A new screening method for identifying breast cancer risk in the pipeline

Ductal lavage, a simple technique of collecting cells from the breast duct, has potential for identifying women at high risk for developing breast cancer and finding cancer at earlier stages than mammography or ultrasound, according to research presented today at the Leura V International Breast Cancer Conference, hosted by the NSW Breast Cancer Institute in Darling Harbour, Sydney, from November 11 to 14.

Dr Susan Love, Clinical Professor at the David Geffen School of Medicine at UCLA and President of the Dr Susan Love Research Foundation, told delegates that most research efforts in breast cancer have been focused on better treatment of established disease or reductionist studies of single molecular pathways within the breast cancer cell.’To prevent breast cancer, or to reverse its spread, we need a revolutionary technique – a Pap smear for breast cancer. In developing ways to identify women at high risk for breast cancer, what has largely been ignored is the anatomy, physiology and function of the breast itself.’Virtually all breast cancer begins in the breast ducts. Dr Love described ductal lavage as a relatively simple technique that gathers cells from these ducts. A microcatheter is threaded into the milk ducts. The duct is then flushed with saline and this saline is aspirated and examined for evidence of cancerous cells. Dr Love reported that carcinogens have been found in breast duct fluid. In addition, cells obtained through lavage have been found to be predictive of breast cancer risk.’Studies in animals have demonstrated that intraductal techniques including therapy can be used to prevent breast cancer. These techniques, along with ductoscopy [where a microendoscope is used to visualise the ductal lining of the breast as well as provide access to collect cells] are setting the foundation for a purely intraductal approach to screening and localised preventive therapy.’Dr Love’s research foundation is undertaking further investigations where she hopes to demonstrate that the simple technique of ductal lavage can identify women who have ductal cells, which are not yet cancerous, but have the possibility of developing into cancer.’Women will have the time to examine the options for reducing the likelihood that such cells will progress to cancer, including tamoxifen and prophylactic mastectomy.’Conference Convenor and Executive Director of the NSW Breast Cancer Institute Associate Professor John Boyages said the ability to examine the cells from inside the duct paves the way in the future for more non-invasive techniques using genetic markers and cytological studies to detect women earlier who are at high risk of developing breast cancer.(Source: Leura V International Breast Cancer Conference: MedEdge: November 2004.)