There are several avenues of research that may hold some promise. One is the Holy Grail of cancer research: a chemical or biological marker in the blood that reliably indicates whether even a few cancer cells are present. We already have something like that for prostate cancer, the PSA test; and while I know that there are some feminists who would say this is no coincidence, I’m a scientist as well as a feminist, and I know that it really is a coincidence. The prostate research just happened to pan out first; a reliable breast-cancer blood test has proved more elusive. But there are lots of people working on this problem, and I think we will see some results in the near future.
I am exploring another area: duct endoscopy, which is the direct visual examination of the milk ducts. That’s where cancers start, but we haven’t had direct access to that area. It’s a tricky problem: the anatomy is complicated and not well understood, and the openings in the nipple are tiny. Using a single fiber-optic cable, just 0.5 millimeters, I’ve been able to get in and look around and retrieve some cells for examination. But it’s still much too early to know if this will help detect early-stage cancers.
Going beyond detection, I think there’s still a lot of room for improvement in how we treat breast cancer surgically. It’s been estimated that 70 percent of women with breast cancer are candidates for breast-conservation techniques–that is, lumpectomy with radiation–and only 30 percent need a radical mastectomy, but the actual proportions in this country are reversed: seven out of 10 women still get mastectomies. Surgeons are resistant to change, and most of them were trained at a time when mastectomies were all they did. They tell women: well, it’s up to you, but if you were my wife, this would be my advice. I tell women, if you hear that, it could be a sign his marriage is in trouble. And getting a good technical and cosmetic result with a lumpectomy isn’t simple. Surgeons operate on patients when they’re lying on their backs, and sometimes they don’t consider that women are more concerned about how their breasts look when they’re standing up. There’s still a lot of education that needs to go on.
We desperately need research into prevention–and not just with drugs. I dream of the day when advances in detection and treatment will become less important as we learn how to prevent this disease. I think we may well have a vaccine against breast cancer within my lifetime, gene therapy for women with a genetic susceptibility to the disease or other tools more effective and benign than the ““slash, burn and poison’’ approach of surgery, radiation and chemotherapy. I tell my daughter, who is 8i now, that she won’t be able to follow in my footsteps, because by the time she’s grown, there won’t be enough cases of breast cancer to treat.
