Interview: Could we detect breast cancer with a fingerprint? with Dr. Dhivya Srinivasa

This is Ted Held, the podcast from Ted, and I'm your host, Dr. Shoshana Unger-Liter. I don't know about you, but there are certain health checkups that I'll happily procrastinate on. Dental cleaning? Fine. I'll push it out a few months. Annual blood work? Yeah, I'll get around to it eventually. But there's one screening that so many people delay or even avoid altogether. The mammogram. We know it saves lives, but the thought of the discomfort, the awkwardness, or even the fear of what the results might show can be enough to keep us from booking that appointment. I get it. That desire to avoid those weird experiences or those negative feelings. But here's the thing. Avoiding a test doesn't make the risk disappear. It just means fewer chances to catch something early when treatment is typically most effective. So the question becomes, how do we make the healthy choice the easier choice? What if breast cancer screening didn't have to involve cold machines that squish, hospital gowns that scratch us, or the kind of experience that makes you think twice before going back? Because if we can make prevention less painful, less embarrassing, and more accessible, more people will actually do it. Chemist and professor, Simona Franciza, is tackling that exact problem by looking for a way to screen for breast cancer using only a fingerprint. You already leave fingerprints all over the place dozens of times a day. On a phone screen, a glass of water, even a doorknob. What difference would it be to leave somebody doctor's office where they could screen for tiny molecular clues about what's happening in your body? Simona's TEDx Manchester talk is about reimagining what's possible when we shift how we think about health, risk, and the small actions that can make the biggest difference. And then stick around after the talk for a conversation with my friend and colleague, Dr. Divia Strenavasa, the founder of the Institute for Advanced Breast Reconstruction in Los Angeles, California. We're talking about how to make people with breast cancer feel seen and supported beyond their medical chart, because the diagnosis is just the first step. But before we dive in, a quick break to hear from our sponsors. And now Simona Franciza. In this room, one in eight women will develop breast cancer. And one in 43 will die. And the next better for men, but not in noon. And in 2022, that's by breast cancer, where 670,000 globally. And 11,500 in the UK, that's 32 people every day. And cases are predicted to rise to 70,000 by 2040. But here's the good news. The death rates are actually falling, and they've been falling remarkably to by 44%. Why? Certainly because interventions and better screen and better treatments, but definitely because we can catch cancer earlier. So let's talk about screening, right? For breast cancer, we have the gold standard of mammography, which is followed by my opsy if the result is positive. And we have the breast screening program that invites women every year after a certain age. But actually, the target is 70% nationally, but the app tick can be really low in some areas of the country. So why is that? We really need to understand the reasons why we can't do more screening and why we can't have a better uptake. And also I think we can. So NHS Mark Long, obviously, this has been exacerbated by COVID. Let me say also my decades of underfunding of the NHS. We have reduced resources, so there is a disproportion between the number of screenings needed and radiologists. Also the mammographic equipment is an exactly present in every city, town, village that you would need. So we have here an accessibility problem, which is significantly worse for underserved populations. That's be honest, I personally would choose my life over my modesty, but this is not exactly an exam, a test that preserves your modesty, right? And for some populations, this is absolutely culturally unacceptable. It is invasive. There is a fear associated with radiation, and for many women is actually so painful that they refuse to go. There was a recent survey of 2,000 women, and the standard 21% said that the embarrassment of being topless and the fear of pay would actually prevent them from undertaking screening. Okay? So these women know they are so important to take up the screening, but this still happens. So but what if I told you that my team and I are probably again changing tests, looks exactly like a test that will bypass NHS backlogs. There doesn't need any more resources from the NHS. It actually preserves your modesty because it's completely non-invasive. There is no radiation and paying associated with it. And what if I told you that this comes from the world of fingerprints, CSI and fingerprints, right? An invisible world like that to the fingerprint. We all know what fingerprints are for, right? So they used to identify a suspect by comparing the mark that they left of the crime scene, with the fingerprint that has been taken upon arrest or from prior commit shoot. So you might tell me, "Okay, what's got this to do with breast cancer?" So bear with me, because I need you to rethink what the fingerprint is. So this is a close-up of a fingertip, right? And the elevated part of the skin are the ridges, and then you see these little holes there, those are the sweat pores from which the sweat comes through. And as you're sweating, as soon as you touch a surface, you transfer that sweat onto the surface. And now you're transferring in a rather mesmerizing way. So it's a beautiful pattern of lines, but it is not just a pattern of lines. It is a pattern of lines made up of molecules, what molecules? Whatever our body produces, metabolizes, and then eliminates through sweat. And of course anything that is sitting on your fingertip as you go around in your activity starting