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Even though Nicole Lambert has more than two decades of experience at Myriad Genetics, which helped discover the BRAC1 and BRAC2 breast cancer genes almost 30 years ago, she hadn’t given much thought to her own risk until several close family members were diagnosed.
“No one in my family had cancer when I joined Myriad,” Lambert said. “But over the years, that changed. My mom was diagnosed with breast cancer twice and then my Aunt Joan died of metastatic breast cancer. We’ve tested millions of patients for the presence of mutations on those genes. But I’d never really looked at my own risk. This was an interesting journey for me personally and professionally … it changed the way that I thought about what we should prioritize as a business in terms of making things easier and more accessible for patients.”
As a genetic counselor by training, Lambert knew that when she was identified as high risk and after receiving a pathology report indicating she had not one but two cancers, one of which was aggressive, she had to take action. Ultimately, a surgery saved her life.
“It was actually empowering to hear because I had already taken control over it,” Lambert said.
Lambert’s journey with Myriad Genetics has spanned numerous roles, which she said is one of the reasons for her longevity at the company.
“When I started with Myriad, we were a $16 million company and now we’re about a $700 million company,” she said. “And that growth trajectory offered me a lot of opportunities for learning and development along the way. I’ve played so many different roles at Myriad from commercial roles in sales and marketing to more operational roles. I’ve always had the opportunity to learn and grow and develop. And the other thing is, Myriad has diversified quite a bit … into dermatology and urology and mental health. So, I was constantly challenged … (and) had the opportunity to change jobs and experiences and learning opportunities without changing my parking spot.”
Among all those roles, including her current position as chief operating officer, Lambert has reveled in the opportunity to change how physicians approach care and problem solve on behalf of patients.
“Someone once said to me, courage is just fear that has said its prayers,” she said. “And I have remembered that statement over and over again. If you’re going to change the world, you’re going to have to do things that are big and bold — things that other people have not had the courage to do. There’s always going to be a certain amount of fear and you just have to say your prayers and go forward.”
She is also dedicated to raising awareness around the importance of genetic testing.
“It is estimated that of all Americans who carry a BRCA mutation, probably fewer than 10% of them know it,” she said. “Over the 30 years, we’ve done a good job of addressing some of these barriers. Recently, some of our market research found that 76% of women are just waiting for their doctor to bring it up. They’re not being proactive about it. So, we’ve got to help them understand what it is, why it’s important and that it’s not something to be afraid of.”
In this episode of the Woman of the Week podcast, Lambert shares her personal journey as a cancer survivor, why she is devoted to thinking about the holistic patient journey and how she hopes to empower other women to take action.
Welcome to WoW, the Woman of the Week podcast by PharmaVoice powered by Industry Dive. In this episode, Taren Grom, editor-in-chief emeritus at PharmaVoice, meets with Nicole Lambert, chief operating officer, Myriad Genetics.
Taren: Nicole, welcome to our WoW podcast program.
Nicole: Thank you so much for having me. I’m excited to be here.
Taren: I’m excited to dig in with you. Nicole, you have stated that you chose a career as a genetics professional because no family, and particularly yours, should be destroyed by cancer. Can you please share some of your personal journey with our audience?
Nicole: Sure. So I’m a genetic counselor by training. And so, I had worked with families over the years that either had some type of pediatric condition or had cancer in their family. I always was drawn to the cancer families because I hated to hear those stories where the patients would say, remember when we got together at this person’s funeral or that person’s funeral? Your family reunions were funerals and I hated that. And so, I was drawn to those patients in the first place but I didn’t have a family history of cancer at all. No one in my family had cancer when I joined Myriad. But over the years, that changed. And so, my mom was diagnosed with breast cancer twice and then my Aunt Joan died of metastatic breast cancer. And so, that changed for me quite a bit.
