Tuesday, September 5, 2000; Page Z06
I attempted to use the function offered at the Washington Post web site to
have this article directly emailed to the list but couldn't get it to work.
Since they do offer that service I felt it would be OK to cut and paste it
here myself. The original site is www.washingtonpost.com and do a search on
ductal. Their full text articles are only available for a short time.
I thought this was interesting. It states the researchers used a manual
breast pump and that "Previous research has determined that ducts yielding
fluid are most likely to contain abnormal cells". Does this fly in the face
of our conventional wisdom that if the fluid is not expressed it is benign??
Next I found one article on Pub Med I will send to the group.
---------now the Washington Post article-----------------
A 'Pap Smear' For Breast Cancer?;
A New Test May Help Identify Cancers Long Before Tumors Develop
As important as mammograms are, they don't always catch cancer before it has
spread, and they can miss the disease in its earliest stages. But a new
breast cancer test may soon offer another screening option, one that's
especially useful for women at high risk.
The test, called ductal lavage, analyzes cells from the lining of the milk
ducts to determine if they are normal, precancerous or cancerous. Since it
is widely believed that nearly all breast cancers begin in the ducts, the
test could become a powerful early screening tool.
"This test is like a Pap smear. It gives us access to the sites where breast
cancer starts before the cells have a chance to develop into a tumor," said
surgeon Susan Love, co-founder of Pro-Duct Health, the company manufacturing
the test. She is also author of "Dr. Susan Love's Breast Book" (Perseus
Publishing). "By the time a tumor appears on a mammogram, it has been
growing in the breast for eight to 10 years."
To perform ductal lavage, a manual breast pump is used to determine which
ducts contain fluid. (Previous research has determined that ducts yielding
fluid are most likely to contain abnormal cells.) After a numbing cream is
applied to reduce the pain, a flexible tube as thick as a piece of yarn is
inserted through the nipple half an inch into the duct. A small amount of
saline solution is squirted through to wash cells from the milk duct lining.
The collected cells are then analyzed by a pathologist. As with a Pap smear,
women may be told they have atypical cells (abnormally shaped but not
malignant), hyperplasia (cells dividing at a rapid rate, which can lead to
cancer) or both. Women with abnormal results can have the test repeated in a
month or two to see if the cells have returned to normal, stayed the same or
advanced to a more severe abnormality.
In a multicenter clinical trial sponsored by Pro-Duct, ductal lavage was
performed in 515 women at high risk for breast cancer who had previously had
normal breast exams and mammograms. The test found atypical cells in 15
percent of the women; an additional 5 percent of the women had severe
abnormalities that warranted a biopsy. Two of these women were found to have
ductal carcinoma in situ, a microscopic cancer that remains confined to the
milk duct.
"This new test is very provocative. It's based on solid science and
certainly merits looking into further," said Larry Norton, chief of medical
oncology at Memorial Sloan-Kettering Cancer Center in New York and
president-elect of the American Society of Clinical Oncology. "It's very
possible that this test will prove useful to complement mammography and
breast exams. But I don't think it will replace these screenings."
While trial results are encouraging, ductal lavage has some major drawbacks.
For one, it doesn't pinpoint the location of the abnormal cells, so surgeons
must do exploratory surgery to find the area to biopsy. After injecting dye
into the duct, they make a large incision and follow the path of the dye to
the base of the duct.
"I'm extremely dissatisfied with this [surgical] technique because it can be
very disfiguring," said William Dooley, director of the Johns Hopkins
University Breast Center. Dooley, who has performed ductal lavage in more
than 100 women, is investigating micro-endoscopy, which would allow surgeons
to follow the path of the dye without making an incision.
Another drawback: Ductal lavage now costs about $750 to $1,000, making it
too expensive for mass screening.
Investigators are also grappling with how to deal with "atypical" cells that
aren't cancer--or even precancer. One concern is that women may be subjected
to unnecessary biopsies on minute growths that never would have turned into
cancer.
"Until more studies are completed, I think this test will be used almost
exclusively in high-risk women," said Bruce Trock, associate professor of
oncology and medicine at the Lombardi Cancer Center at Georgetown University
Medical Center. He said Lombardi plans to begin offering ductal lavage to
high-risk patients by the end of this year.
Ductal lavage may also help high-risk women determine whether to go on the
drug tamoxifen to prevent breast cancer. According to data from the
Tamoxifen Prevention Trial, women with previously diagnosed hyperplasia
(detected via biopsy) experienced an 88 percent reduction in breast cancer
risk after going on tamoxifen compared with a 44 percent reduction in risk
in women who didn't have hyperplasia.
