At the end of last year we announced the launch of the Bacterial and Viral Diversity Study. This study will be the first to investigate whether there are bacteria and viruses normally in the breast ducts of healthy women and women with breast cancer. With the research process already underway, we sat down with our President and Co-Principal Investigator on this study, Dr. Susan Love and Principal Investigator, Dr. Delphine Lee of the John Wayne Cancer Institute to get the inside scoop on their research into bacteria and viruses in the breast.
What inspired you to develop this project? Why investigate bacteria and viruses in the breast? Dr. Love: There are many cancers that have now been shown to be caused by a bacteria or virus such as cancer of the cervix which is caused by the HPV virus and cancer of the stomach which is caused by the bacteria helicobacter. In mice, breast cancer is caused by a virus passed on in mother’s milk, so it would not be so unusual to find that breast cancer in women had an infectious origin as well.
Dr. Lee, you have a background in dermatology and skin diseases, what prompted you to make the shift from the skin to the breast? Dr. Lee: It really was a series of coincidences. First, meeting Dr. Love and then making a change in my professional life by moving from UCLA to John Wayne Cancer Institute. Once in my new role, Dr. Love and I had conversations about the call for more projects in breast cancer. She discussed the breast, its anatomy, and the various types of fluid produced by the ducts. I had no idea you could collect fluid other than milk from the breast! In dermatology you can swab the skin and get thousands of organisms – why was no one looking at this in the breast?
This study is sometimes referred to as a Biome study; what does this mean? Dr. Love: ‘Biome’ is a term used to describe the population of bacteria and viruses that exist in a particular site. While attention has been paid to the biome of the intestine and lungs, no one has investigated the biome of the normal breast. Dr. Lee: In nature a Biome is defined as a location that has similar climate or geography, kind of like an ecosystem, and “micro” biomes are the microbial organisms living in that ecosystem. In our case, the unique climate is the breast, and the micro biomes are the organisms inside the ducts.
With all the other research studies going on, what sets this study apart from the rest? Dr. Love: While there has been some research looking at whether there are viruses or bacteria in breast cancers, no one has looked to see whether they can live in a normal breast. Dr. Lee: Even in the small realm of studies that have looked at viruses and bacteria, our study is unique because rather than saying we think it’s this or that organism, and then looking for it exclusively, we are investigating the ducts to see ALL of what is actually there. We are looking at everything and trying to identify what players are in the game.
What can participants expect when coming in for this study? Who can participate? Dr. Love: Participants will have their breast massaged and a small suction cup applied (like a breast pump during lactation) to try to elicit fluid from their ducts. Because we are looking for bacteria and viruses we don’t want to contaminate the samples with ‘bugs’ that could be in the environment, so the procedure is done under sterile conditions like in an operating room. It takes less than an hour and there is little to no discomfort following the procedure. Dr. Lee: We are studying women with and without a history of breast cancer living in Southern California. A list of more specific eligibility criteria and participant registration can be found on this webpage: https://www.armyofwomen.org/studies/625
What will you do once all of the samples have been collected? Dr. Lee: We will extract and sequence the DNA from the fluid to catalogue every living microbe (bacteria, viruses, maybe even fungi) that can be found in its DNA form. This will be done using a new technology called Next Generation Sequencing that will allow us to identify organisms in the broad scope needed for this study. The sequencing will take some time, but I’m hopeful to have preliminary results by the end of 2013.
Will (or how will) this study bring us closer to finding the cause of breast cancer? Dr. Love: This study is exploratory, in other words we are first exploring the breast to see what bacteria and viruses normally live there. We are looking in the ductal fluid which bathes the ducts where breast cancer is known to start to see what bacteria and viruses are present. Once we have this established, we will go on to figure out whether one of them could cause cancer.
What is the potential impact of this study on breast cancer prevention and treatment? Dr. Love: If we find bacteria and viruses in the breast and if there is a difference between women who have had cancer and those who have not then we may be able to determine whether there is an infectious cause of breast cancer. That will allow new approaches to prevention such as a vaccine or antibiotic. Note there are a lot of if’s in that sentence! This is research and so we don’t really know what we will find. Dr. Lee: If we hit a home run, we find an organism in women with or without breast cancer that may cause this disease. And then go after it! All in all, we’re hopeful that trends in our data will give us with hints to an infectious relationship. This would then lead to a more specific study focused on a particular organism.
Dr. Love, you've described this as a study into “an uncharted area of the body, like exploring the surface of Mars”. What do you hope to learn about this “uncharted area” from this study? Dr. Love: No one has explored this aspect of the breast before and so it is uncharted. We hope, at the very least, to better understand the normal breast. Research is the process of exploring crazy ideas for clues to common problems. If this project shows no evidence of bacteria or viruses, we will know that there must be another cause, but at least we will have looked! If your are living in or near the Los Angeles area and are interested in participating in the Bacterial and Viral Diversity Study, please learn more and sign up here: https://www.armyofwomen.org/studies/625