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Discovery is Not a Straight Line

Research is in our name and our DNA. At Dr. Susan Love Research Foundation, we seek to discover why breast cancer starts in a woman or man’s breast with the goal of using that knowledge to help us treat and ultimately prevent the disease. It is exciting, much the way setting off in a boat to discover a new land is exciting. You have a destination in mind, but along the way you may find completely unexpected places.

Women are the only animals that have protuberant breasts when they don’t need them and, indeed, one of the only animals that gets breast cancer. So, we set out to map the anatomy of the breast ducts in human breasts in order to build a 3D map. 

It is generally agreed that breast cancer starts in the lining of the milk duct or lobules, and yet we do not have a good map of the anatomy. First, we focused on ductal carcinoma in situ (DCIS), where precancerous cells are found contained in a milk duct. We asked the question: Could we study women prior to surgery, by numbing up their nipple and threading a slim catheter into the duct we felt was involved? That part turned out to be easy, but when we tried to use standard 3D ultrasound to map the duct, we found that the hand-held probe only took pictures of slices of tissue and would not be adequate for assembling a map. After trying in two women, we headed back to the drawing board. 

We then explored if we could instead map all the ducts in the breast at the same time using automated whole breast 3D ultrasound. At this point we had a great “aha!” moment. What about studying lactating women? Their ducts are filled with milk so they should be able to be visualized on ultrasound. We recruited nine women who were actively breast feeding. We imaged them full, before feeding their babies, and empty, after nursing, and generated a lot of data. We set out to analyze it with the help of our collaborators at the Jet Propulsion Lab in Pasadena, California. To our surprise, we found that often only some of the ducts are making milk. It seems that the first ductal system to be active in lactation is in the lower-outer quadrant of the breast and, as the baby grows and demand increases, more areas of the breast are called into action. The last area recruited is the upper-outer quadrant. This is very intriguing as that is the very duct that most commonly develops cancer.

Since all the ducts aren’t filled with milk at the same time, it meant that this approach would not yield a map. We are now once again going back to the drawing board. Our plans at the moment include talking with our collaborators and maybe returning to our first approach with the automated whole breast 3D technology. That means we would instill saline in a duct involved with DCIS prior to surgery and image it. Stay tuned and we will keep you abreast!

I share this story because it shows how research, and especially clinical research, is rarely a straight line. Along the way, there are many twists and turns that are valuable in themselves. And it is, in fact, the journey that is critical and most in need of funding. The path may not always be straightforward but without the journey we will never find the answer.