Retooling Precision Oncology for True Equity of Cancer Care

Olufunmilayo Olopade, MD, FACP, University of Chicago, discusses the background and findings of retooling precision oncology for true equity of cancer care, while bringing a focus to patients that have been previously understudied, to the global community of breast cancer researchers. This study was presented at the 2021 Miami Breast Cancer Conference.



I am Dr Olufunmilayo Olopade, and I am a professor of medicine and human genetics at the University of Chicago.

I am really very excited to talk to you about my thinking on how we can reach to precision oncology and focus on bringing patients that have been previously understudied and underserved to the global community of breast cancer researchers. My thinking around this came from lessons we have learned during the pandemic. We have been successful in rapidly getting a new vaccine for COVID.

In fact, several vaccines, multiple vaccines are going to come to the market. Unfortunately, we left a large number of population behind in terms of their participation in research and in their understanding of how research can improve outcomes. At the end of this pandemic, I think the onus is not on all of us in the breast cancer community to make sure that all our advances reach every patient.

When I talk about retooling precision oncology, I mean, retooling how we access patients, how we talk to our patients, how we use telemedicine, and how we accelerate who gets to participate and who is excluded from cancer research. I am really excited that we can do this.

What I presented was what we have learned about genetic testing and how majority of women who self‑report as African Americans in this country originated from West Africa. We talked about the influence of the slave trade and who now self‑identifies as being of African ancestry or being Black in the United States.

We talked about the fact that, number one, a lot of women with breast cancer do not participate in research.

Because of the mistrust that is in the Black and Brown community that has been exposed as a result of this pandemic, I then talked about the fact that when we do research, especially my the work, we have done understanding BRCA1 and BRCA2 mutation, we find that Black women, just like White women, have mutations that are actionable.

The problem is that we have not had enough testing in this Black and Brown communities. We have not done enough outreach to get women who are indigenous Americans to be part of our research. I gave an example of when we had the HIV AIDS epidemic. We did not get out of that epidemic until we had a global action.

We all acted in solidarity to do clinical trials globally and to also make drugs accessible and available globally. The challenge for us in precision oncology is that we do not even know nearly enough about the diversity of genes that contribute to a risk for breast cancer, and we do not know enough about the diversity of genomes that we have to target when we are talking about targeted therapy.

The onus is on us to move forward in solidarity, to make sure that women have a test that they need in their communities, and every community really matters. What we need to do is now use telemedicine, use telehealth to make sure we can meet every patient at their point of care with information about what they can do to get genetic testing, if they have a family history.

Even if they do not have a family history, they have a risk of young‑onset breast cancer. We know Ashkenazi Jewish women have risk of young‑onset breast cancer. African American young women have a risk of triple‑negative breast cancer.

Until we can make sure that everyone is advised about their risk factors and we can integrate genomic testing to do risk stratification, we will be asking women to go and get a mammogram when they do not even know why they should get a mammogram, how often they should get that mammogram, or if they need to get MRI.

We know MRI is much more sensitive to getting breast cancer, especially those breast cancers that start at a very young age.

We talked about how important it is to do genomic testing to know what tests to order in terms of whether a woman needs a mammogram or they need an MRI and really making sure that women can participate in clinical trials to figure that out. That is going to be very important as we move towards precision oncology.

In the era of treatment, we have so many new drugs, new drugs for HER2 breast cancer, new drugs for triple‑negative breast cancer. We have basal‑like breast cancer. We have so many different types of breast cancer. For us to get to precision, every woman no matter where they live or where they are accessing care should have access to precision diagnostics.

Some of these biomarkers have genomic biomarkers, and we know some of them can be used to deescalate treatment. Some of them need to be used to escalate treatment so that every woman has a chance to get what is just right for them. We cannot be treating breast cancer as one‑size‑fits‑all. That is really what I talk about.

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