That’s when I realized, I worked for Myriad Genetics. We helped discover the BRCA1 and 2 genes. We’ve tested millions of patients for the presence of mutations on those genes. But I’d never really looked at my own risk. I had never really thought through that. And so, that was an interesting journey for me personally and professionally to go through the process myself. But it also really changed the way that I thought about what we should prioritize as a business in terms of making things easier and more accessible for patients.
Taren: So your own journey, what did that reveal to you? Because now you are somebody who can change the trajectory and course of therapy for others. But you’re now put yourself into a patient position.
Nicole: Yeah. For my own journey, I did go forward and get tested and I was found to be very high-risk. Which I think is important too. One of the things I would want to share is, genetic testing has come a long way. I mean, when I was a genetic counselor, you either had a mutation and you had an 87 percent lifetime risk or you didn’t and you were thought to be fairly low-risk or familial-risk or something else. With the risk score testing that we have now, you get a lifetime risk to develop cancer and you also get a five-year risk. So for me, my lifetime risk was very high. But my five-year risk was only 3 to 5 percent. So that allowed me to say, okay, you know what, I’m busy with my career and my son, and it was the beginning of the pandemic. I just don’t have time to deal with this right now. And so, I just increased my surveillance.
But overtime, I realized I am high-risk. I really need to go in and have surgery. And what the surgical pathology report uncovered is that I already had two breast cancers and one of them was very aggressive. So if I had not done something right away, if I had not gone through the testing and chosen to act on it, I’d be having really different conversations with my son.
Taren: Wow, that had to be devastating news to hear. And as you say, that little ounce of knowledge really gave you so much more prevention at the end because here you are.
Nicole: Yeah, it’s funny. It was actually empowering to hear because I had already taken control over it. I was very aware in that moment of that dichotomy. Because I did this early, I feel strong and empowered by this. If I had waited another year and gotten a diagnosis, you’re right, I would have felt devastated by it.
Taren: Well, thank you so much for sharing so much of that personal history with us. Your company, as you noted, genetic testing has come a long way, has been at the forefront of this change and has been a game-changer for women and risk assessments. I would love to hear from you, how did that all evolve at Myriad Genetics? And also, due to the lack of the diverse ancestry in genetic databases, can you tell us a little bit about the evolution of the Risk Score?
Nicole: Sure. As I mentioned, we had helped discover the BRCA1 and 2 genes believe it or not, almost 30 years ago.
Taren: I find that hard to believe. Sorry, that …
Nicole: I know. I know, most people do but it really was a long time ago. But we knew that that wasn’t it. We knew that there was more out there. There had to be other genes that predispose to breast cancer. And some of those have been discovered, PALB2 or a CHEK2 or ATM. There are other genes but we also knew there have to be other hotspots. We had to look across the whole genome and say, okay, what else is tracking with breast cancer and families? How can we get a more comprehensive assessment of this? But the other thing is, are we sure this works the same across ancestries because there were other groups working on a personalized risk score. But when people would ask at scientific conferences like, hey, does this work the same in women of other ancestries? Often researchers would say, yeah, we suspect it does.
But that was not what we were seeing in our data at Myriad. We were seeing something very different. And if you look at the group of genetic markers that goes into risk score, if you look across women of European ancestry, there’s a certain bell curve distribution. But if you look at women with Hispanic ancestry, that bell curve is shifted quite a bit to the right. It’s shifted even more for women of Asian ancestry and it’s shifted even more for women of black or African ancestry. And so, if you were to take the same genetic score and interpret it the same for a black woman versus a white woman, you would over or underestimate her risk by several-fold.
Taren: That’s unbelievable.
Nicole: Yeah, it’s true. And so, it was really, really important for us to get that science out there to say, no, we’ve looked at this. We’ve done the studies. We have looked at women of different ancestry and it’s not the same. And we’re going to give the most accurate answer that we can to all women.
Taren: And how is that being communicated then to these different patient populations? How are you changing the trajectory for these women, their course of treatment or therapy or assessment?
