Photo: Ryan Dorsett
In May 2006, as she was getting dressed for work, Lori Booker felt a small lump in her left breast. Only 32, she was concerned but thought it was probably just a cyst and made an appointment to see her gynecologist. With a demanding job as a computer teacher at a Chicago public high school, Lori missed a couple of appointments, and two months later, when she finally had her first mammogram, the lump had doubled in size. A biopsy came back with grim results: She had aggressive, advanced-stage breast cancer. Crying, Lori thought the lab must have made a mistake. "I'm too young for this," she sobbed.
Angel Jacobs, 29, figured the same thing. A single mother of a 3-year-old, she was sure what she felt in her right breast was nothing to be anxious about, but an ultrasound found a tumor. It turned out to be the same type as Lori Booker's.
A decade ago, the fact that both of these women were under 35 would have surprised oncologist Olufunmilayo Olopade, MD, director of the Cancer Risk Clinic at the University of Chicago Medical Center. But not anymore. Lori and Angel are like many of the breast cancer patients Olopade (nicknamed Funmi) has seen, both in her native Nigeria, where she studied medicine, and on Chicago's South Side—women who are black, unusually young, and diagnosed with aggressive "triple negative" tumors that are difficult to treat.
"I had never heard of that type of cancer before," Lori recalls. "I was scared. It made me think I was a triple loser."
The last decade has delivered increasingly good news about breast cancer. Although the disease is expected to strike an estimated 240,510 American women this year, the majority are diagnosed after menopause and have tumors that can be treated with a combination of chemo and the latest hormone or targeted therapies. For the most common kind of breast cancer—hormone receptor positive (meaning tumor growth is driven by estrogen or progesterone)—drugs like tamoxifen and Femara have boosted survival rates. Herceptin, a breakthrough targeted drug, improved the outlook for HER2-positive tumors, which have an excess of a protein called human epidermal growth factor receptor 2.
None of the new treatments, however, can touch breast cancers that test negative for estrogen, progesterone, or HER2; the only option for such triple negative cases is chemotherapy, which may or may not work.
Striking the young and spreading rapidly, this type of virulent breast cancer was hardly a blip on the radar of oncology research until about five years ago, when groundbreaking studies by Olopade and others brought it to the attention of the medical community.
The daughter of an Anglican minister, Olopade came to the United States in 1982 hoping to coax her brother back home after he finished graduate school here. During her visit, though, political unrest in Nigeria worsened and she decided to stay put and complete her residency at Chicago's Cook County Hospital. Later, she joined the faculty at the University of Chicago as a professor of medicine and human genetics. It was on a trip home to Nigeria for a niece's wedding in 1997 that Olopade visited a cancer clinic and paused when she passed the women in the waiting room—they were all so young. "What is this about?" she wondered. "It was the same thing I was seeing with my patients back in Chicago." Later, she decided to initiate a study. A collaborating doctor collected tumor samples from 378 women in Nigeria and Senegal and brought them back to her lab. This was a big step. "In some African languages," says Olopade, "there are no words for 'breast cancer.'"