New Breast Cancer Detection
It’s being called the Pap smear for the breast. A new medical procedure that tests the cells in the breast for breast cancer, much like a pap smear tests cells for cervical cancer. This device could be the key to detecting breast cancer earlier.
“Breast cancer is a disease that starts in the cells that line the breast duct, or the milk duct.” Dr. Elledge says for the first time doctors are able to collect and test these potentially cancerous cells, essentially locating the disease before a lump develops.
“Up to now, it has not been possible to sample the cells that cause breast cancer, because they haven’t been accessible, they’re inside the breast,” explains Dr. Elledge.
The procedure, called ductal lavage, is for high-risk patients like Mary Parham. Mary had breast cancer two-years ago. She had a mastectomy, but doctors say she has a three-times-greater risk of developing cancer in her other breast.
Mary says, “Once you’ve had breast cancer it’s on your mind a lot.”
Mary considered having her other breast removed as a preventative measure. Instead, she agreed to have the new procedure to find out if her cells show signs of cancer. The results gave her peace of mind.
Mary says, “There were no abnormal cells in the fluid they extracted from that duct.”
Dr. Elledge says ductal lavage will not replace mammography, but it could be an important addition for breast cancer screening.
Doctors say there are two benefits of detecting the cancer earlier. First, patients can receive treatments that have fewer side effects. Second, if a cancer is caught earlier it may be more curable. Patients say the procedure is virtually painless.
BACKGROUND: Breast cancer is the second most common cancer among women, second to skin cancer. It is the second leading cause of cancer death in women, after lung cancer. The American Cancer Society predicts that there will be about 182,800 new cases of invasive breast cancer in the year 2000 in the United States. It is estimated there will be about 40,800 deaths from the disease. Doctors agree that early detection of cancer is crucial to improve survival rates. It’s been difficult for doctors to detect breast cancer before a lump forms. Now a new technique called ductal lavage enables doctors to get to the source of breast cancer and detect it before a lump develops. The technique is being tested at ten centers to determine if it can offer a look at the early cellular changes inside the milk duct. Researchers specifically look at women who have normal mammograms to see if there are atypical or malignant cells in their ducts. The ultimate goal is to develop a minimally invasive test that could be used along with mammograms for improved breast cancer screening.
DUCTAL LAVAGE: Most breast cancer starts out in the duct of the breast. In the past, doctors were not able to access this area to test the cells. Ductal lavage involves a two-step process. First, doctors identify the ducts in the breast that produce fluid by using a pump. Doctors want to test the ducts that secrete fluid because they are the ducts at the highest risk of developing cancer. The second part of the procedure is the “lavage.” Doctors wash out these ducts with saline to obtain thousands of cells that line the ducts to examine them under a microscope. Pathologists then determine whether the samples are normal, atypical or malignant. Richard Elledge, M.D., from Baylor College of Medicine, says, “The procedure offers the potential of diagnosing either breast cancer or changes that occur before the breast cancer. A mammogram’s ability to detect breast cancer can be limited in the very earliest stages where we would ideally like to detect it, even before the cancer has started to form.” The concept behind ductal lavage is very similar to the screening for cervical cancer, the Pap smear.
Like a Pap smear, ductal lavage takes cells from where the cancer begins. The procedure is done under local anesthetic. Once the fluid producing ducts are identified, a very fine catheter is inserted into the ducts. The cells are then collected. Doctors say there are eight to ten ductal openings in each nipple, but only a few will produce fluid.
WHO IS IT FOR? Doctors say ductal lavage will never replace mammography. But they say it could be used in addition to mammograms, especially in women at high-risk for breast cancer. Those at high-risk include women with a strong family history of breast cancer and those women who have had breast cancer in one breast. The latter group is at a three times higher risk of developing cancer in their second breast.