Dr. Jingmei Li, a Senior Research Scientist at the Genome Institute of Singapore, uses genetics to improve women’s health and prevent breast cancer.
Dr. Jingmei Li is a Senior Research Scientist at A*STAR’s Genome Institute of Singapore (GIS). She holds a bachelor’s degree in Science from the National University of Singapore (NUS), majoring in Life Sciences and minoring in Technopreneurship. She pursued her Ph.D. at the Karolinska Institutet in Sweden. A decade later at GIS, Jingmei leads her own group under a national initiative that seeks to use genomic sciences to improve public health and public prosperity in Singapore. Jingmei’s personal mission is to improve the lives of women. She studies genetic and non-genetic risk factors of breast cancer, including X-ray images of breasts (known as mammograms), to identify women who are more predisposed to developing the disease. In 2014, Jingmei received the prestigious UNESCO-L’Oreal For Women in Science International Fellowship for her work on breast cancer. In 2017, she received the Young Scientist Award administered by the Singapore National Academy of Science, a prominent accolade given to young researchers and scientists. Through her work, Jingmei has unearthed insights into the mechanisms and variants that can increase a woman’s risk of developing breast cancer. Jingmei is passionate about science communication, education, and promoting breast cancer awareness. Jingmei’s research pushes the boundaries of what we know in science to benefit society and make a difference to the worldwide community.
What’s the story behind your motivation to study Science and Human Genetics? Was it a childhood dream to carve a career in the fields of Science?
Like any child, my what-I-want-to-be-when-I-grow-up moment is based on what I read about in books. I have imagined myself as a doctor, nurse, teacher, mathematician, engineer, astronaut, and rocket scientist among others at different points. As for how I ended up studying breast cancer, I like to tell people that it’s love at first sight. For my graduate school (Karolinska Institutet, Sweden) I was drawn to a group of brilliant clinicians and researchers who were really passionate about the work they do. Above and beyond science, they genuinely cared about the patients. The energy was positively contagious!
Who had inspired you and greatly influenced your life philosophy?
I stand on the shoulders of giants. I am also incredibly lucky to be blessed with shining role models – both men and women. I have done a lot of work in the space of women’s health, most notably – my work on breast cancer. Typically seen as a woman’s disease, it is easy to forget men who have also contributed significantly to improving women’s health. One in every 100 breast cancer happens to a man. Science is genderless. Every day, I walk into the research institute as a woman. But once I am in the lab, I am a scientist like everyone else. Whether it’s a man’s problem or a woman’s problem, it is a problem that we must tackle and solve. Naturally, we have a lot to thank men who worked really hard to improve women’s health. Take for example my own Ph.D. supervisor, Professor Per Hall in Sweden. He was originally a radiation oncologist but later became a full-time researcher. The reason he gave was that as a doctor, he could only treat one woman at a time. However, as a researcher, his findings could potentially make a difference to millions of women.
That’s why he was very passionate about doing studies on how breast cancer can be prevented. Also, it wasn’t a one man’s war against breast cancer, Per also infected many of his students with his passion. I found even deeper motivation when I shadowed a breast cancer surgeon in Singapore when he ran clinic to see breast cancer patients. It was only for a day, and I acted as a translator in dialects when I could. But I felt the same anxiety when the patients come in for the visit, not knowing what diagnosis they would hear. When they cried with relief and profusely said thank you when told it wasn’t cancer, I had to fight back my own tears. There are millions of reasons why I choose to work on breast cancer because every breast cancer case is a motivation for my work to continue.
Can you introduce and tell us about your work and researches?
