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

0:01This is Ted Health, a podcast from Ted, and I'm your host Dr. Shoshana Ungerleider. 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.

0:38But 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 Franchiza is tackling that exact problem by looking for a way to screen for breast cancer using only a fingerprint.

1:18You 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 some at a 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. Divya Srinivasa, the founder of the Institute for Advanced Breast Reconstruction in Los Angeles, California.

1:52We'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.

2:09And now, Simona Franchiza. In this room, one in eight women will develop breast cancer. And one in 43 will die. Looks better for men, but they're not immune. And in 2022, the deaths by breast cancer were 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. Right? But here's the good news. the death rates are actually falling and they've been falling remarkably 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?

3:10For breast cancer, we have the gold standard of mammography, which is followed by myopsy 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 uptake 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. Because I think we can. We can. So NHS backlogs. Obviously, this has been exacerbated by COVID. Let me say also by decades of underfunding of the NHS. We have reduced resources.

3:58So there is a disproportion between the number of screenings needed and radiologists. Also, the mammographic equipment isn't exactly present in every city, town, village that you will need. So we have here an accessibility problem, which is significantly worse for underserved populations. Let'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, it's actually so painful that they refuse to go.

4:44There was a recent survey of 2 ,000 women, and a staggering 21 % said that the embarrassment of being topless and the fear of pay would actually prevent them from undertaking screening. Okay. At least women know that it's 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 a game-changing test that looks exactly like a test that will bypass NHS backlogs, that doesn't need any more resources from the NHS, that actually preserves your modesty because it's completely non-invasive. There is no radiation and pain associated with it.

5:34And what if I told you that this comes from the world of fingerprints, CSI and fingerprints, right? An invisible world like that of a 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 a fingerprint that has been taken upon arrest or from prior convictions, right? 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.

6:19And as you're sweating, as soon as you touch a surface, you transfer that sweat onto the surface. And now you transfer it 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. Of course, anything that is sitting on your fingertip as you go around in your activities touching things, right? So that's really what a fingerprint is, is a molecular pattern unique to an individual, a molecular pattern aligns. And what can we do with this?

7:05We've exploited this knowledge, and in some pioneering research, we have developed a mass spectrometry technique called MALDI 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 homogeneously onto the rich pattern, by visualizing them, you can visualize a beautiful rich pattern. So now you get a molecular image of a fingerprint. Or we can even resolve overlapping fingerprints because we've just interrogated the software and recalled the image of distribution of molecules that are unique to each of those fingerprints.

7:54So, for example, we can eliminate the fingerprint of 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 Home Office, 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.

8:32And even, what have you been doing just prior to or during committing the crime? So now you're still asking, okay, so when are we going to get to the part of 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. We fire laser. and we get the molecules blast off and then taken up by the mass spectrometer that measures the way.

9:16And 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, right? And this is folks where serendipity manifested in all of its beauty, right? Because my next question was, who are these proteins? 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. Fingertip smears or smudged fingerprints contain proteins that might be able to tell whether a woman is affected by breast cancer or not.

10:05So, of course, I rushed to my team and, you know, we have a meeting and our jaws really dropped. I mean, mine was 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 optimization of this method? Can we refine it to maybe produce a non-invasive screening of breast cancer? And maybe even just as a pre-screening, so then 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 the NHS a lot of resources.

11:05So CARS organization then has actually estimated a cost of£17.5 billion associated to breast cancer interventions, 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 the best part of six years because I was labeled crazy, the best part of six years to obtain£45 ,000 to prove the concept. And we did prove the concept. So with that£45 ,000, I also hijacked some of the fundings that I had. But anyway, with those£45 ,000, we were able to look at 15 women that gave us three different fingerprint smears. we then analyzed these smears in three different locations.

12:02So 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 a couple of hours, but the results can be obtained in minutes. Then we trained a machine learning algorithm to recognize the protein patterns coming from women with early breast cancer, benign, and metastatic. And we found out that we can tell them apart with the 97.8 % of accuracy against the 70 to 90 % accuracy of a mammogram. And the results are shown in this confusion matrix. I don't know why it's called confusion, but it's the confusion matrix.

12:53What it tells you there is that of 135 samples, we spot it every time a woman had cancer. So do you think that a test that will reduce the NHS costs, that bypasses the backlogs, that doesn't require any more resources, that is non-invasive, that is painless, radiation-free, that increases accessibility because in our vision, we can take this test of the GP practices, even in the comfort of your own home, and then we can ship it 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 hence, it saves lives.

13:42And 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 worth sharing. Thank you very much.

14:11That was Simona Franchiza at TEDxManchester in 2025. I'm joined now by my colleague and friend, Dr. Divya Srinivasa, 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. Srinivasa to offer women natural advanced options for breast reconstruction after mastectomy.

14:48As 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. Srinivasan's work, not just for the surgical skill that she brings, but for the way she walks alongside her patients through some of the hardest choices of their lives.

15:25In 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. Divya Srinivasa.

15:42Dr. Divya Srinivasa, welcome to TED Health. 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 cancer? So like 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 it immediate reconstruction versus delayed reconstruction. So either you've gotten the diagnosis of breast cancer and you need some type of surgery to remove that, whether it's part of the breast or all of the breast, and then you need reconstruction.

16:20Or increasingly, I'm seeing women who already had reconstruction and want it fixed or opted 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, hyper practical, just want to get the dang thing over with, move on with their life, have a lot of support. They just want facts.

16:58They want streamlined information. They want a solution. There are some women, and you can literally hear it in 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 say, like, read 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, you know, 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 around the same time?

17:36Whether 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 over it. 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 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.

18:08For 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, whatever you want. But if 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. We call it a tonic breast. And many surgeons will say, you're not a great nipple sparing mastectomy candidate.

