‘Actionable research is key to defeating prostate cancer’

The Founder Prostate Cancer Transatlantic Consortium and Famous Cancer Scientist from University of Florida, US, Prof. Folakemi Odedina received the Carnegie African Diaspora Fellowship to study prostate cancer in West African men. In this interview with KEMI SOKOYA, she speaks on prostrate cancer, her journey into the study, her family, career and others

Who is Folakemi Odedina and what was your growing up like?
I am Professor Folakemi Odedina; a Professor of Pharmacotherapy and Translational research at University of Florida, affiliated with both the College of Pharmacy and Medicine, as well as the Principal Investigator of the Prostate Cancer Transatlantic Consortium.

I am married to Prince Oladapo Odedina and we are blessed with three children and one son-in-law. I was born in Abeokuta, Ogun State, but raised in Lagos. I do not recall living in Abeokuta so much having left when I was a baby. My primary school education was at the Apostolic Church Primary School, while my secondary school was at Methodist Girls High School both in Lagos.

I graduated from University of Ife (Great Ife) with my Bachelor of Science (B.Sc.) in Pharmacy before going to the United States to do my PhD in Pharmaceutical Sciences. For over 20 years, I have focused my research in making a difference in the Black community in United States of America. I am well known globally for the work that I do in fighting prostate cancer in Black men.

What really inspired you into your chosen career?
When I graduated from the University of Ife (now Obafemi Awolowo University), I worked in Nigeria for two years. I worked at the General Hospital Ikeja as a community pharmacy, but it was not something I really liked.

Pharmacy was not my first choice (it was my late mother’s choice for me. I actually wanted to be a petroleum engineer. After practicing as a pharmacist for two years, I really didn’t like it. It was not what I wanted to do. In addition, I was not happy with the profession the way it was being practiced at that time, not only in Nigeria but also all over the world.

I went to University of Florida in United States and got my Ph.D. in Pharmaceutical Sciences. After graduating with my PhD degree, I got an Assistant Professor appointment at West Virginia University, and focused my research on changing the practices of healthcare providers for better patient outcomes.

However, changing the healthcare system was quite challenging and so I decided to focus my research on patients.

Early in my career, I was blessed to get funding for my research and be recognised through multiple awards. However, after some time, I realised that it is not about the awards or grant funding, it is about changing lives and making a difference. As we say in the United States, ‘’I don’t want to sit in the Ivory Tower thinking I’m making a difference with the funding, publications and award’’.

If I affect one person’s life through research, I have achieved my career goal. To make a difference in the world and fulfill what some people refer to “as my calling” I decided to focus on a disease that affects Black men in the United States and that disease is prostate cancer.

In the early 90s, Black men in the United States had one of the lowest life expectancy. Therefore, I decided to focus my research on Black men. It was a no brainer because it was a chance to do meaningful research that will increase their life expectancy and make a difference in their quality of life. I made the decision in 1996 to fight prostate cancer for Black men and that for me was the turning point.

What led you to study Prostate Cancer in Black Men, instead of women?
For me, it was by chance. It was not what I intended to do. It was something that accidentally happened because of a prostate cancer grant that I got in 2004. I had a grant from the US Department of Defence, which was over a million-dollar grant, and it included a Town hall forum to disseminate some of the research results to the Black community.

The Prostate cancer Town Hall forum had an expert panel that included researchers, oncologists and urologists and was attended by Black men of different ages. The goal of the forum was to educate the men, let them know about the disease that is killing Black men in the United States and how they can fight the disease. I clearly remember the question that was asked by one of the participants, who said: “I was diagnosed with prostate cancer in my 30’s and since the diagnosis I have a lot of friends with the same diagnosis. However, I have never heard an African man diagnosed with prostate cancer. If our relatives who are Africans are not getting prostate cancer, at least I am not hearing them say they have prostate cancer, is it only the US Blacks that have prostate cancer? Does that mean that if we in US move back to Africa we will not have prostate cancer?”
No one was able to answer his question in 2005. All the members of the expert panel were passing the microphone around because nobody was able to answer his question on prostate cancer in US Blacks compared to African Blacks. So I finally told the man, obviously we do not know the answer, because all of us studying prostate cancer in the US at that time were not disaggregating US Blacks from African immigrants.

I told him I was willing to put a pause on my career, take a sabbatical and go to Africa to find out the answer for him. And I would let him know as soon as I find the answer. The man laughed and thought I was joking. However, I was not. I took a sabbatical and I was privileged to get the Fulbright Research Scholar award to study prostate cancer in Nigeria in 2006.

Before I came to Nigeria for my sabbatical, I read history books on the Transatlantic Slave Trade to understand how we are connected with the US Blacks. I found out that the populations that are part of the Transatlantic Slave Trade came from different places in Africa, and journeyed to the Americas, Caribbean and Europe. Majority of the transatlantic slaves were taken from the Bight of Benin and Bight of Biafra – over 30%.

The Bight of Biafra and Benin regions are approximated to be the country Nigeria, which means that majority of the US Blacks are ancestral populations of Nigerians. If we really want to understand the etiology of diseases, such as prostate cancer, we need to study populations that are genetically connected to fully understand the genetic and environmental contributing factors for the disease.

For example, studying Africans, including Nigerians, and US Blacks will allow us to better understand the genetic contribution as opposed to the environmental contribution for prostate cancer. This is why I founded the Prostate Cancer Transatlantic Consortium, popularly known as CaPTC, in 2005.