things, right? So that's really what the fingerprint is. Is a molecular pattern unique to an individual or a molecular pattern of lines? And what can we do with this? We've exploded this knowledge. I mean, some pioneering research, we have developed a mass spectrometry technique called the moldy, that actually measure the weight of the molecules. And by making these measurements, we are able to know what these molecules are, who these molecules are, but we can also see them. So if these molecules are distributed, almost geniusly onto the witch pattern, by visualizing them, you can visualize a beautiful witch pattern. So now you get a molecular image of a fingerprint. Or we can even resolve overlapping fingerprints because we just interrogated the software and we called the image of distribution of molecules that are unique to each of those fingerprints. So for example, we can eliminate the fingerprint on the victim or we can submit to the database for identification, the fingerprint of the perpetrator. But although this technique has been used already nationally and internationally, it's been endorsed by the O'MawFest, that's actually not the only thing that we can do with this. Remember, we are looking at molecules. And molecules are there for a reason. They tell a story about you. They tell about your lifestyle. They might tell about the medications that you're taking. We can even say something about your state of mind if you take drugs or abuse. And even, what have you been doing just prior to or during committing the crime? So now you're still asking, okay, so when we're going to get to the part of the breast cancer? Okay, we're going to get there. We were looking at personal information. So we were looking at the possibility to, from a fingerprint, say whether that belongs to a man or to a woman. So for this study, we asked the donors to actually swipe a fingertip on a surface. Okay, so this is now a smudged fingerprint. And then we used our moldy technique with fire laser. We got the molecules blasted off and then taken up by the mass patrol method and measures the way. And we were looking at proteins and we discovered that the protein profiles between men and women are different enough. And we can tell them apart with the 86% of accuracy. And this is folks where serendipity manifested in all of its beauty. And so that's why I was looking at this. And as I was looking into this, I realized that some of these proteins actually were already reported in the scientific literature as biomarkers of breast cancer. Let that sink in. a tips me airs on smushed fingerprint, contain. proteins, they might be able to tell whether a woman is affected by breast cancer or not. So of course I washed my team and we have a meeting and our Jo's really dropped. I mean my, my we're still dropping from the early discovery and we all had the same two images together in our mind. We had a mammogram versus a swipe of a fingertip. And also then at that point we thought well then can we further the optimisation of this method? Can we refine it to maybe produce a non-invasive screening or breast cancer? And maybe even just as a pre-screening so then women that only women that are positive to this very simple test go through mammograms. And that is going to save a lot of emotional distress to women and to family as well as saving in a NHS a lot of resources. So cars organisation them as I've actually estimated a cost of 17.5 billion pounds associated to breast cancer intervention treatment and screening. It's a lot. We can reduce the distress to families to communities and we can also reduce this cost. So it took me best part of six years because I was labeled crazy. The best part of six years to obtain 45,000 pounds to prove the concept. And we did prove the concept so with that 45,000 pounds I'm also hijacked some of the findings that I had. But anyway with those 45,000 pounds we were able to look at 15 women that gave us three different fingerprints, smears. We then analysed these smears in three different locations so we had 135 samples to look at. Simply they came and did actually this three times. One, two, three. That's my sample. I know it sounds crazy. The sample preparation for us takes about couple of hours but the results can be obtained in minutes. Then we trained a machine learning algorithm to recognise the protein patterns coming from women with early breast cancer, benign and metastatic. And we found out that we can tell them apart. In the 97.8% of accuracy against the 70 to 90% accuracy of mammogram. And the results are shown in this confusion matrix, the normal white skull confusion, the confusion matrix. What tells you there is that all of 135 samples we spotted every time a woman had cancer. So do you think that a test that will reduce the NHS costs, the bypasses the backlogs, that doesn't require any more resources, that is not invasive, that is painless, radiation free, that increases accessibility because in our vision we can take this test and the GP practices, even in the comfort of your own home. And then we can ship a COVID style as we used to do, so it really solves the accessibility problem as well. And in doing all this, it obviously increases compliance and hands it saves lives. And do you think that something like this is not worth the investment, the dedication, the perseverance? I think it is. And I think that this is definitely an idea we're sharing. Thank you very much. That was Simona Franciza, a TEDx Manchester in 2025. I'm joined now by my colleague and friend, Dr. Divia Shrinavasa, the founder of the Institute for Advanced Breast Reconstruction in Los Angeles. She's a double board certified plastic surgeon. She additionally completed a fellowship in microsurgery, which allows her to bring the artistry of reconstruction alongside the highly technical expertise to reconnect tiny blood vessels, sometimes smaller than a