Breast surgeon Susan Love, MD and her colleagues are developing a procedure that samples cells from nipple fluid to target women at high risk of breast cancer.  The procedure, called ductal lavage, helps identify cancerous and pre-cancerous cells in the milk ducts of the breast and may be performed in a physician’s office. Dubbed the "breast pap smear," Dr. Love believes the ductal lavage procedure can help physicians better understand how breast cancer develops and help identify women at high risk of the disease.

The idea of testing fluid from the nipple was first suggested in the 1950s by Dr. Papanicolaou, the physician who developed the Pap smear to test for cervical cancer. Nipple aspirate fluid contains several cells and proteins that may be analyzed for the presence of disease. One protein, PSA (protein-specific antigen) is secreted from the breast ducts—the origin of most breast cancers, said Edward Sauter, MD, PhD, lead researcher of a nipple aspirate fluid study at Thomas Jefferson University in Philadelphia. Researchers were reluctant at first to develop a nipple fluid analysis test because they previously believed that PSA was only produced in the male prostate gland. However, recent research has shown that PSA is also present in the breast and is associated with an increased breast cancer risk.

The ductal lavage procedure was developed by Dr. Love and her colleagues as a rapid nipple fluid analysis test. To perform the procedure, a breast pump (or aspirator) is used to apply mild suction to the nipple to draw out nipple fluid. Typically, fluid will only be extracted from one or two breast ducts (each breast contains six to eight ducts). These ducts, according to Dr. Love, are most likely to contain abnormal cells. Once these ducts have been identified, an anesthetic is applied to the nipple and a catheter is threaded into the duct opening in the nipple for a small distance. Next, salt water is sent through the catheter into the breast duct and then washed out again. The breast cells that are washed out are sent to the pathology laboratory for analysis.

According to Dr. Love, the ductal lavage procedure is currently available at select centers in the United States (see www.susanlovemd.com for a list of centers) and may become more widespread as researchers learn more about the procedure. Ductal lavage is not meant to replace mammography ,clinical breast exams ,or breast-self exams . Rather, information supplied by the ductal lavage procedure is only used to supplement other breast cancer screening exams. According to Dr. Love, ductal lavage is designed for women at high risk of breast cancer or those who have breast cancer in one breast.

For instance, if the ductal lavage procedure reveals that a woman has pre-cancerous cells, she may wish to consider measures to help prevent breast cancer, such as using the drug tamoxifen or a prophylactic mastectomy (preventive breast removal). According to Dr. Love, ductal cells could also be used for studying the breast cancer genes and environmental factors affect breast cells.

Guidelines for the early detection of breast cancer:

• All women between 20 and 39 years of age should practice monthly breast self-exams and have a physician performed clinical breast exam at least every three years.
• All women 40 years of age and older should have annual screening mammograms, practice monthly breast self-exams, and have yearly clinical breast exams.
• Women with a family history of breast cancer or those who test positive for the BRCA1 (breast cancer gene 1) or BRCA2 (breast cancer gene 2) mutations may want to talk to their physicians about beginning annual screening mammograms earlier than age 40, as early as age 25 in some cases.

• Susan Love, MD provides detailed information on the ductal lavage procedure, including a list of centers that currently offer the procedure, on her website at http://www.susanlovemd.com/lavage_frames.html
• The February 24, 2000 Imaginis.com report, "New Breast Cancer Detection Method Involves Testing Nipple Fluid," is available at http://www.imaginis.com/breasthealth/news/news2.24.00.asp
• Dr. Susan Love's Breast Book (1995) by Susan M. Love, MD and Karen Lindsey contains substantial information about all aspects of breast cancer, including risk factors, symptoms, diagnosis, treatment, and survival. Click here for pricing and ordering information.
• To learn more about the guidelines for early breast cancer detection, please visit http://www.imaginis.com/breasthealth/earlydetection.asp

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