Dr. Nneka:

Good morning, Doctor Omofoye

Dr. Omofoye:

Good morning. How are you?

Dr. Nneka:

I'm very well, thank you. How are you?

Dr. Omofoye:

I'm doing well.

Dr. Nneka:

It is so lovely to have you in this interview. Could you kindly Introduce yourself?

Dr. Omofoye:

Well, my name is Toma Omofoye. I am a breast radiologist and Associate Professor of Radiology in Houston, Texas.

Dr. Nneka:

Lovely to meet you. Your research interests are global health and the imaging of breast cancer and breast diseases, can we know how you came about this career choice?

Dr. Omofoye:

Well, I think global health chose me first of all and I think it chose me before I even had decided if I was going to be a physician or not. I was born in Nigeria to two physician parents. And so It was very clear how much of a need there was for health care and for people to participate in health education. For a long time, I considered public health or even healthcare journalism. But eventually, when I got to medical school, I decided on breast radiology and it has been wonderful so far.

Dr. Nneka:

That's fantastic. That is a major contribution to the field of oncology.

Diagnostic radiology uses noninvasive imaging scans to diagnose breast disease. Can you further describe diagnostic radiology, its entailments, technologies, and effectiveness in diagnosing breast cancer?

Dr. Omofoye:

Well, that's a wonderful question. Very broad but I'll try to do it justice.

Diagnostic radiology is medical imaging. This includes X-rays, CT scans, MRIs, and other sorts of technologies to take pictures of the inside of the human body. And based on this very large body of knowledge, when we have those images of the inside of the body, we can find the patterns that are characteristic of different diseases. And we're able to diagnose a lot of diseases just based on imaging in a way that people couldn't do 50 or 100 years ago.

But part of what is so wonderful about diagnostic imaging is that we also can, in some cases, actually confirm diagnoses by doing biopsies. For some disease processes, when we see the images and the characteristics that make us suspect that a particular disease is present, we can help confirm that it's truly a case of that disease by performing a biopsy.

In the olden days, if you needed a biopsy to confirm a disease, the patient had to be taken to the operating room and a surgeon had to perform a whole surgical operation to get a sample of the tissue to send to the lab to confirm the disease. So the patient had gone through a surgical procedure, the pain that came with it, and even the cost involved. And often that's just step one because that's just the diagnosis. Afterward, the patient still has to go through the whole treatment paradigm.

So I loved how smart diagnostic radiology and interventional radiology were. Because now using images, I can go with an ultrasound machine over the exact spot where I see the abnormality, take the tiniest needle, make a tiny incision, get a sample out, and send it to the lab in a way that is much more comfortable for the patient. This reduces the possibility of healing difficulties, costs less in most cases, and allows the patient to begin treatment sooner.

It's funny that in a lot of cases, especially in breast imaging, when we are diagnosing breast cancer or breast disease through biopsy, our patients are awake and we're talking with them. And the patients will often ask 'Okay, have you started?' and I'll tell them 'Actually, that was the end. We're done now.' The ability to provide health care in a humane, gentle, and smart manner while leveraging technology to improve health is wonderful.

Dr. Nneka:

Fantastic. Infiuss Health focuses on democratizing clinical research in Africa because we want to ensure patients and African patients have access to the best and most advanced medical interventions, including pharmaceutical products.

Do you see differences in the anatomy or physiology of patients that might affect the variations in breast cancer incidence or prevalence in your practice? If you compare the typical African American to the typical Anglo-American, are there differences that you've noticed?

Dr. Omofoye:

That's a really interesting question. And there's a third piece there. Is there a difference between the Africans in Africa, the African Americans, or the Anglo Americans, right? There's that whole spectrum. And the truth is that we find that breast cancer in African American women and women of African ancestry tends to be diagnosed at a younger age. So there is some difference, we just don't have all the answers as to why.

Interestingly, also, in the African American women and women of African ancestry, we find that they have a lower survival rate from breast cancer compared to their Caucasian counterparts. Some of this is very confusing.

We also know that a particularly aggressive kind of breast cancer, called triple-negative breast cancer, a version that can be a bit harder to treat, is more common in women who are African American or of African descent. So there are some differences, I think, in the biology of these women. This raises a lot of questions for current research on how to eliminate health disparities and improve health for women everywhere.

For women in these groups, it becomes even more important that we work very hard toward early diagnosis. In Africa, for example, we know that 70% of breast cancer cases are diagnosed at later stages, stages three and four, which is very, very different from a lot of the high-income countries, where the majority of cases are diagnosed at the earliest stages.

