BREAST CANCER

Future Tech

While it is technology that drives Dr Li to work, tech is also something the 36-yearold scientist draws on to integrate with traditional cancer research. She cites our ubiquitous usage of apps to track our fitness, diets, and sleep cycles, and says that “when used properly, Fitbits will not lie about how many steps one takes a day, yet, many cancer research studies are still collecting data in the form of questionnaires where subjects are asked to recall and quantify diet and exercise”.

Which leads her to wonder: “If we have all the variables in the universe, can we predict the future? If we have all the correct variables, can we prevent breast cancer?” It’s this insight that grounds her research, and the fact that she’s determined to propel breast cancer research into the 21st century. “Everything we know about breast cancer now is based on one generation ago: age of first period, age of first birth, number of kids… everything has to be calibrated to suit our context now,” she shares. “A lot of the breast cancer studies are done on Caucasian women. It’s important to do work on Asians as well.”

The Woman Behind the Work

In broad strokes, her work aims to identify women at increased risk of breast cancer, so that preventive measures like individualised screening, or eventually chemoprophylaxis (the use of drugs to prevent disease) or surgery, can help to reduce the mortality of the disease. And be under no delusion – it is a very common disease. In Singapore, one in five women will develop cancer by age 75, on average. Among all the women diagnosed with cancer, one in three has breast cancer. One woman gets diagnosed with breast cancer every five hours. More women die from breast cancer than any other cancer. Dr Li is trying to change the dismal statistics through her research and advocacy.

Beyond cancer, she is also using genetics to look into what causes nonlactational breast infections, an area she feels is currently lacking research.

The National Research Foundation Singapore is funding her current research project. Her studies aim to address the rising incidence of breast cancer in Singapore, and the lukewarm response to mammography screening (low participation and adherence), by integrating mammographic density, lifestyle and genetic data.

Working with her is her immediate team, which includes two postdoctoral fellows, one research officer and one student. They collaborate with research teams from various hospitals in Singapore and Malaysia.

“The openness to collaborate makes the disease rather unique. Without the combined effort of different groups all over the world, we wouldn’t have come so far in identifying the different risk and survival markers.”

The Past Informs the Present

Her work has brought her recognition in Singapore and beyond. Last year, she was the only woman to receive the Young Scientist Award in the President’s Science and Technology Awards – the most prestigious accolade given to researchers and scientists in Singapore. In 2014, she was one of 15 women to receive the L’Oreal-Unesco For Women In Science Fellowship Award.

Her initial trajectory was unassuming: Jingmei went from Loyang Primary School to Anglican High School and Hwa Chong Junior College, then to the National University of Singapore, where she studied life sciences and was valedictorian for the class of 2006. That same year, the Karolinska Institutet in Stockholm welcomed her to their lab (by then she was an A*Star Graduate Scholarship holder). As a student, she loved the energy and overwhelming positivity of the people working there. “It did not matter that I knew nothing about statistics, genetics or epidemiology at that time. I just knew that I wanted to be part of it,” she recalls.

Science didn’t choose her, she chose science: “When would you know if you want to marry a certain man? You

go out with a few candidates, and decide that this choice is for you. Similarly, I took up many courses offered by different faculties and interned at various companies before deciding that I was ready to take up science as a career.”

Current Mode

Dr Li does a lot of writing, looks at hundreds of mammograms, attends far too many meetings and, like us, is distracted by too many e-mails. But she takes occasional dive trips to get away from it all. And she somehow still finds time to read medical thrillers (it’s Robin Cook she curls up with, if you must know). She also loves dressing up, and it’s no coincidence that pink is her favourite colour.

The next chapter in her own medical thriller is “Precision Health Care”, which proposes the customisation of health care, with medical decisions, treatments, practices or products tailored to the individual patient.

“The enemy is cancer. I’m establishing an understanding of its target through breast cancer patients and breast cancer study participants (healthy volunteers). Without their participation and belief in science, no real progress in breast cancer research can be made,” she adds.

Dr Li’s PhD supervisor, medical epidemiologist Per Hall from Karolinska Institutet, says her commitment to data analyses makes her one of the new generation of epidemiologists. “To make predictions about whether an individual has a high risk for breast cancer, Dr Li looks for genetic markers as well as lifestyle factors, such as obesity, that are linked to an increased risk of cancer. She also incorporates a third component into her risk assessment, using mammogram images to study breast density.”

Breast Cancer Awareness Month

“A few years ago, my mother had abnormalities in her throat. She kept it from me until she got the test results showing that she was going to be okay. My best friend, too, kept a testicular cancer scare from me until it was confirmed to be just that, a scare,” Dr Li says, adding that she hopes the “cancer conversation” or narrative will expand its focus on treatment to also include prevention.

“It is not just breast cancer that can turn a woman’s world upside down. Certain non-cancerous breast infections can present themselves with symptoms similar to those of cancer (for example, a painful lump in the breast). While not acutely life-threatening, breast infections can be extremely upsetting and damaging for the psychological and physical health of the patient. To make it worse, certain infections have a tendency to recur.

“Many doctors don’t know what causes this, so there’s no standard treatment, and it can be very trial-and-error,” she says. She wants to be able to help doctors find a way to treat sufferers without causing side effects or discomfort.

“There have been cases where a breast infection was so agonising that an otherwise healthy patient without cancer opted for a total mastectomy, surgery that removes the entire breast. Recognising that improving women’s health is not just limited to breast cancer, one of my main goals will be to work closely with different clinical collaborators in Singapore to study breast infections.”

In August, she delivered a TEDxNTU Talk on “whether cancer has been cured yet”.

“We are making progress. In 1970, the median survival of all cancers was one year after diagnosis. In 2007, it had increased five-fold to five years after diagnosis. That’s five extra years gained: 1,800 more days, 43,000 more hours. With the advent of genomics and personalised medicine, we will be able to push the boundaries of survival and gain even more time.”

So, no cure for cancer? Don’t bet on it.

“Breast cancer may not be ‘cured’ in my lifetime, but we will most certainly be better at preventing it. Prevention, however, sometimes needs that little nudge and reminder.”