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Women's Health

Assessing Risk A new way to screen for breast cancer. By Dr. Lisa KaramardianPublished: October, 2003

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There's a new tool in the fight against breast cancer. We know that breast cancer will affect 1 of every 8 American women. While these statistics are great for counseling populations, they don't tell you how an individual woman can assess her own personal risk for developing breast cancer. It's finally here. There has been a major breakthrough over the past year in screening high-risk women for breast cancer. I've written about the promising treatments available to women who are diagnosed with breast cancer and about the improvements in breast cancer survival. That's all well and good. But finally we have something to talk about that goes beyond treatment - or I should say it comes before treatment. There is something that is really going to make a difference in helping to diagnose which women are going to develop breast cancer. This new technology is called ductal lavage. The past is past Until now, physicians have relied on family and personal medical history in order to assess a woman's breast cancer risk. Then they use statistical calculations to predict her chances for developing breast cancer within a certain period of time. General statistics from a large population of women are used to approximate an individual woman's risk. For women considered at high risk, this, at best, provides a vague picture of their future. Today we can move beyond statistics and turn to ductal lavage to offer high-risk women a more individual picture of their risk of developing breast cancer through a biological assessment. Ductal lavage uses cellular information from a woman's breast to determine whether she personally is at higher risk. How it works Ductal lavage (marketed as the FirstCyte Breast Test) is a minimally invasive office procedure that collects cells from a woman's milk ducts where 95 percent of breast cancers originate. It only takes 30 minutes in the doctor's office. A cannula is placed in the nipple, and through it the nipple is irrigated with saline and the duct is washed. The sample of cells from the ductal wash is sent to a laboratory where it is analyzed to determine whether the cells are atypical. Atypical cells are abnormal cells inside the milk ducts. While atypical cells don't necessarily progress to cancer, studies throughout the years have shown that the presence of atypical cells increases a woman's risk of developing breast cancer by 4 to 5 times. For women with a family history of breast cancer, the risk increases up to 10 times more. Until now, we have only had tools that will diagnose a breast cancer once it is established. It is great to finally have a tool that can essentially diagnose a "precancerous" state in the breast. Ductal lavage may in fact revolutionize how we screen for breast cancer in much the way pap smears have done for cervical cancer. The first step in ductal lavage is to make sure it is an appropriate procedure for the patient. Only women who already are determined to be at high risk for developing breast cancer should consider ductal lavage. High-risk women should also only use ductal lavage in conjunction with standard breast cancer detection techniques, which include mammography, clinical breast exams and breast self-exams. The information gained from ductal lavage is complementary, but very different. Collecting and analyzing cells from the breast allows doctors to provide risk information that is unique to each individual woman. High-risk women face particularly difficult decisions about whether to take active steps to reduce their breast cancer risk. These steps may have significant consequences. By providing current information that is unique to the individual woman, ductal lavage can help with her decision to consider options such as closer surveillance with MRI, drug therapy or even preventative mastectomy. Because the FirstCyte Breast Test can be repeated over time, it also provides another way for high-risk women to check their risk status at defined intervals. To learn more about ductal lavage, visit www.ductallavage.com. Dr. Lisa M. Karamardian of Newport Beach is a board-certified OB/GYN and Fellow of the American College of Obstetricians and Gynecologists. A frequent speaker in the community, she also serves as medical advisor for Contemporary Nutrition. Information: 949.644.2722.

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