Study: Ductal Lavage Effective at Examining Breast Duct Cells for Pre-Cancerous Changes (dateline December 6, 2001)

A procedure that involves analyzing the breast tissue cells in the milk ducts for suspicious changes continues to hold promise as a method of identifying women at high risk of breast cancer, according to a newly published study. Ductal lavage, a test originally developed by breast surgeon Susan Love, MD, appears to be more effective at gathering adequate cell samples than a similar, previously developed procedure that also tests nipple aspiration fluid (NAF) using a different technique. Experts believe that while the ductal lavage should not be a replacement for mammography or clinical breast exams, the procedure can provide valuable information to women at high risk of breast cancer.

Physicians estimate that over 95% of breast cancers begin in the cells lining the breast ducts. Ductal lavage is a new procedure (lavage translates as "wash" or "rinse" in French) that involves analyzing cells washed out from the breast ducts to determine whether they have pre-cancerous qualities and are likely to develop into cancer in the near future.

William C. Dooley, MD of the Institute for Breast Health at the University of Oklahoma Health Sciences Center, and his colleagues decided to compare the ductal lavage procedure to nipple aspiration, a previously developed procedure that also involves a massage/pumping technique to extract nipple fluid from the breast. To conduct the study, Dr. Dooley’s team performed both ductal lavage and the nipple aspiration test on 507 women who were determined to be at high risk of breast cancer, based on personal histories and other factors.

The results of the study found that ductal lavage provided adequate cell samples in 78% of the cases versus only 27% with the nipple aspiration test. Furthermore, ductal lavage provided significantly more ductal cells for examination than the nipple aspiration test and was more accurate at detecting abnormal breast cells. Thus, Dr. Dooley and his colleagues concluded that ductal lavage is a more sensitive method of detecting cellular abnormalities than nipple aspiration.

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. To perform ductal lavage, a physician uses a breast pump to apply mild suction to the nipple to draw out tiny amounts of nipple fluid from the milk ducts up to the nipple surface. Typically, fluid will only be extracted from one to two breast ducts (each breast contains six to eight ducts). These ducts, according to Dr. Susan Love, are most likely to contain abnormal cells. Once the suction identifies the opening on the nipple surface, a catheter is inserted into the duct opening, and saline is used to "wash" the duct and collect cells. The cells are then sent to the pathology laboratory for microscopic examination.

The goal of ductal lavage is to determine whether breast duct cells have certain abnormal characteristics which may cause them to develop into cancer at a later date. If pre-cancerous cells exist, women may wish to consider preventive measures to help protect against breast cancer. However, experts are quick to point out that the benefits of ductal lavage have not yet been proven. According to Jeanne Petrek, MD, a surgeon at Memorial Sloan Kettering Cancer Center, it is difficult for physicians to predict which women will develop breast cancer just by examining cells in the milk ducts.

Nevertheless, Dr. Petrek and other physicians believe ductal lavage has value in helping some women at high risk of breast cancer weigh preventive options. Preventive options for breast cancer include:

Close monitoring with mammography, clinical breast exams, and breast self-exams
Taking the drug tamoxifen for a period of five years
Considering prophylactic mastectomy (preventive breast removal) for women at very high risk of breast cancer.

However, determining the presence of atypical breast cells with ductal lavage does not necessarily mean that a woman will develop breast cancer, and in fact, most atypical cells do not progress to cancer. Therefore, experts are careful to only recommend ductal lavage to women at high risk of breast cancer. Ductal lavage should not replace mammography, clinical breast exams, or monthly breast self-exams.

Note: Pro-Duct Health, the company that is developing ductal lavage, has recently been acquired by Cytyc Corporation. Cytyc is the maker of the "ThinPrep System" to improve cervical cancer cell sample collection and specimen quality during a Pap smear. The ThinPrep System involves a new "direct-to-vial" technique of cell collection in which cervical cells are immediately rinsed with a special solution to ensure preservation. This technique is similar to the ductal lavage technique used on breast cells. (Click here to read more about the latest advances in Pap smear collection and analysis).

Additional Resources and References

The study, "Ductal Lavage for Detection of Cellular Atypia in Women at High Risk for Breast Cancer," is published in the November 7, 2001 issue of the Journal of the National Cancer Institute (Vol. 93, No. 21). An abstract of the study is available at http://jnci.oupjournals.org/
The February 24, 2000 Imaginis report, "New Breast Cancer Detection Method Involves Testing Nipple Fluid," is available at http://www.imaginis.com/breasthealth/news/news2.24.00.asp
To learn more about ductal lavage, including locations in the U.S. where the procedure is performed, please visit http://www.imaginis.com/breasthealth/ductal_lavage.asp
To learn more about preventive options for breast cancer, please visit http://www.imaginis.com/breasthealth/preventive.asp
To learn about the guidelines for early breast cancer detection, please visit http://www.imaginis.com/breasthealth/earlydetection.asp

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