WomanOf the Month 6-03: Dr. Susan Love

The recent spate of studies turning long-held theories about hormone therapy’s benefits upside-down has many women frustrated and confused. But one expert, Dr. Susan Love, suggests it’s also an exciting time in women’s health care. "The big message is really exciting," she says. "We’re finally getting the studies that we never had. As long as we didn’t do studies, it was easy to tell women what to do, because there was no data. Now we have science on which to base decisions, and that’s great. There will be plenty more science coming, so stay tuned."

Love was a founder of the breast cancer advocacy movement, and her best-selling books, Dr. Susan Love’s Breast Book and Dr. Susan Love’s Menopause and Hormone Book, have become indispensable sources of information for women. She is president and medical director of the Susan Love MD Breast Cancer Research Foundation in Santa Barbara, Calif., a nonprofit dedicated to eradicating breast cancer, teaches at the David Geffin School of Medicine at UCLA, and is founder and senior partner in Lluminari Inc., a multimedia women’s health company. Her web site at www.susanlovemd.org offers everything from news about breast cancer research and treatment options to the opportunity to e-mail her a question, share experiences with others, locate events and other happenings, link to support organizations, and much more. Like Dr. Love, the web site encourages women to take charge of their health, participate in decision making, and stay informed.

Love graduated from the State University of New York Downstate Medical Center of New York in Brooklyn after spending her high school years in Mexico City, where her father worked for a U S corporation. When she entered medical school, the quota for women was set at just 5%. She trained in surgery at Harvard Medical School. "This was pre-women’s lib, and there were no women surgeons and no such thing as breast surgery," she says. "Generally it was looked down on as a lower type of surgery for physicians who couldn’t do big operations or who were retiring soon. At first I thought I wouldn’t be a breast surgeon either, that I would do ‘macho’ surgery like everyone else. But when I went into practice, all they would send me were women with breast problems. And I found that I could make a much bigger difference for these women than for someone with a gall bladder problem, for example."

Radical mastectomies were the norm in the late 1970s, physicians spent little or no time on patient education, and women generally went into surgery not knowing if they were going to wake up with a breast or not. Soon, Love helped start the Dana Farber Cancer Institute and breast center in Boston, and her all-women practice flourished. "Before long we had four breast surgeons, a plastic surgeon, two oncologists, therapists, and we were turning patients away. The guys couldn’t figure out what we were doing differently. The answer was, we were treating women like intelligent human beings. We told them their choices and listened to them, and that was a whole new thing."

In 1990 Dr. Love published the Breast Book to fill a void she recognized in medical books that explained breast cancer and its treatments. "Most of the books were ‘keep a stiff upper lip’, or ‘this is how I did it’ books," she says. Love teamed up with a poet to write the book. "She was good at capturing my voice," recalls Love. "I’m good at explaining, but I hate to write. She knew how to convert the spoken word to the written word, and our partnership has continued."

It became clear as the book neared completion that the time was ripe for a breast cancer advocacy movement. "This was post-women’s liberation, after AIDS had arrived, and for the first time people were getting involved in decision-making about research. People were fed up that there wasn’t more progress in curing the disease," says Love. She helped found the National Breast Cancer Coalition in 1991, which focuses on advocacy and political issues. Fundraising soared from $99 million to $400 million in three years.

In 1992 Love was recruited to launch the Revlon/UCLA Breast Center and moved to Los Angeles. Four years later, fearing burnout after 20 years of practice, she decided that what she really wanted was to "get rid of breast cancer altogether." She stopped practicing and returned to business school to earn her MBA. Research led to her invention of a catheter that could be threaded into the milk duct to look at cells and determine "which ones are thinking about becoming cancerous. All breast cancer begins in the lining of the milk ducts, and by the time it can be seen on mammogram or felt, it has been present for 10 years," she says.

She has since sold her company and now focuses on her nonprofit foundation, through which she hopes to conduct further research to answer the question, why does breast cancer start in the milk duct? "My fantasy is that one of these days we’ll find a marker in the fluid—maybe a protein, a mutation—and then we’ll be able to massage a drop of fluid out of the breast, dipstick it, and if it turns blue, go to the doctor, figure out what duct it is in, put treatment into the duct, and be done. It’s very clear to me that that’s how we’re going to get rid of breast cancer. I don’t want to find a cure. I want to have it not happen."

Love’s Menopause and Hormone Book derived from patients’ questions and her own concerns about overuse of hormones. "Hormones were being given out like M&Ms, with everyone under the impression that they could just take them forever. The more I researched it, the more I realized we didn’t have the data to support that."

Love was out on a limb; while others supported her stance, most didn’t want to make their views public. But with recent studies confirming the risks of hormone therapy, including a recent one suggesting it increases the risk of dementia, "The other shoe has dropped," says Love. "I didn’t think it was going to prevent dementia, but I didn’t think it was going to double the chance of it!" Recent studies have shown that hormones in fact increase heart attacks, stroke, the chance of dementia, and the risk of breast cancer. "There is no good argument for the long-term use for prevention," she says.

The trick in using hormone therapy to treat symptoms of menopause is to remember that those symptoms are transient, Love says. "The symptoms are not caused by low estrogen, they are caused by the shifts in hormones. It lasts on average three years. So if people need hormones to get them over the hump, okay, take the lowest dose you can, but long term you don’t want to stay on them. And if you are on them, you don’t want to stop cold turkey; you want to stop gradually over a period of six months to a year. There’s no rush.

"Really, it’s a reminder that we aren’t in control of anything. One of the problems of modern women is that with birth control, suddenly we were in control of our fertility to some degree. Then with fertility drugs, which help on the other side of it, it started to feel like we’re not prey to our biology. And then with hormone replacement therapy, we start to think we don’t have to have menopause. But we really aren’t in control. We are going to die and we won’t look young forever, so it’s really a reminder to live life to the fullest. The best way to prevent diseases of aging is through lifestyle: diet, exercise, and not smoking. We know the drill, we just don’t want to believe it."