The focus of my research is on disease prevention. Or at least early detection. The total spend on cancer drug discovery outnumbers prevention research by as much as 40-fold, according to the European Commission during Framework Programme 6 (2002–2006). Too much hype is focused on looking for a cure; too little attention is spent on preventing cancer in the first place. In my projects, I look into the book of life itself. I scrutinize the DNA that defines us to look for genetic differences that spell who is likely to get breast cancer, and who is not. The same goes for who is going to die from breast cancer, and who will die with breast cancer. My aim is to discover novel susceptibility markers and mechanisms, which are bits and pieces of clues essential to solving the puzzle of the disease. Knowing what makes the cancer bomb ticks will ultimately be helpful in stratifying the population according to the likelihood of getting the disease so that resources can be reallocated to individuals at high risk more often than those with the below-average risk of getting breast cancer.
Breast cancer is the most common cancer in women and the leading cause of cancer deaths among women. Survival can depend on when the cancer is diagnosed. The research could provide future opportunities for early intervention to stop breast tumors developing. Predicting an individual’s cancer risk can go a long way towards detecting cancer early.
What were the biggest challenges you encountered during your researches?
Clinical and follow-up data is usually kept by each hospital separately. Retrieval of samples and data and coordination between different sites can be laborious and time-consuming. Quality, for example, too many missing values, may also be an issue. IMHO, breast cancer research has come a long way in Asia. With the confluence of affordable genomic analysis, accessible information and educated public, the potential to improve women’s health are tremendous. There is also an emphasis on clinicians to be active in scientific research. The barriers to breast cancer research pale in comparison to barriers to bringing the fruits of science to the public.
What gave you the strength to go on and achieve your goals?
Like I said before, there are millions of reasons why I choose to work on breast cancer because every breast cancer case is a motivation for my work to continue.
What did winning the L’Oréal-Unesco Women In Science International Fellowship mean to you, and what has changed for you since then?
As many wise men said: “Talent is everywhere but the opportunity is not.” I find joy in encouraging others to explore the education and funding opportunities that were offered to me. To be honest, I may not be in the Science field today if my senior in high school did not pass me an application form to apply for a Science scholarship. Without the support of initiatives such as the L’Oréal-UNESCO For Women In Science International Fellowship, the importance of breast cancer awareness and the work we do may not be shared as widely to the correct audience (through press releases, etc.). Through digital media and public outreach, I hope to bring the same opportunities to young aspiring scientists.
How much has changed in the research of genetic risk factors for aggressive breast cancer from when you started your study? What has been achieved and what significant challenges that still needs to be overcome?
In the past decade, I have been deeply involved in a journey to identify common genetic variants (i.e. SNPs, pronounced “snips”) that are linked to breast cancer. To date, there are 313 such known breast cancer SNPs. Individually, each SNP increases breast cancer risk by only a little bit. I call them “genetic fortune cookies” since the associated increased risk is often so small. However, when the information from all known 313 SNPs is combined, the collective ability to group women into those with high and low risk of breast cancer is tangible and actionable.
It is important to know whether an individual has high or low blood pressure so that he or she can modify diet or lifestyle to prevent heart diseases.
Similarly, it can be immensely helpful to know whether a woman is at high or low genetic risk of breast cancer so she can make similar lifestyle changes to prevent cancer. More importantly, knowing one’s genetic risk allows a woman to make conscious and informed choices about whether to go attend mammography screening, which has been shown to save lives through the early detection of breast cancer.
However, the bulk of genetic knowledge we know today is based on studies performed on participants of European descent. Less than 14% of the studies were Asian. The frequencies in which disease-associated SNPs can vary greatly between populations, potentially leading to inaccurate risk estimates and limited clinical utility in other populations.
Apart from genetic susceptibility to disease, Asian women are substantially different from women of European ancestry in nearly all aspects: lifestyle, reproductive profile, cultural and religious beliefs related to health, socioeconomic status, and drug metabolism and response.
Major differences are also known to exist within ethnic subgroups. Among the three main ethnic groups in Singapore, Chinese women were at higher risk of developing breast cancer in comparison to their Malay and Indian counterparts (Singapore Cancer Registry Annual Registry Report 2015, National Registry of Diseases Office). However, Chinese breast cancer patients were less likely to die from breast cancer compared to Malays and Indians.
