Notes from Dr. Susan Love Speaking at the Summit

I really enjoyed hearing Dr. Susan Love speak at the Inaugural Advocate Leadership Summit. For starters it was such a thrill and so exciting to see her after knowing that she went through intense treatment including chemotherapy and surgery for leukemia. I always feel so uplifted when she talks about breast cancer and opens our minds to see things with a fresh perspective. She raised some great points. I took my notes and I hope I am reflecting what she spoke about in the best way possible to help others read what she had to say.

susan-love-cancer-20130213-001She spoke about breast cancer today, and the damage of treatment and over diagnosis. She said with our goal of finding every tumor even those that are just DCIS and have not progressed to cancer, is like the TSA screening. We are in a climate of over treatment where we tend to slash, burn and poison. Then when we have recurrences we have done so much treatment that it could reduce the treatment’s effectiveness. She acknowledges that doctors roles are to find things. Yet 29% of cancers would not kill. Only 20 -30% will become invasive. We over treat and over test. We are in a climate of more is better. We use MRI, PET CT, and Markers. All of this equals finding reasons for treatment. So we do surgery, radiation, chemo, and hormone targeted therapy.

Yet we never think of not doing a treatment or subtracting from a treatment plan. We just throw everything we can at whatever we find. She talked about how the oncotype dx and/or the mammaprint test at least looks at whether all of this treatment is necessary. She says none of this is malicious on the doctor’s part. It’s just that no one is looking at the big picture.

For example, when patients are diagnosed, they are scared. So they listen to their doctors and do what they are told. But with all of this treatment thrown on all the over diagnostic testing and never subtracting from the treatment especially at an early stage comes in a climate of intense fear. No one is ever told about the terrible toll side effects will play on the patient from all of this slash and burn treatment. There is a huge amount of collateral damage.

Oncotype_boxMammaPrint_posevnoHaving come from doing chemotherapy herself she understands how much this type of treatment takes its toll. Side effects are always down played. No one talks about the effect of AI’s or lymphedema. At least the oncotype dx test and mammaprint test looks at whether treatments might work. It would help us to know before treatment, what all these side effects were, whether all of this treatment is necessary and if every case warranted and needed all of this treatment. Also is all this treatment going to be effective or will it just overtax the body and mind? Is anyone looking at the big picture? Can we try to predict if someone will get lymphedema before we rush to do surgery?

With radiation there is skin damage. Treatment causes muscles to atrophy. Do we make all women wear a protective sleeve on an airplane? Do we let patients know that when we take breast tissue away that there will be no sensation left in the breast? Do we tell ahead of all the pain from surgery?

There is pain from surgery. There is collateral damage from all treatment. There’s numbness, muscle atrophy, skin changes, and heart disease. With all of this systematic therapy all things have side effects. The fatigue and chemobrain lasts for years. There’s heart disease from chemotherapy. Anthracyclines can cause leukemia. These things have lasting side effects. Fertility problems, joint problems, fractures and second cancers…all of these things are real. Treatment is not a free lunch.

chemodrip.jpg.pagespeed.ic.1vc9PB_Kv3When someone is triple negative at the beginning they can do well, but statistics show that triple negative breast cancer tends to recur early on. Other cancers tend to recur later while the patients are far away from all of this intense treatment. This is where prevention makes the most sense. If we can prevent the problem in the first place and knew what the real bugs in the breast were at the beginning wouldn’t we be better off? If we understood the environment before the problems took place and we had a vaccine to prevent these problems and we really understood how to keep a normal breast before we rush to all this treatment, wouldn’t that be a better approach? If we really looked at immunology, anatomy, physiology and found new clues and new ways to study DCIS before we rushed to throw everything in the kitchen sink on it, would we need surgery for DCIS? Could 3D ultrasound help with DCIS?

Ductal carcinoma in sity (DCIS)
Ductal carcinoma in sity (DCIS) (Photo credit: Wikipedia)

Instead of continuing to follow the things as they are, we at least owe it to ourselves to be asking these questions. Instead of rushing to treatment with DCIS would it be better to see carefully what was happening before we put a patient through these treatments that have collateral damage and side effects? Tamoxifen has a lot of side effects as well as AI’s.

