Abstract IA25: Black Lives Matter Worldwide: Retooling Precision Oncology for True Equity of Cancer Care
Authors: Olopade Olufunmilayo 
Published: December 2020

Analysis of cancer genomes has provided fundamental insights into the process of malignant transformation, and cancer genomes have rapidly become an integral part of the practice of clinical oncology, with implications for diagnosis, prognosis, treatment and prevention. Inherited and sporadic cancers often share common mutational events. When inherited mutations are identified, genetic counseling is an essential component of care. Risk-stratified breast cancer screening strategies are a paradigm shift from the one-size-fits-all screening approach. Previous age-based screening strategies proved to be disadvantageous to specific minority populations, particularly those at high risk for interval breast cancers developed at a younger age with a poorer prognosis. With the increasing use of personalized risk assessment tools in the clinic and the uptake of risk-reducing prevention and early detection interventions, risk-stratified screening approaches promise to reduce racial disparity in breast cancer outcomes. Using high throughput whole genome strategies, including genome-wide association studies, whole exome sequencing, and whole genome sequencing, we can now deeply explore the most foundational instigators of the most aggressive forms of breast cancer. Work from our group and others have demonstrated the significant burden of early onset ER negative breast cancer as well as high rates of pathogenic BRCA1 and BRCA2 mutations among African American and Hispanic women in the US. Globally, breast cancer is a disease of young women and pathogenic mutations in BRCA1 and BRCA2 are the strongest predictors of risk and have also been categorized as the strongest predictors of aggressive prostate cancer risk. Our work is informed by attentive, interdisciplinary study of the most aggressive phenotypes of breast cancer in diverse populations in the US and abroad. BRCA-associated basal-like breast cancers have defects in homologous recombination pathways and based on the fundamental biology of these tumors, there are novel pathways including DNA repair, metabolic and immune pathways that can potentially be targeted for more effective management strategies. While basal-like breast cancer remains the molecular subtype with the worst outcome in all populations, we have evidence from randomized clinical trials that it is most curable when diagnosed early and treated promptly with multimodality cancer therapies. Work from our group as well as other laboratories show that high temporal resolution Dynamic Contrast Enhanced Magnetic Resonance Imaging (DCE-MRI) is likely to increase lesion conspicuity and diagnostic accuracy. Our group is also pioneering the potential of an automated, quantitative radiomics platform on DCE-MRI breast imaging for inferring underlying activity of clinically relevant gene expression pathways of invasive breast cancers at diagnosis. Waiting to treat advanced cancer with targeted therapies is a failure of primary prevention and population-based strategies for risk assessment and management in high-risk populations will be needed. I will discuss our recent findings and future directions for the early detection and prevention of the most aggressive subtypes of breast cancer in vulnerable high-risk populations.

Citation Format: Olufunmilayo Olopade. Black Lives Matter Worldwide: Retooling Precision Oncology for True Equity of Cancer Care [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr IA25.