIVE PATIENTS WITH
[INDISCERNIBLE] DISEASE, ONE NO
LONGER HAD THE B2 AMPLIFICATION.
WHEN WE DO DRUG STUDIES NOW WE
TREAT EVERYBODY THE SAME.
WITHOUT REALLY GETTING THE
GRANULAR DATA WHY DIDN'T YOU
TUMOR RESPOND TO THERAPY?
WELL, THE OTHER ONE RESPONDED.
I THINK THESE ARE THE CHALLENGES
I SEE AS WE GO TOWARDS PRECISION
MEDICINE.
THIS IS A PAPER MY MEDICAL
STUDENT PRESENTED AT SA SAN
ANTONIO.
NATIONAL OF CLINICAL OUTCOMES
AND [INDISCERNIBLE] TWO TRIALS.
THIS IS A NATIONWIDE STUDY,
PUTTING PATIENTS WHO HAVE HIGH
RISK BREAST CANCER INTO
INNOVATIVE ANY ACCESS TO
CLINICAL TRIALS.
ALL RIGHT.
WE LOOKED AT IT.
WHETHER YOU ARE WHITE, BLACK,
ASIAN, IF YOU HAVE YOUR PAP CR,
YOU DO OKAY.
THERE IS NO RACIAL DISPARITY.
IF YOU DON'T GET A PASS CR, YOU
CAN SEE THAT THERE IS OF COURSE
DISPARITY IN WHO IS SURVIVING
AND NOT.
SO LET ME BARROW THIS SLIDE.
THINKING ABOUT THIS EVOLUTION
THAT CHARLES DARWIN WROTE IN HIS
NOTEBOOK.
NOTHING IN CANCER MAKES SENSE
EXCEPT IN THE LIGHT OF
EVOLUTION.
EVOLUTION VULNERABILITY TO
CANCER.
CANCER PROGRESSION BY
NATURALIZED SELECTION IN TISSUE
ECOSYSTEMS.
WHEN WE TALK ABOUT THE
MICROENVIRONMENT, IS IT
DIFFERENT OR THE SAME.
EMERGENCE OF DRUG RESISTANT
VARIANTS ON SELECTIVE PRESSURE
OF THERAPY.
HOW DO WE DESIGN THE NEXT
GENERATION OF STUDIES?
I'M GOING TO END BY SAYING I
WORK IN NIGERIA, WE NEED TO
THINK ABOUT IN THE GLOBAL HEALTH
WHERE WE HAVE ALL THIS DATA,
THESE WOMEN DON'T HAVE ACCESS TO
ANY TREATMENT BECAUSE IT'S SO
EXPENSIVE.
WHAT IS OUR OBLIGATION TO MAKE
SURE THEY ARE TREATED. WE HAVE
A STUDY WE'RE COLLABORATING TO
TREAT THE WOMEN OPTIMALLY, THE
FIRST TIME THEY WILL GET TREATED
FOR BREAST CANCER SO WE KNOW WHO
WILL RESPOND AND WHO IS NOT
RESPONDING.
BECAUSE IF WE'RE ABLE TO
ACTUALLY LEARN AND YOU KNOW, DO
THE RIGHT EXPERIMENT, WHEN WE'RE
ABLE TO SAMPLE WHETHER WE DO
BULK SEQUENCING, WE DO WHOLE
GENOME OR LIQUID BIOS, WE CAN
FIGURE OUT HOW TO OPTIMIZE
THERAPY.
I THINK THAT SHOULD BE THE WAVE
OF THE FUTURE.
IF IT WE WANT TO GET TO EQUITY,
I TEACH GLOBAL HEALTH TO MY
STUDENTS.
SO WE TALK ABOUT THE WORLD
HEALTH ORGANIZATION SAYING, YOU
KNOW, THERE IS A RIGHT TO
HEALTH.
AND THIS WAS ALL AGREED UPON IN
1948.
AND HEALTH IS A STATE OF
COMPLETE PHYSICAL, HEALTH AND
SOCIAL WELL-BEING AND NOT MERELY
THE ABSENT OF DISEASE.
HOW ARE WE GOING TO THINK ABOUT
RIGHT TO HEALTH AND
RESPONSIBILITY SAID.
WHENEVER I SAY NIH, WHAT IS YOUR
RESPONSIBILITY FOR REDUCING
DISPARITY?
I ALWAYS SAY, WE ONLY DO
RESEARCH.
WE'RE ALL IN THE SAME ECOSYSTEM.
I THINK WE NEED TO BEGIN TO
THINK ABOUT WHAT WE NEED TO DO.
LET ME THANK YOU FOR THIS REALLY
WONDERFUL HONOR TO GIVE TO
REMEMBER DR. NIRENBERG.