millimeter in diameter under the microscope. This training makes it possible for Dr. Shrinavasa to offer women natural, advanced options for breast reconstruction after mastectomy. As listeners of this show may know, I carry a BRCA mutation. This is an inherited genetic mutation, which means I have a heightened lifetime risk of breast, ovarian, pancreatic, and melanoma cancers. And I've had to navigate my own difficult decisions about preventative surgery. And this journey has made me deeply aware of how complex and overwhelming and deeply personal the healthcare experience can be for patients. Which is why I'm so drawn to Dr. Shrinavasa's work, not just for the surgical skill that she brings, but for the ways she walks alongside her patients through some of the hardest choices of their lives. In our interview, we talk about how patients can better advocate for themselves and what it means to restore not only physical form, but also a sense of wholeness in the aftermath of a cancer diagnosis or preventative surgery. Here's my conversation with Dr. Divia Shrinavasa. Dr. Divia Shrinavasa, welcome to Ted Helm. Thank you for having me. So you're a plastic surgeon and you specialize in breast cancer surgery. Can you explain how you fit into the bigger picture of care for a patient with breast cancers? How does a patient actually end up in your office and what usually brings them to you at that particular point in their journey? It's usually one of two scenarios. And we in the plastic surgery community call an immediate reconstruction versus delayed reconstruction. So either you've got the diagnosis of breast cancer and you need some type of surgery to remove that, whether it's part of the breast or on the breast and then you need reconstruction. Or increasingly I'm seeing women who already had reconstruction and want it fixed or acted not to have reconstruction and then they're choosing to get reconstruction. How do you address the fact that you're meeting your patients at one of the most vulnerable moments in their lives? How do you think about that? I think it has to be different with each patient. And I think this is where having a charged social battery and high EQ really comes into the picture as a doctor. So some women hyperpractical to swan, I get the dang thing over when it's moving with their life. Have a lot of support. They just want facts. They want streamlined information. They want a solution. There are some women and you can literally hear them. Their voice and see it in their eyes. They've just been hit with an avalanche. 90% of what you're saying is not being registered that requires a very different interaction. So you know, I said, I agree with the room. That's what I try to do. You read the room. Who came with them to the visit? Is this person supportive? Somebody taking notes. Do they know they can record the visit? Is there somebody who can help write down important facts? Do they need a follow-up? One of the things I do really commonly is I tell everyone, why don't we just make a visit for next week or on the same time? You choose me as your plastic surgeon or not. You're going to get questions and thoughts between today and next week. Let's just go. Yeah. I feel like most patients probably fit into that camp, right? Where it's overwhelming and they've just had a bunch of information, dumped on them, and it's really hard to process all of that. And you're a phenomenal. I know from firsthand that you're really good at sitting with patients and walking them through that. Patients often describe breast cancer as a journey with many chapters, right? There's diagnosis, there's treatment, there's recovery. For people who are not familiar, where does reconstruction fit into that story and what's the process of reconstruction like for the average patient? What I tell people is you can definitely delay it, you can fit in reconstruction whenever you want, but with the plastic surgeon is good at what they do and they're involved in the process from the beginning, they can actually be tremendously influential in a positive way in your overall outcome. And I'll give you an example. Sometimes women have very large breasts and their nipples have dropped, they call them an atomic breast. And many surgeons will say you're not a great nipple sparing mastectinine candidate. Now, you can do a breast lift or a breast reduction with the lumpectomy or in preventative cases ahead of time to reposition the nipple to then do a nipple sparing mastectomy. That's an option, it's safe we do it all the time. But a lot of you come to me and they go, I didn't know I could save my nipple. And so when they were told may have been surgical preference or sort of a quicker way to get through the chapters, but if given all of the options, the patient may have actually chosen the other way to go about it. And you won't really know all of your options unless you include all the doctors from the beginning so that they all talk to each other and they're all part of the team. And then you just get all your options. You can choose to not sub the nipple if it's if that is not a priority for you. I get it. I get patients like that all the time. But why the not? I get the woman who shares her grant because she didn't realize there was a way to go. That resonates with me certainly and such good advice. You know, Divya, so much of medicine is about survival and cure, but your work also touches on identity and self image and dignity. How do you see reconstruction as part of a person's healing and not just their treatment? I think it's different from so many people. I think what most women want is to close the book and move on. But I find that you have to reframe that. And again, I'm speaking as someone who's a medical provider but hasn't gone through most of the book. But I tell a lot of patients, it's clearly going through puberty. There's a beginning and end