What I want everyone to keep in mind is that breast cancer is a highly treatable disease, especially when diagnosed in the earliest stages. In most instances, the five-year survival rate is over 90%. And so when we lose the opportunity to diagnose it in the earliest stages, we are placing the burden on a longer course of treatment that may not be as successful. The multiple treatment regimens take longer time, and may not be as efficacious as the treatment that we're able to implement in earlier stages. So early diagnosis is especially important. And while we may not have all the answers about biology, and the differences in subgroups, we do know that early diagnosis improves outcomes for everyone across the board. That's one thing we always want to emphasize.

How can we communicate one-on-one with women everywhere that all women have some risks, especially women who are of African or African-American ancestry? We want to always be thinking, how can we implement early diagnosis? Beyond that, we also want to do all that we can to provide access to people so that the people who are trying to come in for a screening exam or come in the first time they feel a lump, have the opportunity to have early access and early diagnosis of disease as well.

Dr. Nneka:

Yes, definitely. Thanks for the explanation. It's very interesting. I wonder if you also see differences in the response to treatment.

Dr. Omofoye:

I will say that, because I'm a diagnostician, the treatment piece is not as much my work or purview. But there may be differences in the treatments that are offered now. If you're looking at large population groups, there may be differences in treatments that are offered to African American women versus white women. And some data has suggested that African American women were more likely to receive treatment that fell outside the guidelines. They may have had shorter courses of treatment, or more interruptions to their treatment, certainly longer delays before beginning treatment. And all of these cumulative effects could contribute to the poor mortality of that group as a whole. About the treatment and the response, I think I would have to defer that to an oncologist. Nevertheless, as of now, we see that overall treatment outcomes do not seem balanced.

Dr. Nneka:

And that is quite unfortunate, isn't it?

Dr. Omofoye:

Yeah. Absolutely. We want everyone to be able to take advantage of medical advances in a way that helps to prolong life for all of us. It will help us to be here for our families.

Dr. Nneka:

Yes, definitely.

Just another question. Are there any epidemiological risk factors associated with an increased incidence of breast cancer in patients that you have observed?

Dr. Omofoye:

This is such a great question. Thank you for asking this.

If there's one thing that you take away from this, let it be that there are differences that can confer a higher risk of developing breast cancer in certain groups. The two groups that we now have a higher risk for developing breast cancer are Ashkenazi Jewish women and black women. So women who are of African ancestry do tend to have a higher rate of breast cancer-associated genes, BRCA-1 and BRCA-2 genes. It increases their risk of developing breast cancer throughout their lives.

A lot of times when you speak one on one with patients, they'll say, 'Well, breast cancer doesn't run in my family. I don't know why this would happen to me.'

Every person, every woman has some risk of developing breast cancer. But we want to be especially careful when we're talking about women who are of African ancestry or Ashkenazi Jewish descent because there is a higher risk in those populations. We want people to know that they have the opportunity, way before anything pops up, to go ahead and assess the risk. It's something that we offer at our institution. You can have a meeting with your physician to estimate your risk of breast cancer. This is important because we have solutions. If you have that estimation done and your lifetime risk of developing breast cancer is above 20%, you have several treatment options available to you.

For some people, it means that they would just undergo screening more frequently. They would have two screening exams a year, a mammogram every year, and an MRI every year. And they will typically start with these six months apart so that every six months, they're getting screened. You have the opportunity of screening more frequently with more modalities. Also, depending on the cause of that elevated breast cancer risk, you may be eligible for some medication that can help to reduce that risk over your lifetime.

And then some people whose risks are high, like some women who have genetic mutations, may consider performing a mastectomy before breast cancer has a chance to develop. It was in the news a few years ago, when some high-profile actresses had undergone mastectomies for these reasons.

There are always options when you know your risk. People must be empowered to know that whatever we find, we will find a solution to help address it.

Dr. Nneka:

Yes, that's amazing to know. Thank you very much, Dr. Toma.

Among the radiological methods of diagnosing breast cancer in your practice, what would you consider to be the safest and most effective? And what are the advantages and disadvantages of each method?

Dr. Omofoye:

The truth is that mammography is one of the safest and best imaging modalities that we have, especially for diagnosing breast cancer. It's not exciting. Women don't often want us to talk about mammography because they associate getting that mammogram done with having their breasts put in the machine, and there's some compression and discomfort for a few seconds. But mammography has been proven over and over again, to find breast cancer at its earliest stages before it can be felt. That is when treatment is most effective. And we know that the cancers that are found in mammography tend to be smaller, and easier to treat. So mammography has been linked with decreased mortality in breast cancer.

