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NEW PROCEDURE PROVIDES EARLY DETECTION OF BREAST CANCER RISK
"Ductal lavage may be the most powerful diagnostic weapon against breast cancer to come along for years for women who have elevated risk factors for developing this devastating disease," says James L. Weese, MD, chair of the Department of Surgery at SOM. "With ductal lavage we can find cells that are just becoming cancerous." He explains the technique is primarily used for patients who have a nipple discharge. The term "lavage" is French and means wash or rinse. In the procedure, a breast pump or aspirator is used to apply mild suction to the nipple to draw out ductal fluid. Typically, fluid will be extracted from only one or two milk ducts (each breast contains six to eight ducts). These ducts, according to experts, are the most likely to contain abnormal cells. Once the ducts have been identified, a hair-thin catheter is inserted into them. Saline solution is sent through the catheters to "wash" the duct and collect cells. The cells are then analyzed in a laboratory. If they are found to be abnormal, the patient may wish to consider preventive measures, including the drug tamoxifen. The procedure was developed by renowned breast surgeon Susan Love, MD, but the idea of testing fluid from the nipple was first put forth by Nicholas Papanicolaou, the physician who developed the Pap smear. It is recommended for women at high risk for breast cancer and those with breast cancer in one breast, and is not meant to replace mammography, clinical breast exams or breast self-examination, but to supplement them. "Over 95 per cent of all breast cancers begin in the cells lining the milk ducts," Weese says. "Ductal lavage can help a woman assess her risk of breast cancer in much the same way that a cholesterol test can assess the risk of heart disease. When women have accurate information about their breast cancer risk, they can work with their physician to select the best intervention methods, which may be as simple as closer monitoring by the physician." This technique also offers the opportunity for ongoing surveillance. The procedure can be repeated so that cells from specific milk ducts can be checked over time. "It's important to note that the presence of atypical, or abnormal, cells does not necessarily mean that breast cancer will follow," Weese says. "However, a number of clinical studies have shown that the presence of atypical cells can predict which women are more likely to develop breast cancer." For example, a woman with atypical cells faces a four to five times greater chance of developing breast cancer than a patient without risk factors. If that woman also has a family history of breast cancer, her risk increases even further.
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There's a new weapon in the arsenal for women who are at high risk for
developing breast cancer. It has been described as a "Pap test"
for the breast. Ductal lavage is a minimally invasive procedure that can
assess breast cancer risk eight to 10 years before tumors can be seen
on a mammogram. The test is currently available at select medical centers
across the country, including UMDNJ-School of Osteopathic Medicine (SOM).