18:43Now 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 women come to me and they go, I didn't know I could save my nipple. And so what they were told may have been a 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 a team.

19:23And then you just get all your options. You can choose to not save the nipple if that is not a priority for you. I get it. I get patients like that all the time. But more than that, I get the woman who shares regret because she didn't realize there was a way to go about it. 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 for so many people. I think what most women want is to close the book and move on.

20:01But 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 this cancer. But I tell a lot of patients it's kind of like 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 going to be the same. So I think carefully walking someone through the stages of breast cancer treatment, but with the combined goal of you're going to be different. But gosh, I hope I can make it as good or better.

20:38You'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 was an okay result. I think in clothes, it was fine. She was in a lot of pain. The under the muscle caused a lot of creasing and what we call animation deformity. So she felt like unless her shirt was up to her neck, even movements like pushing the car to Costco, closing the door on her SUV, people would see the implant jump. And I was very honest with her.

21:15I 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 diagnoses and they've been worked up, they haven't found any other cause. When I took the implant out, 100 % of the time, those symptoms have resolved. So I'm happy to take out your implants. And what we did is 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 sends me pictures all the time. She went to her friend's wedding and she wore this cute dress and she wanted to show me how she looked in the dress.

21:44I think part of it is the re-sculpting 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 have to do with her chest wall. But she was so happy with it that it brought back a sense of confidence that wasn't even part of the initial goal as far as like 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, but a quality of life metric that it allowed her to kind of wear what she wanted to wear and just feel better about it because she wasn't in pain.

22:20So 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 that 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 quarter of patients that I meet who decided not to have reconstruction, then come back saying, you know what, I tried it, not for me, I want reconstruction. There's a different cohort of people than those who are recommended not to have reconstruction, because there are certain types of removal surgeries, things like that, that would be a contraindication to immediate reconstruction.

23:00So I'm not talking about those women who are sort of guided in the direction of not doing reconstruction at the time. I'm talking about women who could have it and choose not to. I find 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, that they didn't need that to feel healed.

23:36The most important role that I can play in that is just explaining to you what that will mean. Because if you want a 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.

24:13I find that the reason I call it the pink ribbon club, that the pink ribbon club is so strong, is that women find in speaking to people who went through something similar, and that's not always readily found in your own community or in your own family or one circle. I hear it a lot from patients like, you know what, when you're getting chemo, everyone's dropping off food and doing all the things. but like the six weeks after chemo suck too. And then I had to have surgery and then I had to have radiation. Where'd everybody go? And I think that's why it's so important that there are already support groups and people who are connecting have gone through something similar.

24:50Cause unfortunately I find that despite how much community and support there may be, how well that translates to patient specific support about their condition. I know. I think it's hard. Absolutely. And then, you know, there's just years of survivorship where that's also a very lonely and anxiety ridden place, right? For sure. The repeat scans and the follow up labs and the there's a lot of women that get that sort of waiting for the other shoe to drop anxiety. And it is hard to describe that. And again, I haven't been through it. So I'm speaking through the experiences that I see of my patients.

25:26But I think that can be a very isolating experience. It's real. Wow. 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 the Asian, East Asian community, they don't want anyone to know they want full breast cancer. And 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.

26:07I find that the younger generation comes in requesting reconstruction far more often than older patients. And I think that there's the ebb and flow of implant popularity. It just changes with each decade in the 90s. Don't do it. Then in the 2000s, it became popular again. It's going to keep evolving, just like you said. It's in vogue or it's not. but I find that this current sort of younger generation, mid-20s to I would say early 40s, I'm seeing a lot of women come and say, I don't want breast implants. What can you do for me? That's definitely a trend I see. I find that a lot of African-American women have had difficult interactions with their doctors.

26:50A lot of them share traumatic experiences from childbirth being probably 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 like well when I gave birth you know they ignored my pain or they did this and I had this untoward outcome 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 got to just read the room you got to figure out where they're coming from and meet them where they are. 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 healthcare system?

27:33Yes. If your spidey sense is off, 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 like the good gut instinct feeling, you may be right. So take a minute and rethink about it. 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 comes with you to every visit, I think is helpful. You know, patients ask me all the time, do you mind if I record this? And the answer is always yes. Because, you know, a lot of people are like, why more is it used against me?

28:09Or what if I get sued? Look, if I get sued, I get sued. But go ahead, play the recording. Because I stand by what I say. And I think if you genuinely do a good job and show people that you care, even if you have a complication, people are generally 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 and 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.

28:47And I think it's a scary time right now because there's so much misinformation and negative rhetoric around the word vaccine when I think most people in the scientific community can readily tell you that the future of 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, you know, 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.

29:23And I think looking forward 10, 20 years, we're going to be in the land of immune-based 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 of the trauma of so much surgical training. I was a young mother, and there was just no respect for who I was as a human being, as a wife, as a mother.

30:03And I was not a happy person at the end of general surgery training. And it played out in who I was and how I treated maybe other staff and patient interactions. And I'm not proud to admit it, but it took me sort of acknowledging that. And for lack of a better term, just telling me, you don't need to be a hard ass. Where are you going with that? It does not serve anybody. And then refinding the empathy in 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, kind of like how you raise your kids, right?

30:47You say lead by example. Well, then they don't have to actively try and regain and refine their empathy. It is within them because that is the system in which they trained. Oh, 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. Thank you.

31:14And 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 at ShoshanaMD. This episode was produced by me, Shoshana Ungerleiter, and Jess Shane. Edited by Alejandra Salazar and fact-checked by Vanessa Garcia-Woodworth. Special thanks to Maria Lages, Farrah Degrunge, Daniela Balarezo, Constanza Gallardo, Tansika Sangmarniwang, and Roxanne Heilash.