I am incredibly excited to let you know that the Avon Foundation has just announced that it is awarding the Dr. Susan Love Research Foundation a $1.2 million research grant. Avon is funding our groundbreaking study, “The Development of a Breast Fluid Test to Identify Women at Risk for Breast Cancer.” The goal of this project is to develop a simple, easy, and inexpensive way to identify premenopausal women who are at risk of developing breast cancer by analyzing their nipple fluid.

During my recent travels in China and Africa, I thought a lot about how breast cancer affects women in less developed countries. One of the key differences is that in the developing world, unlike in the US and Europe, the disease mostly affects premenopausal women. As you probably know, mammography is not a good tool for detecting breast tumors in premenopausal women, because premenopausal women have dense breasts, which look white on a mammogram, as do breast tumors. It is also very resource intensive, which poses additional problems for developing countries. In addition, even though breast cancer mostly affects younger women in the developing world it’s still not that common. And that’s true in the US as well. So, in that respect, the developing world has the same problem as we do in the US: the need for a good tool for detecting high-risk premenopausal women.

Right now, finding which premenopausal women are high risk is like looking for a needle in a haystack. We don’t want to have all premenopausal women go through intensive testing to look for a disease they are not likely to have. But at the same time, we need to be able to identify those women who are most at risk of developing breast cancer. To do that, we need a test that will make the haystack smaller—and that’s what we hope our breast fluid test will do.

The breast fluid test we want to develop will be what researchers call “very sensitive.” This means it will be really good at finding the women who are high risk but less good at finding those who aren’t. As a result, our test will probably also find some “false positives” —women who test positive on our test but who really are not high risk. This means that any woman who tests positive on our test will need to then have a cellular test that can differentiate the true high risk women from the “false positives.” (The Foundation is working with Thea Tlsty, PhD, a professor of pathology at the University of California, San Francisco, Comprehensive Cancer Center, to develop this cellular test.) Our hope is that once we can detect those women who are high risk, we will be able to treat the precancerous cells with treatment down the ducts. That is my vision of the future!

So how would the test work? It is well known that all breast cancer begins in the lining of 6-8 breast ducts that open on the nipple. (These are the openings that express milk when a woman is breastfeeding.) By massaging the breast and squeezing the nipple, or by using a simple aspirator, like a breast pump, fluid can be obtained from the nipples of 60-80 percent of premenopausal women. Several small studies have shown that there are markers of breast cancer risk that can be found in this fluid.

We intend to take this to the next step by combing several of these markers into a band-aid that will cover the nipple while a woman massages her breast to express fluid onto the test strip. If the markers of breast cancer risk are detected in the fluid, the band-aid will change color. If that occurs, a woman will know she is at risk of developing breast cancer and that she needs to be checked out.

After we develop the breast fluid test, we will test it in conjunction with China’s Million Women Screening Study, launched in October 2005. We will collaborate with two of the centers in China taking part in the screening study, so that women who come into these centers for mammograms will also have our band-aid test. This will allow us to compare our findings to the density found on mammogram, a known predictor of risk.

I’ve been talking about the idea of a breast fluid test for years. The fact that we have received this grant from Avon to allow us to do this work is remarkable. I can’t tell you how excited I am that we are now going to be able to start getting this work underway. To be sure, this is a high-risk project. We may find that this band-aid doesn’t work. Or that it only detects some high-risk women, but not all of them. But the fact is, if we don’t’ start trying new ideas like this we’ll never change the paradigm of breast cancer detection.

I look forward to keeping you updated on our progress.

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