Breast cancer specialist Susan Love, M.D., has penned one of the best-selling books on breast cancer (Dr. Susan Love's Breast Book), served on the National Cancer Advisory Board and lectured all over the world about women's health, breast cancer and menopause. Ten years ago she stopped practicing surgery so she could devote herself full-time to preventing breast cancer. The goal of her foundation, the Dr. Susan Love Research Foundation, is to eradicate breast cancer in our lifetime. She recently spoke with MAMM about how that work is going.

MAMM: In March the Dr. Susan Love Research Foundation sponsored a conference on the breast's milk ducts. Why do you think that's an important research area?

SL: All breast cancer starts in the milk ducts, and if you're going to really be able to get rid of breast cancer, you need to get to where it starts. Until recently we weren't able to do that. We now have a way that you can numb the nipple and thread a catheter into a milk duct to sample the fluid, cells, carcinogens and hormones. By accessing the part of the breast that develops cancer, we have the potential to figure out what causes it and how to prevent it.

The best example of how this type of access is important is with cancer of the cervix. Back when I was starting out, if you had an abnormal Pap smear, then you had a hysterectomy. They didn't know what else to do, so they just took everything out. Then, because we could get to the cervix and study it, we figured out that you could do something less than a hysterectomy—a cone biopsy, for example, was just as good. By continuing to access where the cancer started, we figured out that cancer of the cervix was caused by a sexually transmitted virus, and now we have a vaccine for that virus. If you can get to where a disease starts, you can figure it out.

In breast cancer, when you do a mammogram, MRI or PET scan, you're looking at a cancer that's already there and the effects that it has already had. It's like looking at the damage a tornado left behind instead of predicting when the tornado is coming. By being able to get into the ducts and look at the fluid and the cells, we have the potential to figure out what the conditions are that lead to cancer before it starts—at a point when it's still preventable.

MAMM: What are some examples of current research projects on the intraductal approach to the breast?

SL: There were a lot of interesting reports from the conference. For example, a lot of people are looking at the fluid in the milk ducts to predict who's more likely to get cancer. If you massage your breasts, a couple of drops of fluid come out and then you can take that fluid and study it. Hormone levels are 40 times higher in that fluid than in the blood because the breast makes its own estrogen. But are those levels always higher or just sometimes? Are they higher in everyone or just women at high risk? We don't know, but we're looking at it.

The purpose of the breast is to make milk, right? But what about when you're not breast-feeding? Then what does it do? We have no idea. Some researchers think it's just a stagnant pond of carcinogens and pesticides, but we don't know. And believe it or not, we don't know the anatomy of the breast because we've always just taken it all off. How many openings are there in the nipple? We don't know that. There's controversy over how many ducts there are. I'm in the school of 6 to 8, other people say 22 to 25.

The reason my foundation is doing research in this area is that I believe really strongly that getting to where breast cancer starts is how we're going to get rid of it. Adding to the other end with more treatments is not the way to find the answer. I'm a breast cancer surgeon and I've spent 20 years operating on people and taking care of them, and it's clear to me that we're working at the wrong end. That's why I started my foundation and that's what we focus on. The way to find the answer is to get to the beginning. Who knows? Maybe we'll find that there is a virus for breast cancer, too, like there is for cancer of the cervix. We don't know because no one's ever looked.