The CaPTC is a US NIH/National Cancer Institute-approved consortium. I have research consortium sites in Africa, Europe, North America and the Caribbean. The CaPTC now has over 50 institutions and hundreds of investigators. Our primary goal is to figure out why Black men all over the world are affected by prostate cancer, whether there are significant differences in the burden of the disease among different Black men, and what can be done to reduce the disease in Black men globally.

How did it go within the period you spent in the country?
The problem we had at that time (2006) was that there was no significant research being conducted on prostate cancer and even cancer in general, in Nigeria. Through the connection of my husband, Prince Oladapo Odedina, I worked with Professor Eyitayo Lambo, the former Minister of Health, from July to December 2006. It was a blessing working closely with the Minister of Health then, which allowed me to contribute to some of the policies on cancer control.

We were able to make several strides, including developing recommendations for cancer registration in Nigeria and developing the first National Cancer Control Plan for Nigeria.

What are the different projects and activities you have rolled out so far?
I have written many publications on our findings on prostate cancer but things are changing rapidly. For example, about five years ago findings point to the fact that the incidence of prostate cancer was highest in US Blacks and mortality was highest among the Caribbean Blacks, especially the Jamaicans.

For one reason or the other, Jamaican men were reported to have the highest prostate cancer mortality compared to other Black populations. Africans were documented to have the lowest incidence and mortality compared to US Blacks and Caribbean Blacks. There are of course several reasons for the statistics reported for Africans, including the fact that population-based screening is not common and the low quality of data from cancer registries in Africa. The latest findings from our research group in Florida is actually pointing to some concerning statistics on prostate cancer in African immigrants.

I am just wrapping up a study funded by the Department of Defense, which studied over 11,000 prostate cancer survivors in the state of Florida. Comparing US Blacks, Caribbean immigrants and African immigrants, the group that was diagnosed with prostate cancer at the youngest age was Africans, mostly Nigerians.

Unfortunately, majority of men who are diagnosed with prostate cancer in Nigeria is at the late stage. The problem is that majority of Nigerians do not do annual physical checkup. We recommend that a Black man should talk to a doctor about prostate cancer immediately you hit 40. It is important to at least have a baseline PSA at that age.

What methods have you used in addressing the disease in Nigeria?
Research is key. I am working with 16 institutions in Nigeria and Cameroon on a Transatlantic Familial Prostate Cancer project that includes data collection in US and Europe. This study is important because we really want to be able to understand what is causing prostate cancer in West African men. We are using a comprehensive survey that includes personal and family history of cancer, lifestyle, diet, nutrition, health and wellness, weight, height, waist circumference, health behaviour and so much more. We are also collecting saliva for genetic analyses.

The project is part of the Carnegie award, which will allow me to spend three months in Nigeria to work with Nigeria investigators from 14 institutions in Nigeria: University of Ilorin, Covenant University, Ahmadu Bello University, University of Calabar, National Hospital Abuja, Ekiti State University, Obafemi Awolowo University, Lagos University Teaching Hospital, Lagos State University Teaching Hospital, University of Maiduguri, Federal University of Agriculture Abeokuta, Ace Medicare Clinics Ltd, University of Ibadan and University of Nigeria Enugu. We just started the study in late May and already have collected data from over 250 men in Nigeria and Cameroon. This study will be the first for so many findings, including the first time we will compare prostate cancer in Nigerian men residing in several countries as well as compare prostate cancer among the major ethnic groups in Nigeria.

We will also be able to have a better understanding of the risk factors for prostate cancer in Nigerian men and figure out how to best address prostate cancer in Nigerian men. I would say we are making a lot of progress but we still have a lot of work to do. For me, it is a call to action and we really need to accelerate biomedical research in Nigeria, including clinical trials. We cannot continue to use therapies that were developed and tested for other populations, such as Caucasians, and expect that these therapies will work perfectly well in Nigerians. The reason I keep coming back to Nigeria is to accelerate cancer biomedical research in Nigeria.

What are the factors that determined if someone has prostate cancer?
There are three risk factors that have been confirmed for prostate cancer. The first one is age; the older you are, the more likely you are going to get prostate cancer. The second factor is family history; if someone in your family has been diagnosed with prostate cancer then you have a higher chance of developing prostate cancer. The third risk factor is Black Race; Black men are more likely to get prostate cancer compared to any other racial group.

Of the three risk factors, the strongest link is family history. Unfortunately, many of us do not know our family medical history. A major problem that I have encountered in Nigeria is that many men do not share their diagnosis with family members. I have seen a case of a father not sharing his prostate cancer diagnosis with his sons, which is disheartening as the sons have increased risk for the disease and do not know.

What can men do to prevent prostate cancer?
This is a very active research area. Unfortunately, there are mixed evidence on prevention and to be honest we still do not know how to prevent prostate cancer. We know that there are some factors that cannot be modified, such as age, family history and race. Prostate cancer has genetic etiology, which is one of the reasons family history is very strong.

They are some things you can do that might reduce your risk of prostate cancer, such as lifestyle modification: maintaining a healthy weight, exercising and eating fruits and vegetables. Another active research area is Vitamin D and prostate cancer. Unfortunately, quite a number of Blacks have Vitamin D deficiency so it is good to take Vitamin D supplement.