DR. LOVE AND THE WAR ON BREAST CANCER.

Byline: Evan Henerson Staff Writer

Every October, Dr. Susan Love finds herself as busy as ``an accountant in April.''

Which figures. During breast cancer awareness month, everyone wants to know what a world-renowned breast cancer researcher - and former surgeon - has to say.

These days, Love, who lives in Pacific Palisades, is as engaged as ever. She is an adjunct professor of medicine at UCLA and the founder and director of the National Breast Cancer Coalition. Although she no longer sees patients, she answers questions on her Web site, www.susanlovemd.com.

Love is also about to start a book tour to promote the third edition of her 1990 book, ``Dr. Susan Love's Breast Book,'' which was released this month. Hailed by The New York Times as ``the bible for women with breast cancer,'' the new version contains revisions to every chapter as well as a new chapter on the intraductal screening technique she has helped develop.

Through ductal lavage, a woman massages her breasts and then suction is applied to the nipple. Doctors then thread a tiny catheter into the milk duct, wash the duct with saline solution and extract cells. Through this test, Love says doctors can analyze the lining of the breast ducts and detect potentially cancerous cells before they develop. The test, she says, is the breast equivalent of a Pap smear.

Marketed through Pro Duct Health, a company that Love co-founded, the test has completed clinical trials, and data is still being compiled. The American Cancer Society has not taken a position on the value of ductal lavage testing. Currently, 19 medical centers around the country - including two in Northern California - are accepting patient referrals for the test. For more information, call [phone] or visit www.producthealth.com.

The plain-speaking Love is hopeful that by the time she readies a fourth edition, researchers will be so close to having the answers to breast cancer that a comprehensive, 700-page update of ``Dr. Susan Love's Breast Book'' won't be necessary. It will simply be a pamphlet that says ``This is the answer. Goodbye.''

Q: So if a new edition of the book comes out every five years, there need to be major breakthroughs in the diagnosis, treatment and prevention of breast cancer by 2005 in order to make your ``Here's the answer, goodbye'' pamphlet a reality. Possible?

A: I think once we really have it, the disease is going to fall right off. It's like tuberculosis, all those sanitariums and there was a whole industry around tuberculosis. It's not completely gone, but almost. Polio is another one. Just think if you were an iron-lung manufacturer. Whoops! Gone. Well that's what I hope will happen with breast cancer.

I'm very optimistic because I think we're entering a new era on two fronts. One is this whole movement from diagnosis and treatment to prediction and prevention - to really move much earlier in the process and then intervene and head it off at the pass. I really think the intraductal approach is going to do that. One of the barriers to research on early breast cancer is that we haven't had any access. By doing this (procedure), we can have access. We can look for markers and do prevention research in ways we haven't done before.

Q: The ductal lavage test is still a new test. What sort of feedback are you getting from patients?

A: I don't hear people getting worried about it. You're going into ducts that are already there through holes that are already there. It's a very low-risk test; it takes 15 to 20 minutes in a doctor's office and no radiation. The biggest barrier is that it's new and we're still learning all of the ramifications of it.

Q: Could ductal lavage or other methods of screening eventually replace the mammogram?

A: Hard to say. My fantasy is that in a couple of years the ductal lavage will be routine. You go in, get your Pap smear and get your ducts checked. So instead of diagnosing people who have cancer, we'll be diagnosing people who have pre-pre-cancers, and we'll reverse it very much in the way we reverse cervical cancer. If that's the case, then mammography will be less important as a screening test, but it will still have some importance. If you found malignant cells, it will be very nice to know where they're coming from and deal with that. Mammography may have a role in that.

Q: A recent Canadian study reported in the Journal of the National Cancer Institute concluded that a breast exam by a qualified physician is as effective at keeping a woman over 50 alive as a mammogram. Your thoughts?

A: There are a couple of caveats to that study. The mammograms have been criticized as not being of very good quality. Maybe it's that a good breast physical exam is the same as a bad mammogram. These people performing the breast physical exam (in the study) were well trained where an average gynecologist or primary-care doctor is not. The good news is that there are options. Women over 50 in particular have choices, and I think that's exciting.

Breast self exams are another thing. They have never been shown to make a difference. Most women find their own cancers, and it's not by doing self exams. It's in the shower or rolling over in bed or a lover finds it. The question is not can you find cancers? Of course you can. It's whether you can find them by doing this at a point that makes a difference in the outcome. And that's what we haven't been able to show.

