In a recent issue of the Journal of the
American College of Surgeons (194:648-656, 2002), a collective review led by
Monica Morrow, MD, director of the Lynn Sage Comprehensive Breast Center at
Northwestern Memorial Hospital in Chicago, presented recommendations on the use
of ductal lavage in women at high risk for breast cancer. The article offers
guidance on which women are most appropriate for ductal lavage and on how
abnormal ductal lavage results should be managed.
Dr. Morrow and coauthors summarize a number of previous
studies demonstrating that the presence of atypical cells in breast milk ducts
significantly increases a woman’s breast cancer risk. In addition, they
discuss the results of a multicenter clinical study on the procedure that was
published late last year in the Journal of the National Cancer Institute
(93:1624-1632, 2001). The study, which found abnormal cells in 24% of the
high-risk but asymptomatic patients who underwent the procedure, demonstrated
that ductal lavage is a safe and effective technique for collecting milk duct
cells from the breast.
The authors cite the value of ductal lavage as a means of
evaluating a woman’s personal risk for breast cancer and of providing
information that can assist in making decisions about risk management options
such as early screening, drug therapy, and prophylactic mastectomy. Furthermore,
they present an algorithm for the evaluation of women with an atypical or
malignant ductal lavage.
"As more high-risk women consider strategies to reduce their risk of
developing breast cancer, ductal lavage can play an important role in helping
women understand their individual risk status," said Dr. Morrow. "At
the same time, the availability of ductal lavage has created the need for
guidance on the appropriate interpretation and use of the procedure. This review
attempts to address this need by providing recommendations on identifying the
most appropriate candidates for ductal lavage, managing women with abnormal
ductal lavage findings and integrating ductal lavage into the spectrum of other
risk assessment methods we currently use," she added.