In Search of a Rare Allele: Breast Cancer Genomics in Peru

INEN
 Instituto Nacional de Enfermedades Neoplásicas (INEN)

This summer in Peru I have worked on a study led by Dr. Laura Fejerman of UCSF School of Medicine that aims to better understand the problem of breast cancer genetics in Latina women, specifically Latina women of high indigenous ancestry. My first contact with Dr. Fejerman was in October 2016, as I started investigating the world of cancer research in developing countries. This has been described to me as a “niche interest” in the larger field of global health, which means there are fewer studies and less money put into this kind of work. Living in Mongolia from 2011-2014 as a Peace Corps Volunteer, the disparity between global health funding for acute and chronic illnesses caught my interest. Efforts to collaborate with the UN and NGOs on health projects were often hamstrung by the prioritization of acute illness, especially infectious illnesses like HIV, over chronic ones, like liver disease, diabetes, and cancer. Mongolia is fortunate to have mostly escaped the ravages of HIV/AIDS, but it was frustrating to me that the worst health problems in Mongolia were not treated as international priorities. I wanted to spend my summer learning about the problem of cancer in the developing world, and I feel incredibly fortunate to have found a mentor as generous and supportive as Dr. Fejerman.

After nearly nine weeks in Peru, my day-to-day life has a consistency and structure that med school has not. I leave my studio apartment and walk the 25 minutes through Surco to the Instituto Nacional de Enfermedades Neoplásicas (INEN—the national cancer hospital of Peru) so that I arrive before 8am, when the medical oncology clinic starts seeing patients, and leave after 4pm, when the phlebotomy office closes.

Most of my time in Peru has been spent discussing the details of the study with doctors and patients. By doctors, I mean I have interacted mostly with resident physicians at INEN. They spend more time interacting with patients than anyone else, and if they are convinced that our study is valuable, they may decide to suggest it to their patients. This usually happens at the end of the patient’s visit. The resident gives the patient an overview of the study, and tell the patients that it is strictly voluntary—that it will not make any difference in the patient’s treatment and that the doctor does not personally care if the patient chooses to participate or not, but that findings from the study might be beneficial to the larger population in the future. The residents tell the patients that they are free to pass, participate, or think about it and decide later. Many of the patients express an interest in at least learning a little more, and at that point the resident might call for me and my colleagues to discuss the study in more detail with the patient.

Dr. Tatiana Vidaurre, an amazing collaborator at INEN, warned us from the beginning that medicine and research are rarely integrated in Peru. To patients and doctors, the importance of non-diagnostic tests is not broadly appreciated. But I have been inspired by the number of patients, even those seriously averse to needles, who have been enthusiastic about participating despite the fact that they may never benefit directly from the study.

I deeply believe in the importance of the study I was helping with, which made my time doing research in Peru highly rewarding.

-Daniel

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