Nicole: The wonderful thing is that we do the math behind the scenes. So it doesn’t have to be communicated differently. So for a physician that sends a patient sample in to us, we’re going to do the analysis and we’re going to adjust based on that patient’s ancestry and give the report back to the physician. So for a physician, they can walk in to any exam room in their office and communicate the same way no matter what that patient’s ancestry is. The way that it’s being communicated really is, the physician can look at the lifetime risk and the five-year risk and say, either if the patient has a score similar to mine, where it’s hey, lifetime, you’re really high-risk but you don’t have to do anything today if you don’t want to. It’s up to you. You can take control. We can make decisions together about what you do when or they could be like — I have a friend that scored pretty low on risk score. And so, her recommendation coming out of risk score testing was pretty close to the general population. She had slightly increased frequency of mammograms but she really didn’t need to do anything different.
Taren: Nicole, you talked about the math behind it and I guess, really what my question was, are physicians are they taking control of this risk assessment? Are they really adopting it in their care protocols?
Nicole: Yeah. I mean, I think it’s like any other new advancement in medicine. You have early adopters who really are and they really get it and they really understand it and they test the majority of their patients for it and they act on the information. And then you have physicians that are either still a little skeptical or kind of sitting on the sidelines or they more leave it up to patient choice. We have that normal distribution of adoption of something new.
Taren: You’ve been with Myriad Genetics for almost 22 years.
Taren: And you know that this is highly unusual in our world. So, what’s kept you with the company all this time?
Nicole: I think opportunities for growth. I mean, when I started with Myriad, we were a $16 million company and now we’re about a $700 million company. And that growth trajectory offered me a lot of opportunities for learning and development along the way. I’ve played so many different roles at Myriad from commercial roles in sales and marketing to more operational roles. So I’ve always had the opportunity to learn and grow and develop. And the other thing was, Myriad diversified quite a bit. When I started, we were just pretty much the BRCA company and we sold to primarily large academic centers. In the early days, you had to go into Sloan Kettering or MD Anderson to get BRCA testing. Over the years, Myriad diversified into dermatology and urology and women’s health and mental health, all these different things. So I constantly was challenged. I was constantly learning. I was constantly learning new businesses. So I had the opportunity to really change jobs and experiences and learning opportunities without changing my parking spot.
Taren: I love that. Is there one role that holds — let’s say, your favorite role that you’ve had through all these 22 years. And you could count your current role as chief operating officer among those if you’d like. But is there one that stands out to you and says, you know what, this was really a pivotal role for me.
Nicole: Oh, gosh. There’s been a lot over the years. I will say this, the times I am happiest are when I can meet with a really adopting physician or customer or a large group that wants to change the way they practice. I’ve had those opportunities in multiple roles. When I was in sales, I certainly had that opportunity. When I was leading a business unit within Myriad, I had those opportunities. I still have them today. But I think innovation really comes from having scientists like ours that can pivot the way that we do science. And you have a clinician that is saying, here’s the problem I’m trying to solve for my patient or here’s a patient dilemma. What could you do about that? And sometimes that answer is scientific. We need a new test that does X. We need a test that determines if this man’s prostate cancer is aggressive and he needs surgery or he’s safe with active surveillance.
It could be something like that or I remember in the early days, the breast surgeons said, BRCA testing is so critical to our decision-making but we can’t wait five weeks to make a surgical decision. So if you could get us a result in 7 to 10 days, we can actually change which surgery we do. And it was a matter of pivoting the operation to be able to do that. But those are the times I find most rewarding is you sit down with a customer that’s really future thinking. You think about a future ideal state and then you go back to the company and say, we need to find a way to get here.
Taren: I love that. So thank you for sharing that. Let’s talk about your current role as chief operating officer. And it’s a position you’ve been in for about the past year. And before that, you were president of Myriad Labs. What’s the last year been like for you? What’s different and anything that surprised you?