It's pretty remarkable. There are not a lot of tests for a lot of cancers. And even for cancers that can be tested, we don't necessarily have robust evidence associated with them, saying that the tests decrease mortality associated with the disease. So mammography is our workhorse. We respect it. We continue to encourage people to undergo annual screening mammography.

Now, in addition to mammography, there are other options. Women may undergo ultrasound examinations as well. That's because, for some women with heavy breasts, mammography is beneficial, but the way their breasts are structured, smaller masses may be missed on a mammogram. So those women still have to undergo mammography, but they have the option of also undergoing ultrasound for additional screening of the breast, or they can undergo an MRI.

Now, breast MRI is a very, very sensitive test. It's different from the mammogram where you come in stand, get your pictures taken, and leave in 20 minutes. The MRI is a bit more involved. You come in, you have an IV placed. We give you some IV contrast medication, while we place you on a table in the scanner, the big donut scanner. And it takes much longer to take images of the breasts. Because here we're not just taking pictures, we're checking images to see how that injected contrast interacts with any potential masses in your breasts. So we'd see lots of masses, some of them may be cancer, some may not be, but it's a much longer study. It is a very sensitive test. In this situation, somebody has to have contrast and they have to be able to tolerate being in the machine. It's just not easy for claustrophobic people. It's a longer amount of time for that examination to happen. And it was more expensive. And so MRI is something that we tend to save for cases where women are at high risk. Some other questions need to be answered by this more sensitive, but more extensive testing.

So we always prioritize mammograms. And in fact, we continue to teach ourselves in mammograms to get better and better at them, to modify them in ways that help us to detect breast cancer even better than we have in previous years.

Dr. Nneka:

Wow, that's fantastic.

Are you aware of any upcoming advancements in the field of radiology for detecting breast cancer?

Dr. Omofoye:

Absolutely. I mean, those of us who go into science, do not give up easily. We're always trying to be a little bit better. There are lots of exciting advances.

Over the last couple of decades, we added on tomosynthesis, which is sort of a 3-D mammogram that can be added on to your usual mammogram. And that helps us, especially with patients who have dense breast tissue.

But even beyond that, more recently, we're going towards contrast mammography, which allows us, similar to the MRI, to inject contrasts into the patient. And it goes through the body relatively quickly. But while it's going through the breast tissue, we take mammogram images of the breast, because that contrast can help any masses in the breast to become more prominent. It helps with the diagnosis of breast cancer. Contrast mammography has probably been the big new thing for us in the last few years. And there's a lot of excitement about ways that this could be beneficial. Some patients cannot tolerate MRI, for example. Being able to do a contrast exam with mammography may allow those patients more options for their screening beyond a standard mammogram. So there is lots of exciting technology all the time.

Dr. Nneka

Yes. And that's why we're here. Our goal is to improve patient care by advancing newer technologies and therapies.

So the final question. As a woman listening or reading this, what piece of advice would you give her about her health? For instance, if she has already received a diagnosis, or if she hasn't, as well as how to take care of her general health about breast cancer.

Dr. Omofoye:

The first thing I would like every person to take away is that every woman has some risk of developing breast cancer. For every woman in the United States, the risk of developing breast cancer is one in eight women. So it's relatively common to see. But beyond that, what I want people to know is that the sooner it is found, the easier it is to treat, and the more likely that treatment is to be successful.

I don't ever want anyone to be paralyzed by fear or worry, we would ideally like to identify cancers before you can even feel them through participating in an annual screening mammogram. But if you do feel something or your dog feels something or your partner or your child feels something, you need to have an appointment to come in as soon as possible to get that checked out. Not all changes to your breasts, skin, shape, or nipple, turn out to be cancerous. But you must come in as soon as possible. And then I think what I want to say to the women who have been diagnosed and really to all women is that there are always options. I think that we continue to make advances in science, in the diagnosis, and management of breast cancer. And so we want people to always stay engaged. You must find doctors that you trust and then follow their recommendations. And if you find that their recommendations are not working for some reason, or that you're running into issues, go back to that doctor that you trust, and say 'Oh, let's find a different option'.

We want patients to feel empowered. We want to be teammates with our patients, with all women, and with their families because everyone has different goals. So stay in communication, and let us try to leverage the best of technology for your benefit.

Dr. Nneka:

That's great. Thank you so much, Dr. Omofoye, for your insightful words, for giving us an insight into your therapeutic expertise, and for taking the time to be here.

Dr. Omofoye:

Thank you for getting the word out about breast cancer and all that you do to try to improve health care for people all over the world. And thank you for having me.

Check out the link to the interview:

https://youtu.be/PPT6TLACFqY

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