Cancer Knows No Borders
Unafraid to tackle cancer disparities across races, Olufunmilayo “Funmi” Olopade has
demonstrated that genomics research can make a big impact on public health.
By Megan Scudellari | August 1, 2013
In November 1982, a military officer practicing on the soccer
field outside the Nigerian Navy Hospital in Lagos, Nigeria,
collapsed and died. Olufunmilayo “Funmi” Olopade, a
young, newly minted doctor, was working inside when the
man was brought in to the emergency room. “We couldn’t
understand why he died,” says Olopade. “That really
shocked me, and made me realize that I needed to do more to
be able to understand and help people.”
Three months earlier, Olopade had visited her brother, a
graduate student at Stanford University, and while in the
United States, she flew to Chicago where she interviewed
with and was offered a job at Cook County Hospital. At the
time, she wasn’t sure she was ready to commit to a medical
residency in the U.S. But the day the soldier died, Olopade
called Cook County and asked if the position was still
available. It was, and 2 months later, she was on a plane to
Chicago.
“I think we can democratize how we prevent and treat cancer, so people on the periphery can
take advantage of the research going on in the center.”
Olopade quickly rose in the ranks at Cook County, becoming Chief Resident in 1986, then going
on to a postdoctoral fellowship in hematology and oncology at the University of Chicago with
geneticist Janet Rowley. Today, 26 years later, Olopade is still at the university, where she’s
built a career bridging research and medicine, races and borders.
In the early 1990s, Olopade opened one of the country’s first clinics for genetic testing of
tumors. She has also pioneered the exploration of population differences in tumor biology,
finding, for example, that women of African descent who contract breast cancer overwhelmingly
have aggressive tumors characterized by BRCA mutations—tumors that do not respond to the
traditional first-line hormone therapy used in the West. Today, Olopade is dedicated to using
genomics, big data, and common sense to improve global health disparities.
Here, this physician-scientist mulls over what it’s like to be a MacArthur “Genius,” the physics
obsession that led her into the arms of her husband, and how fears of genetic discrimination
hinder scientific progress.
Olopade On the Move
Paging Dr. Olopade. Born in Nigeria in 1957 to a pastor and a homemaker, Olopade was the
fifth of six children. “My father really wanted to have scientists and doctors in the family. My
siblings before me were in engineering and science—none of them chose to be in medicine—so I
was his second-to-last hope. However, at that time, I was fascinated by physics. I didn’t care
much for biology, but in Nigeria the option available to me was to be a doctor. I didn’t have any
theoretical-physicist role models. So I passed a qualifying exam and went to medical school.”
Fateful visit. Olopade spent a rigorous 6 years at the University of Ibadan, where she showed an
aptitude for biochemistry and for experimentation. “I was drawn to pathophysiology, and I
wanted to be a cardiologist, because it was applied physics plus physiology.” In 1981, the first of
two summers that Olopade visited her older brother at Stanford, “he couldn’t say enough about
some of the tools and resources available to do his work. Silicon Valley was booming; it was the
place to be in the early 1980s. I visited the medical schools at UCSF and Stanford. That’s when I
got exposed to American medicine and the opportunities that were here.” Olopade returned to
Nigeria, passed the American medical boards, and “the rest is history,” she says with a laugh.
Chance of snow. Well, almost history. The following summer, when Olopade went back to the
U.S. and was offered a job at Cook County Hospital in Chicago, she delayed taking it until the
death of the young sailor spurred her into action. “I came to Chicago in January. It was quite
shocking because I had no idea the temperature was going to be that different from when I had
visited in September. As my plane landed, people were talking about ‘flurries.’ I had no idea
what that meant.”
Solid start. Olopade completed an internship and residency in internal medicine in 1986. At the
beginning of her training in hematology/oncology, the program director, Harvey Golomb,
encouraged Olopade to try a stint doing research, specifically in a genetics lab, which he
predicted would be a hot field. After reading a paper by renowned geneticist Janet Rowley
describing chromosomal changes in cancer, Olopade applied for a fellowship in Rowley’s lab at
the University of Chicago. “I was fortunate to get into her lab and learn molecular biology. It
was the best of times. Rowley advised me that it didn’t matter what I studied, but that I learn the
skills.” At the time, geneticists had made many discoveries concerning blood cancer, but little
was known about genetic abnormalities in solid tumors. “I learned to do chromosome mapping,
what we then called ‘chromosome walking,’ and chose to map chromosome 9—a region that had
shown deletions in leukemias and lymphomas and now was showing up in some solid tumors.”
Olopade reasoned that if there was a tumor suppressor gene on that chromosome, the gene would
be important in multiple cancer types. Indeed, she subsequently identified and characterized a
new tumor suppressor gene on chromosome 9.
Assessing risk. In 1991, Olopade opened her own lab at Chicago and continued to work on
tumor suppressor genes, gradually shifting to the study of genetic predisposition to breast cancer.
But while happily keeping busy in the lab, Olopade began to feel a widening gulf between her
genetics work in the lab and her clinical care of patients. “It was really wonderful to be able to
map and clone genes, but as I worked with families, and saw the suffering that they went through
and the worry about whether they or their relatives would die from breast cancer like their
mother had, I was very compelled. I wanted to figure out a way to begin to do genetic testing in
the clinic. All of my medical training had always emphasized that prevention is better than cure,
and while we were making major discoveries in genetics, it wasn’t really getting translated into
prevention.”