Ductal lavage could be similarly valuable for a woman who tests positive for
the BRCA1 breast cancer gene and is told she has a 30 to 80 percent chance
of getting breast cancer.
"Should she have her healthy breasts removed?" asked Love. "Results from
repeated ductal lavages could help guide her decision."
--Deborah Kotz
Tuesday, September 5, 2000; Page Z06
A 'Pap Smear' For Breast Cancer?;
A New Test May Help Identify Cancers Long Before Tumors Develop
As important as mammograms are, they don't always catch cancer before it has
spread, and they can miss the disease in its earliest stages. But a new
breast cancer test may soon offer another screening option, one that's
especially useful for women at high risk.
The test, called ductal lavage, analyzes cells from the lining of the milk
ducts to determine if they are normal, precancerous or cancerous. Since it
is widely believed that nearly all breast cancers begin in the ducts, the
test could become a powerful early screening tool.
"This test is like a Pap smear. It gives us access to the sites where breast
cancer starts before the cells have a chance to develop into a tumor," said
surgeon Susan Love, co-founder of Pro-Duct Health, the company manufacturing
the test. She is also author of "Dr. Susan Love's Breast Book" (Perseus
Publishing). "By the time a tumor appears on a mammogram, it has been
growing in the breast for eight to 10 years."
To perform ductal lavage, a manual breast pump is used to determine which
ducts contain fluid. (Previous research has determined that ducts yielding
fluid are most likely to contain abnormal cells.) After a numbing cream is
applied to reduce the pain, a flexible tube as thick as a piece of yarn is
inserted through the nipple half an inch into the duct. A small amount of
saline solution is squirted through to wash cells from the milk duct lining.
The collected cells are then analyzed by a pathologist. As with a Pap smear,
women may be told they have atypical cells (abnormally shaped but not
malignant), hyperplasia (cells dividing at a rapid rate, which can lead to
cancer) or both. Women with abnormal results can have the test repeated in a
month or two to see if the cells have returned to normal, stayed the same or
advanced to a more severe abnormality.
In a multicenter clinical trial sponsored by Pro-Duct, ductal lavage was
performed in 515 women at high risk for breast cancer who had previously had
normal breast exams and mammograms. The test found atypical cells in 15
percent of the women; an additional 5 percent of the women had severe
abnormalities that warranted a biopsy. Two of these women were found to have
ductal carcinoma in situ, a microscopic cancer that remains confined to the
milk duct.
"This new test is very provocative. It's based on solid science and
certainly merits looking into further," said Larry Norton, chief of medical
oncology at Memorial Sloan-Kettering Cancer Center in New York and
president-elect of the American Society of Clinical Oncology. "It's very
possible that this test will prove useful to complement mammography and
breast exams. But I don't think it will replace these screenings."
While trial results are encouraging, ductal lavage has some major drawbacks.
For one, it doesn't pinpoint the location of the abnormal cells, so surgeons
must do exploratory surgery to find the area to biopsy. After injecting dye
into the duct, they make a large incision and follow the path of the dye to
the base of the duct.
"I'm extremely dissatisfied with this [surgical] technique because it can be
very disfiguring," said William Dooley, director of the Johns Hopkins
University Breast Center. Dooley, who has performed ductal lavage in more
than 100 women, is investigating micro-endoscopy, which would allow surgeons
to follow the path of the dye without making an incision.
Another drawback: Ductal lavage now costs about $750 to $1,000, making it
too expensive for mass screening.
Investigators are also grappling with how to deal with "atypical" cells that
aren't cancer--or even precancer. One concern is that women may be subjected
to unnecessary biopsies on minute growths that never would have turned into
cancer.
"Until more studies are completed, I think this test will be used almost
exclusively in high-risk women," said Bruce Trock, associate professor of
oncology and medicine at the Lombardi Cancer Center at Georgetown University
Medical Center. He said Lombardi plans to begin offering ductal lavage to
high-risk patients by the end of this year.
Ductal lavage may also help high-risk women determine whether to go on the
drug tamoxifen to prevent breast cancer. According to data from the
Tamoxifen Prevention Trial, women with previously diagnosed hyperplasia
(detected via biopsy) experienced an 88 percent reduction in breast cancer
risk after going on tamoxifen compared with a 44 percent reduction in risk
in women who didn't have hyperplasia.
Ductal lavage could be similarly valuable for a woman who tests positive for
the BRCA1 breast cancer gene and is told she has a 30 to 80 percent chance
of getting breast cancer.
"Should she have her healthy breasts removed?" asked Love. "Results from
repeated ductal lavages could help guide her decision."
--Deborah Kotz
***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html
|