My team and I are currently working with other Asian breast cancer cohorts to clarify and address potential differences for the diverse populations in Asia. Take for example Singapore, which has government-subsidized nation-wide mammography. While the ideal attendance for a screening program to be effective is ~80%, the percentage of women in the target age group who have gone for a recent mammogram scan is only around 35% in recent years (2010-2015). If 35% of the population who attend screening is random, we can expect to detect ~28% of all breast cancers. (Mammography screening itself if not perfect and not 100% effective, hence the lower estimate.) However, if the women were ranked by their genetic risk and only the top 35% at the highest risk were screened, we can expect to find a higher proportion of breast cancers (~50%) in a smaller group of women. The bottom line is: knowledge is power. Knowing what puts us at risk can help to save lives.
Science has made great gaits in research. Do you think there are still personal fears, which may lead some women to choose to postpone breast cancer screening? Or are women getting more concerned about it?
The barriers to breast cancer research pale in comparison to barriers to bringing the fruits of science to the public. I agree with the UK chief scientist when he said that “Science is not finished until it’s communicated.” There is evidence that risk-based screening for breast cancer saves lives, but women, especially those of the age who are most at risk now, still largely hold on to a “don’t know, don’t care” mentality. Some cultural influences may also lead women to believe that any sickness is the will of God and because of that, they delay going to the doctor. In summary, the bigger challenge in breast cancer research is how to communicate relevant findings to the public and patients in a way they can take personal action. Knowledge without action is after all not power, but impotence (misquoting someone else). The bigger questions beyond scientific findings which would be good to address are:
Implications of low public genetic literacy. What are the consequences? The critical challenge of educating the public about genetics. How do we do that? Facts don’t change our minds. How do we change women’s behavior?
The information and increasing breast cancer awareness can help to get clear the personal risk of women and about this disease. Prevention and early detection is the most effective way instead of finding only the cure.
Can a balanced lifestyle (healthy nutrition, fitness exercise and psycho-physical meditation) make the difference and contribute to control and pre-treatment over potential patients at risk? What tips would you like to give to women?
The reason for my emphasis on identifying women at high risk of developing breast cancer is because there can be life after breast cancer if the disease is detected early. The survival rate for early detected cancers (stage 0 or stage 1, usually through mammography screening (i.e. X-rays of the breast)) is almost 100%. While mammography screening can save lives, it does have drawbacks (false positives, missed cancer, radiation, anxiety, etc). In an ideal world, women with higher risk will be screened more often, and women with lower risk can be spared unnecessary screens.
The ability to use germline genetics to identify high-risk women is important as currently only family history (not genetics) is used to make this distinction. If a woman has family members with breast cancer, she is also at a higher risk herself.
However, family history has limitations. Family sizes are getting smaller; relatives may not be on super close terms; taboos regarding the talk of diseases. A person’s genome can be more informative about a person’s medical history (perhaps medical future is apter?) than anyone else in the family. Genomics will become an intimate part of our lives, be it in disease prevention, early detection, or treatment.
Pertaining to your question, while genetics can identify women at high risk of developing the disease, genetics is less likely to be the culprit of the INCREASING breast cancer incidence rates globally. (New mutations take a long time to establish in a population.)
Lifestyle and reproductive factors are the likely culprits for the rapid change in breast cancer incidence rates.
These factors predominantly include a number of children (which dramatically changed over just two generations in Asia) and obesity (which also dramatically changed) and to a lesser extent, other factors such as age at menarche and age at menopause.
A breast cancer risk profile comprises both genetic and environmental components. Making healthier lifestyle choices overall will certainly reduce the risk of breast cancer and other diseases.
You are a woman in science working for women. There is anything else would you like to share or do you have supportive advice?
Madeline Albright has this famous quote: “There is a special place in hell for women who do not help other women.” There are good women, and there are good men.
Photos courtesy of Dr Li Jingmei