In 1992, Olopade founded the Cancer Risk Clinic at the university to perform testing for cancersusceptibility genes in concerned and high-risk individuals. “At the time, it was unheard of. We
had a huge debate between geneticists and oncologists about whether this was a good thing to do
or not.” In 1996, Olopade wrote a frank editorial in the New England Journal of Medicine
declaring that it was time to begin using genetic testing in earnest for cancer risk assessment and
personalized cancer therapies. She chastised the medical community because while wealthy,
informed women were seeking out genetic testing from commercial laboratories, economically
disadvantaged or uninformed women at high risk were not being tested due to limited access to
genetic testing. “I was getting frustrated with how long it was taking us to take advantage of
these genetic advances.”
Olopade Observes
Confronting the race question. Both at Cook County Hospital and at the University of Chicago
School of Medicine, Olopade regularly saw African American patients with familial breast
cancer, and she began to wonder if there was a link between breast cancer genetics and the
African diaspora. “People at County Hospital were not different from patients in Nigeria, in their
attitudes and the way they presented with illness. So I was really curious about whether that was
something peculiar to people of the African diaspora—whether it was poverty, or an underlying
genetic factor we had not paid attention to. The literature was filled with disparities about how
black people did poorly in every aspect of medicine. Social scientists would say that was because
they had no access to medicine, but I thought maybe it was how early life events could impact a
person, such as how poor nutrition early in life can make you disadvantaged forever.” In 2005,
Olopade proposed that not just genetic constitution but societal factors, such as toxin exposure
and obesity, can vary by race or ethnicity and affect breast cancer incidence. “That work
recognized the fact that there will be population differences in tumor biology based on what’s
driving the tumor,” she says.
Triple threat. Then Olopade went back to Nigeria to examine genetic patterns of breast cancer
in African women, as breast cancer is a particularly virulent disease for young women on the
continent. In 2009, she published the groundbreaking finding that the majority of tumors in
indigenous African women with breast cancer are triple-negative tumors, a particularly
aggressive type of breast cancer that grows rapidly and does not respond to some of the low-cost
treatments common in the region. “The conventional wisdom was that these poor women just
delayed getting their cancer diagnosis, so when they showed up, the cancer was big. But now we
know some of them are mutation carriers, and within 2 weeks [of onset] their cancer can get
really big.” The finding suggested that mammogram screenings and current first-line treatments
might not be the best way to control breast cancer in Africa. The study “brought awareness to the
fact that the real thing causing health disparities was an overrepresentation of the most
aggressive type of breast cancer among Africans and African Americans,” says Olopade.
Genetic guidance. Today, Olopade continues to study the population genetics of breast cancer.
“We really need to understand these complex interactions to understand cancer and develop
effective interventions,” she says. Last year, her team sequenced the BRCA1 and BRCA2 genes
of 434 Nigerian breast cancer patients and found that the population has an exceptionally high
frequency of mutations in both genes, suggesting that genetic counseling should be broadly
disseminated in Nigeria and other understudied populations. Her team also recently identified
unique BRCA mutations in African families that are significantly different from those seen in
Caucasian populations, mutations that many BRCA genetic tests do not currently identify. “I
truly believe that once you understand the genetic basis [of cancer in a population], then you can
look at pathways to disrupt, and get better drugs and better prevention. If people were not so
afraid of genetic discrimination, we could direct more genomics toward public health.”
Big ideas. “My main project now continues to be to understand how to use genomics to improve
global health and global cancer research. I’m building a big database of cancer patients I can use
to inform the treatment of any patient, no matter where they are in the world. I think we can
democratize how we prevent and treat cancer, so people on the periphery can take advantage of
the research going on in the center. With health information tools, we can actually do that.”
Olopade Opines
Language barrier. “When we started our work in Nigeria, there wasn’t even a word in the
language for breast cancer. The only word they had was “ulcer,” which meant that the cancer
was advanced and ulcerating. People were not making a diagnosis until it was too late. And it
wasn’t that these women didn’t show up to the doctor. They went to a low-level health
professional who misdiagnosed them and gave them antibiotics, because the professional didn’t
even know it was cancer.” Olopade has since organized numerous conferences in the country to
raise awareness about breast cancer. “Through advocacy and now the US government funding of
medical schools there to reform curriculums, we’re having better success.
“If people were not so afraid of genetic discrimination, we could direct more genomics toward
public health.”
Genius club. In 2005, Olopade was awarded a MacArthur Fellowship “Genius” Award, a
prestigious recognition of “extraordinary originality” and a no-strings-attached stipend of
$500,000. “It’s not a lot of money, but the MacArthur gives you the ability to attract more
funding. It allowed me to really be a physician-scientist. Physician-scientists are a dying breed,
and I was being compelled to choose one or the other.” With the additional funding and
recognition, Olopade has been able to continue her work in both the clinic and the laboratory.
Physical attraction. Olopade and her husband met while both were in medical school in Nigeria.
“He was playing cricket for the university team, and I played badminton and squash. I would go
over and keep score for the cricket team, because I just loved the numbers and watching the
trajectory of the cricket ball as they pitched. It was the most beautiful way I could enjoy physics
and nature. And that’s how we met.”
Family hike. Olopade and her husband have three grown children, ages 24, 28, and 29. “Our
family climbed Mount Kilimanjaro last year. Our daughter was reporting on a book about Africa
and living in Kenya, and she asked if we could do Kilimanjaro as a family. We decided it should
be all or none, so we all trained. I thought I was going to be the weak link, so I worked hard to
make sure I wouldn’t get sick. We all made it to the top. It was amazing.”
Giving back. “You may find me during the week lecturing to Nobel laureates at the university,
but on the weekend I’m at a black church at a community event speaking about health care. I
also try to mentor kids from the community so we can get more individuals with African
ancestry into STEM. Unless they can see a role model, they don’t think it’s possible. I tell them I
couldn’t ever have dreamt that I’d be a professor of genetics at the University of Chicago, but if I
can do it, anyone can do it.”