IN MY MIND, WE HAVE TO STOP
STRATIFYING PEOPLE BASED ON
BLACK AND WHITE AND ALL OF
WHETHER THEY EXPOSED AND HAVE
TOXICITY AT HOME OR STRESSED
OUT, WHETHER THEY HAVE LOW
RESOURCE, NO INSURANCE, WE
ACTUALLY BEGIN TO THINK ABOUT
WHAT IS THIS PERSON, WHAT THAT
DNA MADE OF?
WHAT IS THE EPIGENOME MADE OF
AND THE TUMOR MICROENVIRONMENT
AND THEN WE CAN BEGIN TO THINK
ABOUT HOW WE EITHER SCREEN FOR
EARLY DETECTION OR BEGIN TO
THINK ABOUT PREVENTION OR CANCER
INTERCEPTION.
SO LET ME END BY SAYING THAT
THERE IS A LOT WE CAN DO NOW.
AND WE COULD EVEN ONCE WE KNOW
AND WE CAN STRATIFY, MAYBE ALL
WE NEED TO DO IS INTEGRATE
LIFESTYLE CHANGES.
IF YOU ARE GOING TO, IF YOU HAVE
A BRCA1 -- BCCA2 MUTATION AND IT
WILL INCREASE YOUR RISK OF
PANCREATIC CANCER, MAYBE YOU
WOULDN'T SPOKE -- SMOKE.
I'M GRATEFUL TO WORK IN CHICAGO.
THE WOMEN'S BASKETBALL LEAGUE
LAST YEAR, THAT BROUGHT A LOT OF
JOY FOR US.
WE GO OUT AND HANG OUT IN THE
CITY THAT NEVER SLEEPS.
THIS IS MY TEAM.
WE HAVE A REALLY DIVERSE TEAM IN
OUR BREAST PROGRAM.
I HAVE TO GIVE A SHOUT-OUT TO
THE NCI CENTER TO REDUCE CANCER
HEALTH DISPARITIES FOR GETTING A
P20 OUT THAT ALLOWED US TO DO
THIS WORK.
AND OF COURSE, THESE ARE MY
COLLEAGUES IN NIGERIA.
THEY ARE REALLY LOOKING TO
BE PART OF A GLOBAL COMMUNITY.
WHEN WE LAUNCHED FIRST CLINICAL
TRIAL, THIS WAS ALL OF THEM.
YOUNG, OLD, SAYING WE CAN DO
THIS AND WE MUST DO THIS.
SO I REALLY WANTED TO THANK THE
INVESTIGATORS FOR MOVING US
FORWARD WITH OUR CLINICAL
TRIALS.
THANK YOU.
[ APPLAUSE ]
>>HANK YOU FOR A WONDERFUL
TALK.
I THINK SO MANY LESSONS LEARNED
CAN BE APPLIED TO OTHER CANCERS
WE'RE NOT DOING WELL LIKE ORAL
CANCER.
I WANTED TO ASK AS YOU MOVE FROM
STRATIFICATION, DO YOU THINK
THAT THOSE OTHER THINGS THAT WE
ARE TYPICALLY LOOKING AT CAN
ACTUALLY EMBODIED WHEN YOU LOOK
AT THE EPIGENOME.
FOR INSTANCE, RESPONSES TO THE
STRESSFUL OTHER ENVIRONMENTAL
FACTORS THAT RESULTED IN THE
SHIFT, WHICH YOU SEE IN A
PERSON'S DNA IS ENOUGH?
RIGHT?
MAYBE WE DON'T NEED TO
BE LOOKING SO MUCH AT WHERE A
PERSON LIVES AND ALL OF THAT
STUFF, NOT SAYING IT'S NOT
IMPORTANT.
BUT MAYBE IT'S ALREADY RECORDED
WITHIN THE CONTEXT OF THE
PERSON'S NUCLEIC ACID.
>>
Dr. Olopade: YEAH.
I THINK THE
ANTHROPOLOGIST WILL SAY
YOU ARE MORE THAN YOUR
DNA, RIGHT?
>> I'M A BIOLOGIST AND A
GENETICISTS, EVERYTHING
WALKS DOWNSTREAM THROUGH
THE GENES.
I CAN MEASURE THAT,
RIGHT?
AND THEN THE SOCIETAL
FACTORS, WE KNOW THAT.
NIH HAS BEEN TALKING
ABOUT RACISM.
EVERYBODY SAYING LET'S
MEASURE MEASURE THAT.
I MEASURED THAT FOR 30
YEARS, PRACTICING ON THE
SOUTH SIDE OF CHICAGO.
I WANT TO GIVE THEM THE
RIGHT DRUGS AT THE RIGHT
TIME.
I THINK WE HAVE THE
TOOLS TO DO THAT BY
FOCUSING ON THE PATIENT
AND GETTING THE CARE TO
THEM.
