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HEALTH | fall 2005

Fighting Breast Cancer Where It Begins
A renowned physician believes women's milk ducts hold the key to eradicating the disease.

Women were afraid to admit they had breast cancer when I wrote the first edition of Dr. Susan Love’s Breast Book,and there were only a smattering of charities raising money for research on the disease. Today, 15 years later, breast-cancer awareness and fundraising is all around us, with breast-cancer walks in every city. People can even buy yogurt, cereal and ribbons for the cause. Pink is everywhere you go—and yet so is breast cancer.

Bible of the Breast

In its newly published fourth edition, Dr. Susan Love’s Breast Book retains its authority as the ultimate guide to breast care, a ranking it has held since its first appearance 15 years ago. In its latest guise, the 700-page tome has been updated on such topics as preventative measures for carriers of the breastcancer gene, the benefits and dangers of tamoxifen (plus, new aromatase inhibitors that may replace tamoxifen as the drug of choice for preventing breast cancer recurrence), forthcoming blood tests for breast cancer and a new
technique for freezing benign tumors (fibroadenomas). Just as effective as surgery, this last procedure is virtually painless, won’t leave scarring that might interfere with mammography screening and takes only 30 minutes in a doctor’s office.

Love also discusses the future of breast cancer, which she confidently predicts can be eradicated in 10 years. “This is an audacious goal,” she writes, “but one that is doable... I guess you’d better buy this upgrade: It may one
day be a collector’s item that reflects the history of a defunct disease.”

Never known for sugarcoating medical information, Love presents the particulars in a simple, welcoming style, with plentiful illustrations to make complicated data picture-clear. Moreover, she offers readers tools for dealing emotionally with breast-cancer risk factors, prevention strategies,
screening procedures and, if necessary, diagnosis, treatment options, clinical trials and so forth. Ultimately, Love’s breast book seeks to empower women and encourage them to become their own advocates of breast health.

Crystal Rainey

In 2005, more than 200,000 women in this country alone will get breast cancer, and more than 40,000 women will die of the disease. That equates to five women an hour: mothers, sisters, grandmothers, cousins, daughters, aunts, nieces and friends. Although we have made slow progress toward a cure, we still have a long way to go.

Most medical research has focused on understanding the breast-cancer cell itself: its characteristics and behavior. This reductionist approach to breast-cancer research is comparable to carefully studying the personality of criminals while they are in isolation and characterizing the traits that lead to their committing a crime. Cancer cells, like criminals, do not exist in isolation but are in an environment which supports and incites them. We need to go beyond understanding the breast-cancer cell to understanding the breast, the environment in which cancer arises. The amazing fact is that we actually know very little about how the breast works. Although we understand breastfeeding, we do not know what the breast does, if anything, when it is not making milk. Are changes taking place that might predispose some women to develop cancer?

We do know that nearly all breast cancer starts in the lining of the milk ducts or the attached lobules. That’s why I believe the best way to understand breast cancer is to look at where the problem begins: in the breast duct. And we now have the techniques to do it. Tiny scopes can be threaded through the nipple into a duct to look directly at the duct lining. Microcatheters can be used in the ducts to wash out cells for examination.

In the ductal fluid, we can look for carcinogens. We can identify not only cancer cells, but also the cells that are just thinking about becoming cancer some day when they grow up. This procedure, ductal lavage—currently available at selected medical centers around the country—has been termed “a Pap smear for the breast.”

Now, we’re ready to do more. We can figure out how the non-breastfeeding breast works, and what conditions lead to malignancy. We can learn whether we can put drugs into the breast to treat cancer where it starts, avoiding the side effects that occur with the current ways we deliver chemotherapy. We can discover whether we might be able to prevent breast cancer entirely by squirting a low dose of chemotherapy down the ducts.

I’ve devoted my life to eradicating breast cancer, and this research focusing on the healthy breast is the closest we have come to really understanding the disease and ways to stop it. This is the approach that the Dr. Susan Love Research Foundation is focused on. We know that the payoff of getting to where cancer starts and determining how to prevent it is enormous.

I cannot do this alone. We need researchers, physicians and volunteers to help us really move this effort toward this end. We are recruiting an army of women to help us. Not only by raising money for this promising area of research but by volunteering to participate in research studies so that we can quickly determine what is normal for the breast and what is not.

Imagine a day when detecting a breast abnormality can be done with a home test on nipple fluid, and the treatment takes no longer than a gynecological exam. You would simply go to your doctor with your test results, get treatment down the duct and be back to normal breast health. Imagine, no more chemotherapy, radiation or surgery! Breast cancer as we know it would be eradicated. Imagine contributing to the end of a disease.

With your help we can eradicate breast cancer in the next 10 years. It is time to move beyond pink ribbons and make sure that the research we’ve all worked so hard to fund will actually move us toward this goal.

 

Dr. Susan M. Love, a physician and author, is president and medical
director of the Dr. Susan Love Research Foundation. To learn more about her research: www.drsusanloveresearchfoundation.org.