TUESDAY, Oct. 19, 2004 (HealthDayNews) -- A technique that researchers had hoped might aid in the early detection of breast cancer has turned out not to fulfill that promise.
But the method, called ductal lavage, may still hold hope as a tool to indicate which women face an increased risk for developing the disease.
"We feel like it's helpful to give a better quantification of what a woman's subsequent risk of breast cancer is, and this, in turn, lets her make some decisions about what to do about that risk," said Dr. Freya R. Schnabel, chief of the breast surgery section and medical director of Women at Risk, at Columbia University Medical Center in New York City. "One of the big decisions is whether or not to take tamoxifen to reduce risk. This may give patients an opportunity to make a decision about taking tamoxifen."
"When women have atypical or abnormal-looking cells in the breast, then those women have an increased risk of breast cancer in the future," added study author Dr. Seema A. Khan, interim director of the Lynn Sage Comprehensive Breast Center and a surgeon at Northwestern Memorial Hospital. "Women who were armed with that information can then make a decision about things they would like to do to reduce risk."
The results appear in the Oct. 20 issue of the Journal of the National Cancer Institute.
Ductal lavage is a method used to gather cells from the milk ducts of the breast, where cancer is thought to begin. If cancer could be detected in these cells, the thinking goes, it would be at a much earlier stage and therefore more amenable to early treatment. It was also hoped the technique might be valuable in young women, for whom mammography is less effective.
According to the Cleveland Clinic, ductal lavage is a minimally invasive procedure that first involves suction to identify which milk ducts produce fluid on the surface of the nipple. Then a tiny microcatheter is inserted into the duct opening to collect fluid. The fluid sample is then sent to a lab for analysis.
This pilot study looked at 44 breasts from 32 women, all of whom were known to have breast cancer and were about to undergo mastectomies. The researchers also looked at eight breasts from seven women undergoing prophylactic mastectomy.
Markedly atypical or cancerous cells were found only in five breasts known to have cancer.
While the sensitivity of the procedure was low (meaning it caught very few cancers), the specificity was high (when it detected cancer it was indeed cancer and not something else).
Despite the results, ductal lavage may yet have a role to play. In addition to risk assessment, the procedure may also aid in research, when testing new drugs for prevention. "We could use this as a way of getting samples of cells from healthy women without giving them scars or having to do a biopsy," Khan said. "Then you could repeat the procedure after a while to see if there are changes in the breast cells." Preliminary results of a study by Khan's group showed these cells undergoing changes in response to tamoxifen.
"Ductal lavage is not intended to be a screening test for cancer," Schnabel said. "Ductal lavage gives us access to the cells inside the breast in a way that we never had before with no needles, no incisions. It's an opportunity to examine cells, and then an opportunity to detect changes which are associated with a subsequent increase in risk."
The risk and benefits of ductal lavage are still being worked out, however. "This is a really new technology, so a lot of the hoo-ha is the kind of thing that goes on when you have a new technology that is getting introduced and we don't know who to do it on and for what reasons," Schnabel said. "We're trying to grope our way towards that."
To detect breast cancer, women should stick with mammography and physical examinations.
More information
For more on ductal lavage, visit the Cleveland Clinic.