AND I THINK COVID HAS
SHOWED US NOW, RIGHT,
THAT IF WE VACCINATE WE
CAN BE IN THIS TOGETHER
IN SOLID AREA ATE.
IF WE'RE SEGREGATED
WE'LL SPEND MONEY
TREATING ADVANCED
CANCER.
AND THEN GET BETTER WITH
THAT TREATMENT.
>> I DO HAVE A QUESTION.
THANK YOU FOR THIS
ENLIGHTING LECTURE.
ARE THE RESULTS OF YOUR
EXTRAORDINARY WORK WELL
KNOWN IN THE MEDICAL
COMMUNITY?
WHERE IS THE BEST PLACE
TO HAVE BREAST CANCER IF
YOU HAVE AN AFRICAN
AMERICAN WOMEN AND WHERE
IS THE WORST PLACE?
Dr. Olopade: I'M A SCHOLAR, AND
IT'S NICE THAT NOW WE CAN
ACTUALLY GET GEOGRAPHIC, WE CAN
MEASURE WHO IS GETTING BREAST
CANCER BY ZIP CODE, RIGHT?
SO ONE OF THE WORST
PLACES IS THE ZIP CODE
WHERE I LIVE ON THE
SOUTH SIDE OF CHICAGO.
YOU CAN SEE IN THE SOUTH
AND WHERE RURAL AMERICA.
SO BY ACTUALLY REPORTING
ON WHERE PEOPLE ARE,
WE'RE SEEING THE
PATTERNS AND WE'RE
SEEING THE PATTERN OF
THE SEGREGATION.
SO WHEN WE AND STUDENTS
ASKED FAMILY CARE
PHYSICIANS ON THE SOUTH
SIDE IF A WOMEN SHOWED
UP WITH A LUMP ON THE
SOUTH SIDE OF CHICAGO,
WHERE WOULD YOU SHOW
THEM TO GET A MAMMOGRAM?
THEY DON'T KNOW BECAUSE
THEY ARE NOT DOCTORS
THAT DO QUALITY
MAMMOGRAPH IN THE
NEIGHBORHOOD.
TAKE THREE BOSSES AND GO
TO COUNTY HOSPITAL.
HOW WILL THEY DO THAT ON
A COLD, YOU KNOW, WINTER
DAY IN CHICAGO.
SO I THINK, YOU KNOW, I
WAS AT LUNCH I WAS
SAYING WE MADE SOME
PROGRESS.
WHEN I GOT TO CHICAGO,
THE ONLY HOSPITAL WAS
COOK COUNTY HOSPITAL.
AND WOMEN WOULD WAIT AND
WAIT AND WAIT.
IT'S ALMOST LIKE IN
GLOBAL HEALTH SECS, THIS
IS IN AMERICA.
I THINK THERE IS A LOT
WE CAN DO TO PROMOTE
EQUITY AND EQUITABLE
DISTRIBUTION OF
RESOURCES TO SAVE LIVES.
>> THAT WAS A LOVELY
TALK.
THE QUESTION I HAD I
GUESS IS ARE YOU GETTING
CLUES FROM THE POLYGENIC
TRADES AND GENETIC
TRADES HOW TO MOVE
TOWARDS NOT JUST
SCREENING AND SURGIC
SURGICAL -- PROPHYLACTIC
SURGERIES, MORE COMMON
IN THE AFRICAN AMERICAN.
>> I SENT A NARROW ONE
IN FEBRUARY.
IF IT'S FUNDED THAT'S
THE STUDY WE WANT TO DO
IS BEGIN TO APPLY THIS.
WE KNOW IT'S NOT
PERFECT.
IT'S NOT READY FOR PRIME
TIME.
BUT IF WE CAN GET A
COHORT OF WOMEN THAT
WILL REALLY WANT TO HAVE
THE TEST DONE AND THEN
FOLLOW THEM OVER TIME WE
WILL LEARN A LOT FROM
THEM.
WE HAVE TO MAKE SURE THE
STUDIES ARE
PATIENT-CENTERED.
WE WERE TALKING ABOUT
MULTIDETECTION, LIQUID
BIOFEED AND ANALYZE THE
EARLY DETECTION RESOURCE
NETWORK IS TRYING TO
BRING INTO POPULATION
SCREENING.
THERE IS A LOT OF
OPPORTUNITIES.
BUT WE HAVE TO MAKE SURE
IT'S INCLUSIVE AND WE GO
OUT INSTEAD OF HAVING
EVERYBODY COME INTO US.
>> THE VIDEO --
>> I THANK YOU FROM MY
HEART FOR MODELING FOR
US HOW DISCOVERY SCIENCE
CAN BE EXTENDED FOR THE
BENEFIT OF HUMANITY.
AND HOW IMPORTANT THE
GLOBAL COMMUNITY IS FOR
US TO LEARN FROM.