Nicole: The last year has been great. I mean, the last 20 years have been great. I would probably continue on the same theme as my previous answer is, once you have those great customer meetings, you come back to the organization and now you have to figure out, okay, how are we actually going to get to that place that I just kind of promised the customer, right?
Nicole: And as I said, sometimes that is okay, we need our team of scientists to do X and sometimes that is, okay, we need a change of customer service process to give the customer a better experience even though it’s going to double our labor costs or it’s going to – okay, if we make that change, we’ve got to find a different way to work with the payer or we’ve got to change something else in this domino chain of events that it takes to generate a test result and get it to a patient and bill for it. So that’s been the most, I guess, challenging and surprising is just, you have to know the organization inside and out to know where you can push it to get the outcome you need.
Taren: I love that. And so, you really are really uniquely positioned for this role because you do know the organization inside and out. Are you the go-to person? If somebody has an issue in Myriad, are you their first call?
Nicole: Usually, I’m not their first call but if it can’t be figured out before me, I do eventually get that call.
Taren: So tell me, aside from the customer interactions, what’s the most interesting part of your job right now? Is it putting those pieces together?
Nicole: Yes, I think it’s about thinking holistically about the patient journey. How do we go from patients up at 3:00 in the morning thinking, you know what, I’ve put this off for a long time, I do have a family history. My sister was just diagnosed. I should be worried. So they’re Googling at in 3:00 in the morning. How do we go from there to where I am? Which is, they’ve gotten the test results. They’ve talked about it with the physician. They’ve addressed their risk and they’re going forward with their life strong and healthy. How does that patient get through that entire journey?
Taren: Perfect. And you talked about patients up at 3:00 a.m. What keeps you up at 3:00 a.m.?
Nicole: The number of patients that are up that are doing that. We’ve been doing this genetic testing for almost 30 years and still, we estimated that, of all Americans that carry a BRCA mutation, probably less than 10 percent of them know it.
Taren: Wow. So how do you go about changing that?
Nicole: It’s a lot more outreach and we’ve got to find these patients where they are. Where are they at 3:00 in the morning? So it’s a lot of thinking differently about okay, if you were that patient, where would you be? Would you be on Instagram? Would you be on Google? What would you be Googling?
We recently announced the acquisition of Gateway Genomics, which is a company that does fetal sex testing, gender identification for pregnant women. That’s a place that a lot of young women consumers are and it gives us an opportunity to meet them where they are such that we can reach them early in their pregnancy journey and offer them additional prenatal screening, carrier screening, non-invasive prenatal testing, et cetera. When they get through their pregnancy, hopefully, we continue that relationship with them to offer them hereditary cancer testing or testing for depression they may be dealing with throughout their lifetime. We have to constantly think about those ways to say where are these patients and how can we pull them closer to us?
Taren: Interesting. Breast cancer is obviously very well-funded. Breast cancer research is very well-funded. It’s very predominant out there and yet we’re still talking about 10 percent and that to me is just an amazing number. The 90 percent that’s not being addressed. Is it a certain amount of fear for women? Is it like head in the sand, if I don’t know I don’t have to worry about it? And how do we overcome that?
Nicole: Yeah, yeah. So I think over the 30 years, we’ve done a good job of addressing some of those barriers. Like I said, in the early days, you were going in to MD Anderson or Sloan Kettering and you were meeting with a genetic counselor for two hours. It was a very intense process. These days, women can get this in their normal ob-gyn visit. But we recently found in some of our market research that 76% of women are just waiting for their doctor to bring it up. They’re not being proactive about it. So we’ve got to help them understand what it is, why it’s important and that it’s not something to be afraid of. You’re going to come out of this experience feeling very strong and empowered. You’re not going to come out of this feeling like a victim or devastated. This is a strong healthy part of self-care.
Taren: I love it. And that goes back to your earlier comments about being empowered yourself. You can certainly be such a spokesperson for the empowerment piece of this. What a platform you have to change the game. Again, platform to change the game. You’re sitting in the C-suite. You’re a woman. You are obviously a role model to others within your organization and outside of your organization. How does this mantle of responsibility feel to you? Does it feel comfortable?
