UCLA professor and noted breast cancer specialist Susan Love envisions a time in the not too distant future when breast cancer — and especially today's treatment of it — will be a thing of the past.
“I'm very, very excited. We're heading into a whole new era with breast cancer. I think we can eradicate this disease and I don't think it's a pipe dream.” she told a packed auditorium in Bldg. 123 Love, who is an adjunct professor of surgery at UCLA and medical director of the Susan Love M.D. Breast Cancer Foundation, spoke at the Lab Tuesday as part of the Director's Distinguished Lecture Series. Her talk was also the final installment in the Lab's monthlong Cancer Awareness Campaign.
Her presentation, “Wishful Thinking Is Not Enough,” was engaging, informative and often humorous. She spoke off the cuff for more than an hour on a wide range of subjects, from describing new research on improving detection, treatment and recovery to hormone replacement therapy. She answered questions from the audience for nearly a half hour more in the auditorium and spent another 30 minutes signing books and answering still more questions.. Scores of women in the auditorium not only had copies of her books for her to sign afterward, but also took copious notes during her talk.
Love, who was appointed by President Clinton to the National Cancer Advisory Board and is one of the founders and a director of the National Breast Cancer Coalition, calls today's treatment of cancer — surgery, chemotherapy and radiation — “slash, burn and poison.”
“They are very crude. But it's all we have. If I had cancer today, I'd be first in line for those treatments,” Love said. “We've been thinking of cancer cells as if they're foreign invaders and we have to blast them away. But these are our own cells gone crazy.
“Maybe they're not all irrevocably bad. Maybe we can rehabilitate them, give them food and sunshine and they will behave normally.”
For too long, she said, cancer cells have been studied in isolation. By studying cancer cells and how they interact with healthy cells, researchers may be able to determine how to change their behaviors, she said.
Researchers are also looking into how to “put cancer cells to sleep” for 10 or 20 years, and believe one of the ways to do that is through hormones.
There are new hormonal drugs that are now being studied, she said, noting that tamoxifen has been shown to prevent breast cancer from coming back when given for five years.
“We’re moving into control instead of kill,” Love noted. “Treatments are shifting from chemotherapy for everyone to treatments for tumors sensitive to hormones. They are treatments targeted only to the cells that are abnormal.”
New research is also starting to look at how to eliminate some of the side effects of the harsher treatments, such as chemotherapy. Love refers to this treatment as a “poison” that not only kills the cancerous cells, but destroys healthy tissue as well.
Too often, breast cancer survivors who complain after treatment about swollen arms and limited mobility, fuzzy thinking and other uncomfortable side effects are told, “you’re lucky to be alive, dear,” Love said.
“It’s beyond ‘you’re lucky to be alive.’ We’re finally getting to the point that we realize we need to pay attention to the side effects of treatments.”
One of the biggest side effects is premature menopause, which can lead to other health problems, Love said. “That’s a whole other area we’re just starting to figure out,” Love said. “I’ve been asked why, as a surgeon, I’m looking into menopause. Well, my patients are asking me about it, and I’m 53 and flashing,” she added, drawing a laugh from the crowd.
“After menopause, our ovaries don’t shrivel up and fade away. When they are done with reproduction, they shift into a different function and still produce hormones into your 80s,” Love said.
Contrary to popular belief, this declining hormone production can be enough for most women, she added.
She also discussed imaging methods, such as mammograms. By the time tumors are seen on mammograms, they have been there eight to 10 years, Love said. Mammograms are most effective for women over 50, she said, because younger women have denser breast tissue, making it difficult to spot tumors.
“When you go through menopause, you lose breast tissue. It turns to fat and cancer shows up great against fat. We need something that will show cancers in younger women,” Love said.
She has spent much time studying ductal cancer, which is breast cancer that starts in the milk ducts. “I want to find those cells before they're criminals, when they are cells that are just thinking about going bad,” Love said.
She has developed a method to insert a tiny catheter into a breast duct to extract cells. It’s called ductal lavage and is now FDA-approved for high-risk women. It is being used at a number of clinics, including UC San Francisco.
Right now, it’s good for providing additional information for women who are at a high risk for breast cancer, but Love hopes it will lead to figuring out how breast cancer starts and, ultimately, how to prevent it.
“A lot more research needs to be done,” she noted.
During her talk, she also addressed hormone replacement therapy in menopausal women, although she objects to the name of the treatment.
“The way you position something really affects how you think about it. With hormone replacement, you’re saying premenopausal women are normal and we have to get postmenopausal women back to normal. But menopausal women don’t need that high level of hormones. We’re now starting to figure out that much lower doses may be enough for older women who don’t need as much,” Love said. “If you don't have breast cancer, you can take hormones for two to five years for symptom relief and then taper off.”
New studies are showing that long-term hormones do not necessarily reduce an older woman’s risk of heart disease and osteoporosis, she said.
Lifestyle changes are the best defense, she noted. “Exercise helps prevent heart disease, osteoporosis and you feel morally superior doing it,” she said, again drawing laughter from the crowd.
Other changes include following a low-fat diet and not smoking. “You should have lifestyle changes first and then add drugs if they are needed,” she added.
Love’s talk will be rebroadcast on Lab TV channel 2 on Thursday, July 19, at 10 a.m., noon, 2, 4 and 8 p.m. and Friday, July 20, at 4 a.m.