Thread by @kegill

Live-tweeting tonight from #UW @fredhutch with Olufunmilayo (Fumni) Olopade, Director Center for Clinical Cancer Genetics @ U of Chicago #breastcancer

Her bio >
cancergenetics.uchicago.edu/directory/oluf…
"Cancer is a Genetic Disease/Disorder" (tonight's topic)

In the 1960s, no one believed that genetics were involved in cancer. While she was a student, they discovered BCR-ABL1 leukemia
mycancergenome.org/content/diseas…

Approximately 1.5 percent of men and women will be diagnosed with leukemia in US > seer.cancer.gov/statfacts/html…

Fraction of leukemia patients have this genetic abnormalit.
Chronic myeloid leukemia accounts for 0.5% of all cancer cases and 0.2% of all cancer deaths.
seer.cancer.gov/statfacts/html…

Genome project - $5 billion
With cancer - genomic data used to help with treatment
[#breastcancer > breastcancer.org/symptoms/diagn… ]

Now talking about genes (nature) versus environment (nurture)
Then ...
Germline mutations and Somatic mutations

How does cancer metastasize? (No answer)

Now a segue into BRCA1 and BRCA2 mutations.

These mutations are "relatively rare in the general population" but convey a high risk of cancer
cancer.gov/about-cancer/c…

Important to ask about father's family history -- too often the focus has been mother's family history. These mutations may be associated with more than reproductive organ cancer.

She's said pancreatic cancer several times.

The cost of doing genetic screening is dropping, making it possible to test more people. SCOTUS overturned attempt to patent genes -- which jumpstarted research (she said)
theguardian.com/law/2013/jun/1…

"Why would you do genetic testing? Your insurance company would drop you."
This was a REAL barrier. Now we have HIPPA (privacy protected).
You did not choose your genes - so genetic discrimination should not be how we manage medicine.

Who wants to know that she has triple negative breast cancer if there is nothing you can do about it?

We know that Ashkenazi Jewish heritage increases risk of breast cancer. She is focused on African American women.

High risk women (BRC1 and BRC2) - MRI imaging every six months; started in 2004. It was a successful trial (4 DCIS and 13 early stage cancer, no lymph node environment). The average tumor size was 6.1mm.

Reminder of lifestyle factors (smoking, excessive drinking) that predispose you to cancer.

Reminder that mammography doesn't show #breastcancer well for young women or women with dense breasts.

Now discussion of over-diagnosis of DCIS.
How to identify cancers that will kill you.

Population risk stratification.
Chart shows that MRI is more successful than mammogram for BRCA-high-risk women.

Yes, genetic mutations provide path for target therapies.
BUT (I am arguing here) ... most cancers still do not have distinct genetic mutation.

Where you live determines whether you live -- chart of age-adjusted African American mortality (State cancer profiles)

Q: Are you recommending early genetic testing?
A: There are times when it's not useful to know (example babies with holes in heart). The question is - when should a woman know? Risk goes up in 30s and 40s. Maybe wait until you have children.

Will doctors be ready to see so many people?
Does a genetic mutation "make you sick"?
How will individuals use that information?

Have a discussion because it runs in the family. The children know what's going on - let them choose but the doctors need to ask. So many say that they had not gotten tests or joined trial because no one asked.

Full thread >
threadreaderapp.com/thread/9990964…

Dr. Olopade in 2011 (photo looks like it was taken yesterday)
news.uchicago.edu/article/2011/0…

I asked question about these data on risk of dying from #breastcancer (no real change in 40 years - data are not age adjusted)
life.wiredpen.com/2017/10/are-br…