AND I COULDN'T THINK OF
A BETTER EXAMPLE.
MY QUESTION IS A LITTLE
BIT CURING MY OWN FUZZY
STATE.
THE GENETIC
HETEROGENEITY YOU
DESCRIBED FOR BREAST
CANCER RELATE TO THE
PHENOTYPIC PRESENTATION
OF [INDISCERNIBLE]
VERSUS ASTHMA.
I WASN'T SURE AS TO HOW.
I KNOW THERE ARE
DIFFERENT PROGNOSIS FOR
EACH SITE, RIGHT?
SITE SPECIFIC.
Dr. Olopade: YEAH, THAT'S A
GREAT QUESTION.
SO WE'VE LOOKED AT
GLOBULAR BREAST CANCER
FOR EXAMPLE IS MORE
LIKELY TO HAVE CGH1
MUTATION, THAT'S MUCH
MORE COMMON IN OLDER
WHITE WOMEN.
AND FOR OUR COHORT WE
WERE LOOKING AT, WE
DIDN'T SEE A LOT OF
LOBLER BREAST CANCER.
WE ALWAYS, YOU KNOW IN
THE PAST WE WENT FROM
PATHOLOGY TO THEN
CLINICAL ASSOCIATION.
BUT NOW WE'RE GOING FROM
GENOTYPES TO SAY WHAT DO
I NEED, IT DOESN'T
MATTER WHETHER YOU HAVE
LOBLER OR DOCTOR, DO I
HAVE THE RIGHT DRUG TO
TREAT YOU.
EVEN STAGE IF YOU HAVE
EFFECTIVE THERAPIES, IT
DOESN'T MATTER WHETHER
YOU HAVE DIAGNOSED AT
STAGE TWO OR THREE, AS
LONG AS YOU HAVE THE
RIGHT BIOMARKER AND
THOSE TUMORS MELT AWAY.
I THINK NOW IN THE
BREAST CANCER COMMUNITY,
EVERYONE HAS ACCEPTED
THAT WE SHOULD BE DOING
GENOMIC ASSAYS FOR RISK
STRATIFICATION.
IF BLACK WOMEN HAVE
AGGRESSIVE HIGH GRADE
TUMORS, PLEASE GIVE THEM
CHEMOTHERAPY BECAUSE WE
HAVE THE DATA I DIDN'T
GET TO PRESENT.
THEY ACTUALLY RESPOND
BECAUSE A TUMOR ARE
HIGHLY PROLIFERATIVE AND
NOT GIVING OPTIMAL
TREATMENT OR GIVING
TREATMENT THAT WILL
CAUSE MORE DAMAGE TO
THEM THAT MAKING THE
PATIENT NOT DO WELL.
WE LOOK AT THE DATA.
ONCE THEY GET INTO US,
THEY GET TREATMENT,
EVERYTHING IS THE SAME.
THEY DO WELL.
BUT IT'S FIRST GET THE
GENOMIC ASSAY AND THEN
GET THEM INTO THE
CLINICAL TRIAL.
THAT'S WHY I THINK THAT
EARLY ADOPTION OF
TECHNOLOGY OF COURSE
GETS A LOT OF PEOPLE TO
PROVIDE THE CANCER THAT
THEY MAY NOT HAVE
SURVIVED.
UNDERSERVED POPULATIONS
ARE THE LAST TO GET
ANYTHING THAT WE BRING
OUT IN AMERICA.
AND THEN WE BLAME THEM
THAT THEY DIDN'T WANT TO
ACCEPT IT WHEN IT'S
IMPOSSIBLE.
THE SYSTEMIC BARRIER TO
COMING TO GET INTO A
CLINICAL TRIAL IS
IMPOSSIBLE.
SO I'M HOPING THAT WITH
THIS PANDEMIC THAT WE
HAVE DISTRIBUTED
RESPONSIBILITIES AND
THAT WE CAN MEET
PATIENTS WHERE THEY ARE.
AND FIGURE OUT HOW TO DO
BETTER CLINICAL TRIALS,
BETTER PRAGMATIC STUDIES
AND LEARN FROM EVERY
PATIENT.
THAT'S I THINK IS WHAT
PATIENTS ARE LOOKING
FOR, TO BE TREATED EQU
EQUALLY.
>> THANK YOU.
>> OKAY. [OFF MIC]
MAYBE YOU AND I CAN HAVE
A FURTHER DISCUSSION.
THE TIME IS UP.
I JUST WANT TO THANK FOR
AN INCREDIBLE,
EYE-OPENING LECTURE.
REALLY APPRECIATE IT.
AND THE AUDIENCE HERE IS
NOT LARGE ON PURPOSE BUT
VERY RESPONSIVE I WOULD
SAY.
AND THANK YOU TO
EVERYONE WHO IS
LISTENING IN AS WELL.