Dr. Love and the politics of disease.

"Lesbians have grabbed hold of breast cancer. as our alternative to AIDS," says Dr. Susan Love. "But I don't think it's altogether appropriate." Such bluntness in addressing a politically sensitive topic is characteristic of Love, an out lesbian who is widely considered the country's foremost authority on breast cancer. But, as she herself acknowledges, it's precisely that capacity for clear, independent thinking that has won Love her place in the national spotlight.

"A lot of my success has come because I have been willing to tell the truth," says Love, who will be honored March 1 with this year's Community Role Model Award by the Los Angeles Gay and Lesbian Center at its annual Women's Night. "My role is to be the person saying that the emperor has no clothes." A crusader in the fight against breast cancer for 20 years, Love is perhaps best known as the former director of the Revlon/UCLA Breast Center and as the author of Dr. Susan Love's Breast Book, which has been hailed as the bible for women with breast cancer.

Throughout her career Love has won notoriety for her outspoken assessments of health care issues. For example, she stirred up the the breast-health movement when she insisted that breast self-exams are unreliable, unnecessary, and even harmful. Love explains that by the time self-examination reveals a malignant lump, it may be too late for early de section to make a significant difference.

"It's important to base what we do on data, not on wishful thinking," Love says. "Breast self-exams are an example of wishful thinking." There are no data that prove that by performing the self-check, women are affecting mortality rates for breast cancer, Love argues. Instead, she says, the emphasis on self-exams wicks money away from other, more effective efforts to improve early detection--such as encouraging women at risk to get mammograms--and even from research that might ultimately find a cure.

Amid such controversy Love has always maintained credibility, says Sharon Green, a member of the original board of the National Breast Cancer Coalition--a group Love cofounded. That's because Love's bold opinions are always firmly based on scientific research, Green says: "We may not always be happy with her answers, but we know they are real."

Love is equally cautious and candid in assessing the emergence of breast cancer as a lesbian cause. In 1992 a study suggested that lesbians were more likely to get the disease than were women in general: Lesbians had a 1-in-3 chance of getting breast cancer as compared with a 1-in-8 chance for women in general. That report should never have been used to make concrete predictions, Love says: "That study just took risk factors for breast cancer," such as not having children and drinking alcohol, and matched them with responses from health surveys of women. "If you do the math, it should be 1 in 3," Love acknowledges. But there were no hard data saying that the results are accurate off the page. Still, lesbians took the study and ran with it. Says Love: "Lesbians who had been so active in AIDS thought, It's payback time!"

Unfortunately, AIDS and breast cancer have sometimes been pitted against each other when it comes to fund-raising efforts. But Love insists that breast-cancer activists aren't trying to take an unfair slice of the funding pie. In all, the NBCC has helped raise the national budget for research and prevention for breast cancer to $430 million. "We weren't taking from AIDS or kids with leukemia," she says. "A whole new source of funding was opened." And, she adds, gay men should be "as supportive on this side as lesbians were with AIDS."

Although her name has become synonymous with women's health care, this was not a career path Love sought out intentionally. In fact, it is one she tried at first to avoid. Raised Catholic, Love considered becoming a nun and went so far as to spend several months in a New York convent. Even when she settled on medicine as a career, she was adamant that she would not specialize in women's health care. "I wanted to prove I could do macho surgery with the best of them, damn it," Love says.

But she soon saw that breast health was where her talents and the world's needs intersected. The lack of adequate understanding about breast cancer was also apparent when she went into practice in the early '80s. Woman after woman came to her having had radical mastectomies when more conservative surgery might have been sufficient. "I saw I could make a contribution [in breast surgery] that I couldn't make by just removing gall bladders," she says.

Love has now become an advocate for another women's health issue: medical treatment for menopause. Though estrogen-replacement therapy has become a popular long-term treatment for menopausal women, Love argues that evidence of its safety and necessity is so far inconclusive. "Even the term replacement therapy insinuates the need to replace something that is missing," says Love, who maintains that menopause is a natural stage in a woman's life, no more demanding of medical attention than, say, puberty.

Why, then, has replacement therapy been widely promoted? "Men are mostly in it to give out drugs," Love says. She's in it to respond to the concerns of her patients. "At dinner parties and everywhere else, I was asked the same questions" about the safety of hormone-replacement therapy, she says. "I figured I may as well write a book and answer them." Dr. Susan Love's Hormone Book: Making Informed Choices About Menopause, due out in February,

Consistent with her no-nonsense attitude, Love has taken a matter-of-fact approach to coming out. When people ask about her husband, she corrects them without making an issue of it. Loove herself didn't realize her sexual orientation until she had completed medical school. "You're sleep-deprived," she recalls. "There's no time to think about anything like that." But when she was ready to start her surgical residency in Boston, Love settled down with Dr. Helen Cooksey. In 1988 Love gave birth to a daughter, Katie, and in 1993 the couple became the first to win Massachusetts supreme court recognition for their status as comothers. The family now lives in Los Angeles.

According to Love, being openly lesbian has had virtually no impact on her professional life: "As a woman surgeon you are already not part of the club. It's not like you were in and then they threw you out. I was never in. I had nothing to lose." Besides, she says, women surgeons are stereotyped as lesbians anyway. Coming out merely confirmed what her colleagues already suspected, she jokes.

And now, after 20 years in medicine, Love is attempting to broaden her impact on health issues by attending business school as part of UCLA's executive MBA program. Love thinks she can build a bridge to improved health care by creatively managing costs: "You need people who are bilingual, who can speak both business, and medicine." And when that's been accomplished, Loove wants to set up an independent think tank on women's health care issues.

While it's obvious that Love drives herself hard, her daughter as well urges her to keep plugging away: Katie wants breast cancer cured before she grows up. Why? "I'm going to be a ballerina," she says, reflecting her desire to follow a different path than her mother's. Adds Love: "She's got better things to do" than continue her mother's work. And Love is up to the challenge: "I was raised to think I have to fix the world, so I have to keep going until I have it fixed."