Specialists Publish Guide on Ductal Lavage for Breast Cancer Risk Assessment

In a recent issue of the Journal of theAmerican College of Surgeons (194:648-656, 2002), a collective review led byMonica Morrow, MD, director of the Lynn Sage Comprehensive Breast Center atNorthwestern Memorial Hospital in Chicago, presented recommendations on the useof ductal lavage in women at high risk for breast cancer. The article offersguidance on which women are most appropriate for ductal lavage and on howabnormal ductal lavage results should be managed.

Dr. Morrow and coauthors summarize a number of previousstudies demonstrating that the presence of atypical cells in breast milk ductssignificantly increases a woman’s breast cancer risk. In addition, theydiscuss the results of a multicenter clinical study on the procedure that waspublished late last year in the Journal of the National Cancer Institute(93:1624-1632, 2001). The study, which found abnormal cells in 24% of thehigh-risk but asymptomatic patients who underwent the procedure, demonstratedthat ductal lavage is a safe and effective technique for collecting milk ductcells from the breast.

Algorithm Included

The authors cite the value of ductal lavage as a means ofevaluating a woman’s personal risk for breast cancer and of providinginformation that can assist in making decisions about risk management optionssuch as early screening, drug therapy, and prophylactic mastectomy. Furthermore,they present an algorithm for the evaluation of women with an atypical ormalignant ductal lavage.

"As more high-risk women consider strategies to reduce their risk ofdeveloping breast cancer, ductal lavage can play an important role in helpingwomen understand their individual risk status," said Dr. Morrow. "Atthe same time, the availability of ductal lavage has created the need forguidance on the appropriate interpretation and use of the procedure. This reviewattempts to address this need by providing recommendations on identifying themost appropriate candidates for ductal lavage, managing women with abnormalductal lavage findings and integrating ductal lavage into the spectrum of otherrisk assessment methods we currently use," she added.