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.