Ductal Lavage Useful for Women at High Risk of Breast Cancer

Peggy Peck

May 02, 2003

May 2, 2003 (New Orleans) — Ductal lavage is a "technology that is in its infancy," yet a short series suggests that the procedure is well accepted by women and is a technology that is easily adapted to office-based practice, said Sheldon H. Cherry, MD, clinical associate professor of obstetrics and gynecology at Mount Sinai School of Medicine in New York City.

Dr. Cherry presented his findings here at the 51st annual meeting of the American College of Obstetricians and Gynecologists.

Ductal lavage may be useful in further stratifying risk in women who "are already identified as high risk, especially if these are women who meet the criteria for tamoxifen, but who are not on tamoxifen," Dr. Cherry told Medscape. "If we find atypical cells in these women, that may be enough information to get them on active therapy, which is desirable."

The median age of the women was 59 years and 22 of the women had a history of breast cancer. Ninety-eight percent of the women were white and 2% were African-American. Eighteen of the women had a history of smoking. Most women (54.3%) had had one or more pregnancies. Eighteen women had a history of hormone replacement therapy and 20.8% of the women were currently taking hormones. A relatively small proportion of the women (3.7%) had spontaneous nipple discharge, Dr. Cherry said.

The study was divided into two steps: the women were counseled and offered nipple aspiration as a method for determining eligibility for ductal lavage during an initial office visit. If fluid was obtained by massage and aspiration, women were scheduled for a second visit for a full 30-minute ductal lavage.

Nipple aspiration was successful in 32.2% of the women, which is "significantly lower than the rates of 60% or higher reported by others," said Dr. Cherry. "We obtained cytology on 17 women. In one case mild atypia was identified, while 14 samples were benign and two samples had inadequate findings," Dr. Cherry said.

Although the series is small, Dr. Cherry said he thinks it illustrates the potential for ductal lavage as an office-based screening procedure because "women are very accepting of this technology."

Julian Kim, MD, from the Cleveland Clinic Foundation Breast Center in Ohio, cautioned that ductal lavage has not yet demonstrated "utility as a tool for detecting breast cancer. What we know about ductal lavage are two things: it can obtain a higher yield of ductal epithelial cells than nipple aspirate and it can find the presence of atypical cells in about 20% of high-risk women."

Dr. Kim, who was not involved in the study, said that ductal lavage is useful in "further stratifying risk in high-risk women, but this is a very select group. And we must remember that very few of the women who have atypical cells are going to end up having cancer." He noted, for example, that a study by researchers at the University of Kansas indicates that women with atypical cells have "increased near-term risk (meaning, a three-year risk) of cancer." Thus, he said that Dr. Cherry's suggestion that ductal lavage might be a factor in a woman's decision to initiate tamoxifen is a valid use for ductal lavage.

But Dr. Kim said that many insurance companies refuse to pay for ductal lavage, which limits the use of the technology because assays cost about $500.

ACOG 51st Annual Clinical Meeting: Poster 22. Presented April 30, 2003.

Reviewed by Gary D. Vogin, MD

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