It's very frustrating. When you talk to young women, they say, ``So what am I going to do? You're telling me mammography doesn't work really well for me. Breast self exam doesn't work.'' That's why I'm working so hard on this ductal lavage thing because I think we desperately need something that works with the younger age group. Right now, we're selling wishful thinking and dreams.

Q: When you entered this field, how far-fetched was the idea of a woman getting a preventive mastectomy: (i.e.) women who are at high risk of developing breast cancer having a healthy breast removed to decrease the risk of developing cancer in the future.

A: When I was first in practice, I was on ``Nightline'' with Ted Koppel about preventive mastectomies, and I said maybe we should take testicles out and put in ping-pong balls. I thought it was pretty horrific, and we had no data at the time showing there was any advantage to doing it, and they were doing it on everybody sort of willy-nilly. There wasn't a good selection process.

At least now we have some data that it reduces your risk of getting breast cancer by 90 percent (for women who, because of their family history, are at high statistical or biological risk of developing breast cancer). As a result, there are many more of them being done, many that I think are being done inappropriately as well. I think that sometimes doctors are just working knee-jerk and saying, ``Well, you have a bad cancer, and we better do everything. We'll cut both your breasts off,'' without really thinking that the risk is not in the breast. The risk is having cancer cells in other places in your body. That's what's going to kill you. Ironically, if anything, it makes more sense in the high-risk woman than in the woman who already has cancer.

Q: Besides ductal lavage, what other reasons do we have to be optimistic about the study of breast cancer in the future?

A: Right now, we treat breast cancer like it was a foreign invader, and our job is to kill every foreign cancer cell. All our metaphors are war and battle: slash, burn and poison. But it's not really a foreign invader. They're your own cells that have gone bad, and it may be possible to reverse them and rehabilitate them.

What we're finding now is that cancer cells live in a context amongst other cells, and there's a lot of cross-talk and interaction going on. The newer treatments are looking at maybe we don't have to kill the cells. Maybe we can control them. Maybe we can revert them. The future is going to be not just ``let's give poison and hope we poison more cancer cells than normal cells,'' which is what we're doing now, but really understanding what is the molecular biological problem of reverting. So it's going to be more targeted and less toxic, and hopefully it will work better.

Breast cancer events

--Cindy Crawford, Tea Leoni and Richard Roundtree will serve as honorary co-chairmen of the fifth annual Expedition Inspiration Take-A-Hike or A-Fun-Run. The event is Saturday, with registration beginning at 8 a.m. at Paramount Ranch in the Santa Monica Mountains National Recreation Area in Agoura. Adults and children of all ages and fitness levels are invited to hike the trails with the stars who will lead beginning, intermediate and advanced hikes through the mountains. The climb for a cure will benefit the Revlon/UCLA and USC/Norris Lee Breast Centers and the Expedition Inspiration Fund for Breast Cancer Research.

Registration is $25 in advance, $30 on the day of the event. The recreation area is located at the intersection of Cornell Road and Mulholland Highway in Agoura. For more information, call [phone].

--More than 3,000 people are expected to walk 60 miles from Santa Barbara to Malibu Oct. 27-29 as part of the Los Angeles Avon Breast Cancer 3-Day. Participants commit to raising a minimum of $1,800. Proceeds from 3-Day events throughout the country will support medical research into the causes, prevention, treatment and cure of breast cancer.

For more information, to volunteer or pledge financial support, call [phone].

--Sunday is the Susan G. Komen Foundation's Race for the Cure, a 5K run/fitness walk with registration beginning at 8:30 a.m. at the Pasadena Rose Bowl. It is sponsored by JC Penney stores and benefits breast cancer research. For more information, call [phone].

CAPTION(S):

3 photos, box

Photo: (1 -- cover -- color) World-renowned researcher and former surgeon Susan Love talks about her prescription for detecting and her hopes for eliminating the disease.

Photo by David Sprague/Staff Photographer

(2) Dr. Susan Love: ``Right now, we treat breast cancer like it was a foreign invader, and our job is to kill every foreign cancer cell. All our metaphors are war and battle: slash, burn and poison. But it's not really a foreign invader. They're your own cells that have gone bad, and it may be possible to reverse them and rehabilitate them.''

David Sprague/Staff Photographer

(3) no caption (book: DR. SUSAN LOVE'S BREAST BOOK)

Box: Breast cancer events (see text)