Nicole: I mean, you’re never entirely comfortable. I don’t view it as I have this title or this role and so therefore, I am well-positioned to give everyone advice and things like that. I definitely think I have certain areas of expertise but there are people all over my organization, all over the cancer care community, in multiple different venues that have expertise that I don’t. One of the most critical parts of our strategy to reach more of these women is digital marketing and outreach. That’s not particularly a strength of mine. So, I view it as a lot of really co-mentorship. If I have younger people that come to me for career advice or business advice or something, I’m happy to give it but I just as equally reach out to other people in other positions for advice in places that I don’t know about.
Taren: Got you. I’m just going to keep pounding this out. But you are having an influence on a lot of women’s careers. But who has had the biggest influence on you in your career?
Nicole: Gosh, a lot of different people. I would say it takes a village. You have to have a lot of different people in your lifetime that can be role models for you. I think when I was younger, I had an aunt that was an attorney. My mother-in-law is a successful businesswoman. They own their own business. So from an early age, I had a lot of role models of successful women with careers or successful women in business. And then over the years, I’ve had lots of mentors and role models that were both men and women that have encouraged my ideas and encouraged me to think differently on things and really positioned me to say, take that role that might not appeal to you right away or you might not think you’re quite qualified for yet. Take that leap of faith.
Taren: I love that. Let’s talk about leadership advice. I love to ask this question to all the women I speak to. What are some of the best leadership advice you’ve received and what’s some of the best leadership advice you provide to others?
Nicole: Gosh, years ago, someone said to me, courage is just fear that has said its prayers. And I have remembered that statement just over and over and over again. If you’re going to change the world, you’re going to have to do things that are big and bold and other people have not had the courage to do them. And you’re never magically just going to be comfortable or confident. You have to realize that if those are your ambitions, there’s always going to be a certain amount of fear and you just have to say your prayers and go forward. So I’ve found that it’s helped me in business and in life. I remember a couple of days before my surgery, I thought, what if this isn’t the right time? What if something happens to be during the surgery and my son is only eight at the time. But I am so glad I went forward once I knew the outcome. I did that surgery just in the nick of time.
Taren: It’s remarkable, your journey to this point and I’m so glad you’ve come out obviously on the other end in such a positive way. Courage is such a funny thing because you have to have courage to get courage. So do you think that’s one of your innate characteristics is courageousness or is that something that you can be taught?
Nicole: No, I definitely think that you can be taught it and I definitely think there are times in my life when I was more courageous than other times. I don’t even think it can be taught. I think it can be reinforced. Over the course of your lifetime, you start to do things that are a little bit more and a little bit more courageous. And when those choices are rewarded and celebrated, you start doing them more and more.
Taren: Fantastic. You’re a busy person. You’re running a company. You’ve got a family. You also sit on the board of Arcus Biosciences. Given your very busy schedule, why is it important for you to carve out this time?
Nicole: Yeah, I love the opportunity with Arcus Biosciences. I think it’s because, especially for someone like myself that’s been at one company for a long time, it’s very important to get another perspective and an opportunity to learn. For us, Arcus was very complimentary for us because we do have an oncology business and it does have companion diagnostic testing. So we interface with pharmaceuticals and I had never personally been in the pharmaceutical industry or pharmaceutical research myself at all. And so, it was a great opportunity for me to learn about that stage of company, the process of drug discovery, to work with a different leadership team and to learn from them.
And so, that’s helped me in my full-time job as well. It’s an area where we don’t compete. There’s no conflict of interest. But the context and the learning that I have gotten from Arcus has been really educational and informative as I think about companion diagnostics in my own business. How does this really interface with pharmaceuticals and how does it not?
Taren: Fantastic. What’s next on the horizon for you? Is it another board role? Obviously, you’ve got such a great gig going on at Myriad. So what’s your next thing that you’re looking at?
