Ductal Lavage for Breast Cancer Risk Assessment

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

Cancer Control. 2002;9(6)

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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No significant relationship exists between the authors and the companies/organizations whose products or services may be referenced in this article.

The print version of this article was originally certified for CME credit. For accreditation details, contact: H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL 33612. Telephone: (813) 632-1349. Fax: (813) 903-4950. Email: ccjournal@moffitt.usf.edu.

Cite this: Ductal Lavage for Breast Cancer Risk Assessment - Medscape - Nov 01, 2002.

Table. Association of Atypical Hyperplasia With Relative Risk for Breast Cancer: Selected Studies
Author	No. of Patients	Selection Criteria	Median Follow-up	% Atypia	Method of Detection	Breast Cancer Relative Risk (95% Confidence Interval)
Fabian et al^[6] 2000	480	University of Kansas patients with high risk via FH/PH breast cancer or history of atypical hyperplasia/ductal carcinoma in situ	45 mos	12.0*	Periareolar FNAs for cytology	5.02 (2.01-12.56)
Wrensch et al^[3] 2001	3,633 (Group 1)	Group 1: UCSF BCDDP participants	21 yrs (Group 1)	2.4	Nipple aspirate fluid	2.4 (1.6-3.7)
Wrensch et al^[3] 2001	3,271 (Group 2)	Group 2: UCSF volunteers	9 yrs (Group 2)	2.4	Nipple aspirate fluid	2.8 (1.5-5.5)
Wrensch et al^[2] 1992	2,343	General screening population	12.7 yrs	2.0	Nipple aspirate fluid	4.9 (1.7-13.9)
Dupont et al^[7] 1999	9,494	Vanderbilt University patients with biopsy-proven benign breast disease	20 yrs	3.0	Surgical biopsy specimens	3.58 (2.6-5.0)
Bodian et al^[8] 1993	1,799	Haagensen patient population from Columbia-Presbyterian Medical Center with biopsy-proven benign breast disease	20.6 yrs	19.0	Surgical biopsy specimens	3.0 (1.5-6.0) (moderate/severe atypia)
Bodian et al^[8] 1993	1,799		20.6 yrs	19.0	Surgical biopsy specimens	2.3 (1.6-3.4) (mild atypia)
Hutchinson et al^[9] 1980	1,053	Private practice patient population with biopsy-proven benign breast disease	12.9 yrs	3.1	Surgical biopsy specimens	2.85 (0.34-10.28)
Carter et al^[10] 1988	16,692	BCDDP participants with history of biopsy-proven benign breast disease	8.3 yrs	7.8	Surgical biopsy specimens	3.0 (2.1-4.1)
Dupont et al^[11] 1985	3,303	History of biopsy-proven benign breast disease	17 yrs	3.6	Surgical biopsy specimens	All: 5.3 (3.1-8.8)
						With FH of breast cancer: 8.9 (4.8-17)
						Without FH of breast cancer: 3.5 (2.3-5.5)
London et al^[12] 1992	121 (cases)	Nurses Health Study participants with either cancer or biopsy-proven benign breast disease	9 yrs	22.3 (cases)	Surgical biopsy specimens	All: 3.7 (2.1-6.8)
	488 (controls)			9.6 (controls)		With FH of breast cancer: 7.3 (1.1-50.1)
	488 (controls)			9.6 (controls)		Without FH of breast cancer: 3.7 (1.9-7.0)
McDivitt et al^[13] 1992	433 (cases)	Cancer and Steroid Hormone Study participants with either cancer or biopsy-proven benign breast disease	N/A	15.9 (cases)	Surgical biopsy specimens	Odds ratio 2.6 (1.6-4.1)
McDivitt et al^[13] 1992	261 (controls)		N/A	10.0 (controls)	Surgical biopsy specimens	Odds ratio 2.6 (1.6-4.1)
Palli et al^[14] 1991	62 (cases)	Women from Florence, Italy, breast cancer screening program	N/A	17.7 (cases)	Surgical biopsy specimens	Odds ratio 13.0 (4.1-41.7)
Palli et al^[14] 1991	315 (controls)	Women from Florence, Italy, breast cancer screening program	2.2 (controls)	17.7 (cases)	Surgical biopsy specimens	Odds ratio 13.0 (4.1-41.7)
Krieger and Hiatt^[15] 1992	2,731	San Francisco, California, women with biopsy-proven benign breast disease	16 yrs	12.0	Surgical biopsy specimens	Rate ratio 7.2 (Black-Chabon score 5/severe atypia)
Dupont et al^[16] 1993	95 (cases)	BCDDP mammography screening program participants	N/A	14.7 (cases)	Surgical biopsy specimens	Odds ratio 4.3 (1.7-11)
Dupont et al^[16] 1993	227 (controls)	BCDDP mammography screening program participants	N/A	4.4 (controls)	Surgical biopsy specimens	Odds ratio 4.3 (1.7-11)
Byrne et al^[17] 2000	133 (cases)	Nurses Health Study participants with either cancer or biopsy-proven benign breast disease	N/A	25.6 (cases)	Surgical biopsy specimens	Odds ratio 3.6 (2.0-6.4)
Byrne et al^[17] 2000	610 (controls)		N/A	11.8 (controls)	Surgical biopsy specimens	Odds ratio 3.6 (2.0-6.4)

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Ductal Lavage for Breast Cancer Risk Assessment

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