to puberty, but you're not the same after puberty that you were before. So the expectation that you will be the same, I find that to be a really difficult expectation because they're just not gonna be the same. So I think carefully walking someone through the stages of breast cancer treatment, but with the combined goal, you're gonna be different, but gosh, I hope I can make it as good a better. - You've said before that you're not working to help create a perfect body for someone. Your goal is to actually help someone feel whole again. Can you share a moment when you saw that shift happen for a patient? - I had a patient who had breast implant reconstruction. And it isn't okay, it was all, I think in close, it was fine. She's a lot of pain. The under the muscle caused a lot of precinct and what we call animation deformity. So she felt like, unless her shirt was octopinaric, even smoothness like pushing the cartoclustoscope, closing the door on her SCV, people would see the implant gel mold. There's very honest with her, I said, "Look, one thing I can tell you as a surgeon is that when patients have all these symptoms and they're not otherwise explained by their diagnosis and they've been worked up, they haven't found any other cause. When I took the implant out 100% of the time, the symptoms have resolved. Now I'm happy to take out your implants and what we did was we replaced the tissue with her natural tissue. And I swear to you, she was a different woman after surgery. She's so cute, she's something that goes on to make sure I'm friends wedding and she's cute, dry since she wanted to show me how she looked in the drawings. And part of it is the restylting of the abdomen gave her a sense of self-confidence that has nothing to do with her breasts, right? It's her abdomen, it doesn't do the truss well. But she was so happy with it that it dropped back to sense of confidence that wasn't even part of the initial bone as far as we surgically what we were working on. And then being pain free, you know, when you're constantly in pain, you're constantly reminded of what you went through. I find that pain is a metric, again not an aesthetic metric, by an equality of life metric, that it allowed her to kind of where she wanted to where and just feel better about it 'cause she wasn't in pain. So with some people, I know, choose not to pursue breast reconstruction at all. Tell us a little bit about that. How do you honor that decision? What does that say about the different ways the people process healing maybe? - I will say that most women who choose not to have reconstruction do not regret it in my experience. I would say maybe a program of patients that I may who decided not to have reconstruction then come back saying, you know what, I tried it not for me, I want reconstruction. Does a different cohort of people than those who are recommended to a recovery construction? Because there are certain types of removal surgeries, things like that that would be a contraindication to immediate reconstruction. So I'm not talking about those women who are certainly guided in the direction of not doing everything's section at the time. I'm talking about women who could have it and choose not to be fined. But that most do not regret it. And that's a very powerful thing for me to realize because it means that when educated about their options, there are women who are perfectly fine choosing not to pursue reconstruction. And I think it just speaks to the multifactorial things that go into what healing is for somebody. For some people, the not having the breast part doesn't bother them. But they didn't need that to feel healed. The most important role that I can play in that is just explaining to you what that will mean. Because if you want to flat closure, the majority of the skin of the breast will be removed. Meaning if you change your mind in the future, some form of skin replacement, skin expansion, expansion plus replacement must then take place to restore the breast as a whole. And so zooming out a little bit, of course, breast cancer doesn't just affect the patient, right? It touches families and relationships, whole communities, even what have you observed about the ripple effects of the experience? I find that despite all of that, it is terribly lonely. I find that the reason I clapped the pink red dot clad that the pink red dot clad is slow, strong, is that women find, and speaking to people who might do something similar, and that's not always readily found in your own community, or in your own family or one circle. I hear a lot of patients say, "You know what, when you're getting to the wrong "and you're going to drop them food and do all the things, "but like the six weeks after came on sock two, "and then I had to have surgery, "and then I had to have radiation." Where did everybody go? And I think that's why it's important that there are already support groups and people who are connecting, but gone through something similar, 'cause unfortunately it might find that despite how much community and support there may be, how well that translates to patient-specific support about their condition, and I think it's hard. Absolutely. And then, you know, there's just years of survivorship where that's also very lonely and anxiety-ridden place, right? Yeah. For sure. Three peak scans in the follow-up glands, and there was a lot of women that get that sort of waiting for the other shoe to drop anxiety. And it is for them to describe that, and again, I haven't been through it. So I'm speaking through the experiences that I see of my patients, but I think that can be a very isolating experience. That's real. So ideas of body of femininity, of strength, and even health and recovery are constantly shifting. Have you noticed differences in how younger generations or different cultural groups even approach the idea of reconstruction? Yeah, definitely. I