Nicole: Yeah, I love Myriad. I’ve had a wonderful experience there. I do think that one day before I retire, I would like to be a CEO and I have loved the opportunity of serving on a board. I would one day like to serve on more boards as well that can also give me that opportunity for learning. Maybe in an industry that is adjacent to mine or next to mine, or really fulfills one of my passions. Obviously, I’m very passionate about cancer, cancer research, cancer cure, making the cancer journey better, women’s health and mental health. I mean, it’s no coincidence that I’m at Myriad. The three businesses and conditions that I’m passionate about are the three businesses that Myriad is in. So I am not in a rush to go on to the next thing.
Taren: Good, I’m glad to hear that for Myriad’s sake as well as for all the people who you’re going to be helping along the way. Let’s talk about women’s health for a second since you noted that it’s one of your passions. It’s really having its moment in time, long overdue, and why do you think that is?
Nicole: Gosh, that’s a great question. I will say because as we look at global health, so much of it starts with prenatal health and childcare and the mother-child bond and women being able to raise good, strong healthy children. And so, it’s just time I think as a society that we reinvest in it.
Taren: Fantastic. I love to see where that trajectory is going. We’re seeing more and more investment from the VC community. We’re seeing more interest from big pharma companies coming in and wanting to partner with smaller women’s health companies. We’re seeing a lot of innovation in the space. I love seeing that wave and I love that you all are being part of that wave through the things that you’re doing at Myriad. We’re at our WoW moment time. So I’m going to ask you – I’m going to challenge you rather to identify that moment that either changed the trajectory of your career or has left a lasting impression on you?
Nicole: Sure. This one was easy for me to answer. I was going through my own personal journey and I knew that I was high-risk and I had already scheduled my surgeries. In the midst of that, we had a CEO transition and so, things were very busy for me at work and I felt a real obligation to keep the company running effectively. But I had my own stuff going on in the background and I hadn’t shared it with anyone because I’m just generally a really private person but also, I felt like it was another burden to put on the company and on the people. I had another CEO, a good friend of mine say to me, I don’t understand why you’re not stepping into this leadership vacuum. I don’t understand that the very thing that you are afraid of is the solution to your problem. And that’s when I made the decision to share my journey with the company. And he was right, because it was a huge source of support for me. And it was a huge – hopefully, I think, a source of motivation and inspiration for the company to go forward and reignite everyone in our mission.
Taren: Talk about courage personified, because that was very courageous to open yourself up to that, to the organization and your very personal, as you said healthcare journey. Wow, what a moment.
Taren: Yeah. And Nicole, that is very, very brave to do that. Not everybody would have. So has there been – since you’ve gone through all this, what has been the company’s and the folks in your organization’s reaction? Do you find that people are more inspired and motivated and engaged than ever?
Nicole: Yeah. I mean, I think honestly, Myriad attracts talent a lot of times that has gone through their own cancer journey as well. So I certainly don’t want to pretend I’m the only person that has gone through this. We have several employees that have gone through this journey or had a family member go through this journey. And people have been very open and willing to share those experiences. So I think for us at Myriad, we are so fortunate enough – fortunate or unfortunate, I guess, to constantly have a stream of places where we’ve impacted patients and patients that are so appreciative and patients that are in a better place because of the testing that we have done. So I do think that’s just part of the fabric of our culture. That wasn’t unique to me.
Taren: Well, maybe you don’t think it’s unique to you but I think it is unique to you because I think again, we’re uniquely positioned in a position of, and a platform of influence and power and you showed great courage. So I thank you very much for sharing that very personal story with us and I want to thank you for being part of our WoW podcast program. And I sincerely wish you continued good health and great success in your career as well as all the good work you’re doing for Myriad Genetics.
Nicole: Absolutely. Thank you, Taren. I really appreciate your time.
Thanks for listening to this episode of WoW, the Woman of the Week podcast. For more WoW episodes, visit pharmavoice.com.