Ductal Lavage for Breast Cancer Risk Assessment

Lisa A. Newman, MD, MPH, FACS, Cassann Blake, MD

Disclosures

Cancer Control. 2002;9(6) 

In This Article

Abstract and Introduction

Background: Effective chemoprevention is available for breast cancer, but it is associated with the potential for life-threatening adverse events. Accurate identification of women facing increased risk of breast cancer is therefore essential. Atypical hyperplasia is a histopathologic pattern that has been consistently associated with an elevated future risk of breast cancer.
Methods: The literature was reviewed to assess the strength of the association between atypical hyperplasia and breast cancer. The rationale for developing a nonsurgical modality to document the presence of atypia is discussed.
Results: Ductal lavage identifies atypical hyperplasia by retrieving epithelial cells shed into the ductal system with a specially designed catheter. Women with clinical evidence of increased breast cancer risk may consider ductal lavage as a means of determining whether abnormal proliferative activity is occurring in their breasts at a given point in time from ducts yielding fluid.
Conclusions: Ductal lavage is a minimally invasive procedure that facilitates the detection of atypia via retrieval of breast ductal fluid that can be evaluated cytologically. It can facilitate the selection of women who may benefit from breast cancer risk reduction intervention.

Breast cancer risk reduction strategies are currently available in the form of medical and surgical interventions, all of which are associated with possible life-threatening complications. Prophylactic mastectomy is clearly a disfiguring and extreme maneuver, oophorectomy in premenopausal women results in the health risks of premature menopause, and chemoprevention with tamoxifen may result in thromboembolic phenomena or uterine cancer.[1] Therefore, it is essential that a woman subjected to this potential morbidity has been reliably identified as having a substantially elevated risk of breast cancer. Unfortunately, established breast cancer risk assessment models based on a woman's gynecologic and family history have well-recognized limitations. Ductal lavage provides the clinician with a nonsurgical means of evaluating risk based on cytopathologic evidence of abnormal breast tissue proliferative activity.

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