At least by asking these questions and trying to prevent the problem with a vaccine we would be looking at everything we are doing and starting to come up with new ways of approaching the problem instead of just following the status quo of what we are doing. We need to do this so that we can avoid all of this collateral damage and also have these treatments available in case things progressed before someone has been so over treated that when they present with advanced disease all of this has been used and is no longer effective.

28627_119149311460178_7118937_aI also asked her whether by working on a vaccine to prevent breast cancer could we also apply using this for metastatic disease by injecting someone with a vaccine and being able to turn their disease around?  She very carefully admitted that this was not her expertise and that she had just finished treatments, but she did feel that there was nothing to prevent us from trying to make a vaccine that also tackled metastatic breast cancer. Whether or not this is feasible I do not know, but what I did appreciate was hearing her perspective after going through as much as she has been through, and I am so glad that she is part of the team of trying to find answers and look at new ways that we approach this terrible disease.

It’s so great to have her back with all of us, after her treatments. She is truly someone who I admire and knows so much about breast cancer and it’s amazing to see her post treatment with so much enthusiasm for getting back to work on all of these important issues revolved around breast cancer.

Dr. Susan Love, MD, MBA, FACS is a Clinical Professor of Surgery at the David Geffen School of Medicine at UCLA, and the President of the Dr. Susan Love Research Foundation. She leads the Love/Avon Army of Women, an initiative partnering of women (and men) who are willing to participate in breast cancer research with scientists who are conducting research on the prevention of breast cancer. She is the author of “Dr. Susan Love’s Breast Book,” which is in it’s 5th edition. Dr. Love is a founding member of NBCC and her foundation is represented on the Board of Directors of NBCC. She received her medical degree from SUNY Downstate Medical Center in New York and did her surgical training at Boston’s Beth Israel Hospital.

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After realizing that some people are not aware of the Oncotype DX test or the Mammaprint test, I went to their websites and here is the current information about the tests. Of course, always discuss this with your oncologist as this is only here to help those that don’t know the latest information about these tests that is available online.

According to the Oncotype DX website:

The Oncotype DX® test is a diagnostic test that helps identify which women with early-stage, estrogen-receptor positive and lymph-node-negative breast cancer are more likely to benefit from adding chemotherapy to their hormonal treatment. This test also helps assess the likelihood that an individual woman’s breast cancer will return. The Oncotype DX test provides important information that you and your doctor may use when making decisions about treatment. Post-menopausal women recently diagnosed with node-positive, hormone-receptor-positive breast cancer may also be appropriate candidates for the Oncotype DX test.

According to the MammaPrint website:

To be eligible for the MammaPrint gene expression profile, a breast cancer patient should fulfill the following criteria:

  • Breast Cancer Stage 1 or Stage 2
  • Invasive carcinoma (infiltrating carcinoma)
  • Tumor size <5.0 cm
  • Lymph node negative
  • Estrogen receptor positive (ER+) or Estrogen receptor negative (ER-)
  • Women of all ages

Dr. Susan Love is Back in Action

Below is the statement from Dr. Susan Love about her returning after going through treatment for leukemia. I was very excited that on January 10th, because I am a volunteer, I joined Dr. Susan Love and the Community Engagement Team at the Dr. Susan Love Research Foundation for an interactive, informative webinar to learn more about the Foundation, its signature Army of Women Program, and mobilizing the community to help create a future without breast cancer!

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For me it was so exciting to hear her voice . I am so used to her being at so many breast cancer events and I missed her. I was also pleased that when I asked her “Although I am very excited about the deadline to end breast cancer in 2020, what is being done to help the metastatic community now?” She expressed that it was an important question and went in to some details about advances being made in the metastatic setting especially in relation to molecular profiling and understanding why it occurs. There is still so much work to do especially when it comes to metastatic breast cancer.