find a lot of women from like the Asian East Asian community, they don't want anyone to know, they want to be rescued. I know that to be a common thread. So they will want reconstruction so that nobody knows. I get that a lot. I find that younger and younger women tend to look more into long-term permanent reconstructive options. I find that the younger generation comes in requesting reconstruction far more often than older patients. And I think that there's the advent loan in plant popularity. It just changes with each decade. And then 90s or even two or a thousand in the game pop area. It's going to keep evolving just like you said. But it's invigorates not. But I find that this current sort of younger generation mid-20s type would say early 40s and say a lot of women come in saying, I don't want breast and transplant care for me. That's definitely what turned I see. I find that a lot of African and American women have had difficult interactions with their doctors. A lot of them show traumatic experiences with childbirth, being healthy, their most recent interaction. And so I find that many are appropriately hesitant to engage in things that they may find not necessary. And it may be because, well, when I get birth, I get a pain or they did this. And I had this onto an upkeep. And nobody believed me. And it's like a very real rational fear. And so I try to be cognizant of that too. Every patient you have to just read the room. They got to figure out where they're coming from and meet them for their. Is there any sort of general advice that you give patients or even a family member or a friend about advocating for themselves and finding their way through the health care system? Yes. If you're spidey sense and zone, just take a minute. Get a second opinion. Talk to people because your gut is one of the strongest sensibilities that you have. If someone doesn't give you the good gut instinct feeling, you may be right. So take a minute and we'll think about it. But I think second and third opinions make sense. And I really think when you're going through something like this, having a point person or two, that can come as a data I realize if I think is helpful, you know, patients ask me all the time, do you mind if I look at this? And so it was always yes. Because you know, I'm going to be honest against me or what if I get sick? Look, if I get sick, I get sick, but go ahead and play the recording. Because I stand by when I say it. And I think if you genuinely do a good job and show people that you care, even if you have a complication, if people are genuinely forgiving human beings. Yeah. I think that's great advice. So I want to look ahead. What excites you most about the future of surgery, not just in breast cancer, but in how medicine can restore an even, I think, reimagine the human body. To me, the most exciting part of the future of medicine is the use of biologics and immunotherapy and immunologics for cancer treatment and prevention. And I think it's a scary tone right now because there's so much misinformation and negative rhetoric around the world vaccine. When I think most people in this scientific community can readily tell you that the future cancer care will be in vaccine-related technology. And so that's what makes me excited. And if you look at the last 10 years, that's where we've moved the needle in a lot of cancer types from something that could have been fatal. So it's so many cancer patients and medications that they may need to be on for their lifetime. But they're looking at the word cure despite later stage cancers. And I think looking forward 10, 20 years, we're going to be in the land of immunandase therapies. With all the innovation happening, it's a wonderful time to be in oncology care. We just need the policy to follow and allow for it all to happen to be able to save lives. How do you think the next generation of surgeons will need to be trained? Not only in technical skill, but in the other things that you've mentioned a bunch, like empathy and communication. I myself had to sort of train my brain and my personality out in the trauma of some surgical training. I was a young mother and there was just noise. back for who I was as a human being as a wife as a mother. And it was not a happy person at the end of general surgery training in it. Played out in who I was and how I treated maybe other styles and patient interactions. And I'm not proud to admit it, but it took me sort of acknowledging that and for lack of better terms, I'm just telling you some, you don't need to be a part of it. We're going with that. It does not serve anybody. And then refinding the empathy and what I did. And for me, the academic paradigm in which I worked didn't do anything to help me find that empathy. And I think we have to start treating doctors as people too. They're humans. And I think when you can create a system that trains doctors with empathy and you treat them with empathy, can I tell you, raise your kids, right? You say lead by example, well, then they don't have to actively try and mediate and refine that, but it is within them because that is the system in which they trained. Ooh, that's powerful. Gosh, thank you so much for having this conversation. I'm so grateful to you, not only personally for myself and my own family, but for all the patients that you treat. - Thank you so much. It was a pleasure. (upbeat music) And that's it for today's episode. Thank you so much for listening. Ted Health is a podcast from Ted. And I'd love to hear your thoughts about this episode. Send me a message on Instagram @ShoshanaMD. This episode was produced by me, Shoshana Ungerliter and Jess Shane, edited by Alejandro Salazar and fact checked by Vanessa Garcia Woodworth. Special thanks to Maria Lagis, Faraday Grunge, Danielle Balerizo, Constanza Gallardo, Tansica Sungmani Wang and Roxanne Highlash. (upbeat music) [Music]