If you don’t know about Dr. Susan Love’s Foundation please click on the links below to learn more. You don’t have to have had breast cancer to join. In fact many of the studies are for women who have not had breast cancer, so please take a look and see if you can join to help!
LINKS FOR INFORMATION:
Dr. Susan Love’s statement about her return:

Back in Action

By On Wednesday, January 16, 2013 · 70 Comments

First of all I want to announce, fanfare please, that I am back to work at the Foundation!  I am feeling stronger every day with my new bone marrow and very short hair.  If I were to encapsulate in one word what my recent experience with leukemia has inspired, I would have to say impatience. I have talked for years about the collateral damage that patients experience from cancer treatments and now I know them first hand.  They are not acceptable!

While we all want a cure, we have to focus collectively on finding the cause!  I have come back to work with new energy focused on research strategies going forward that can have an immediate impact on women’s lives and move  us closer to finding the cause and true prevention! I told you I was impatient!  Stay tuned, as we will need all of you in the Army of Women and Health of Women Study (HOW) study to participate as we move forward!

Help_Button_4678245While out on leave, my team at the Foundation has been steadfast in their efforts to introduce our innovative research projects.  We launched our Bacterial and Viral Diversity Study in collaboration with Delphine Lee MD at the John Wayne Cancer Institute this November. This is a very exciting exploratory study to see if a virus or bacteria could cause breast cancer.  We have already begun out sample collections at the Foundation.  We are collecting fluid from the ducts of Army of Women volunteers and  characterizing all of the non-human DNA we can find.  Then, we will match it to known viruses and bacteria and see who is there!  This is the first step to determine whether breast cancer could be caused by a virus or bacteria.  I’m thrilled to be back doing research and to have this exciting project underway.  Updates to come!

With Leukemia Dr Susan Love Continues to Inspire Us

When l read the terrible news on Dr Susan Love‘s Blog that she has leukemia, I was shocked. I just couldn’t believe that such a great person like Susan could have this terrible disease. She is so dedicated to her work and I am so honored that she has come to so many events that I have also gone to.

My favorite event was when the BCCRF (Breast Cancer Care and Research Fund) headed by Michele Rackoff organized their first summit Saturday September 4th called “Taking Action to End Breast Cancer-A Women’s Conference” in Manhattan Beach. The speakers were Dr. Leslie Bernstein (Epidemiologist & Researcher), Dr. Lupe Salazar, (Medical Oncologist & Immunologist), Michele Rakoff (patient advocate) and Dr. Susan Love. After they spoke Susan had a book signing and my friend took a photo of us.

After that we had a lovely luncheon and Susan sat at my table as we all discussed breast cancer. She was so fascinating to listen to and I really appreciate they way she spoke with us in such an inclusive way. I asked her some questions and her brilliant mind had me mesmerised by everything she was talking about. We talked about the slash and burn approach to breast cancer, whether we are using the right treatments, and how we are going to change the conversation so that we finally make progress in ending this disease. Susan is also so down to earth. We also talked about  her Army of Women. I just finished participating in one of her Army of Women Studies the day before she announced her illness.

Susan started her treatments in the hospital on Monday, June 18th. Leave it to her to say to her friends on Facebook “I have  signed up for a free month of Amazon Prime and streaming Netflix …. I start treatment Monday and face 4-6 weeks in a hospital room! But will have wifi….so stay tuned”! She is such an all around giving person of her time and energy. She has so much grace and cares so much about breast cancer. Her book kept me company while I had to learn what I was facing when diagnosed, had surgery, did chemo, radiation and then had my recurrence. I also looked up everything for my friend Lila who died in January from breast cancer when she had her recurrence in 2009. In fact I made sure I got the latest edition to try to find any bright spot I could about her disease.

I just keep wishing I could do something for her. Of course I have said every prayer I can think of and I am also frightened. I know that she will fight this and keep her awesome personality throughout all of her treatment. But still this kind of treatment is heavy stuff no matter how strong anyone is. Leave it to Susan to have such a bright attitude. Today Susan said, “Day 3 So far so good…doing laps around the floor and found an electronic piano to practice!” She has such great wit.

I have decided because she is going through this with so much positive energy that I am going to follow her lead. Her bravery, humanity, and humor is so inspiring. Keep it up, Susan and thank you for being  in our lives. My prayers and thoughts are with you and the rest of your family.