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Most breast cancers are thought to arise from the epithelial cells that line the milk ducts. Ductal lavage is a minimally invasive method of collecting breast epithelial cells from breast duct fluid for cytological examination. The sample is then sent to a lab, where it can be determined if the cells are normal or atypical.
The ductal lavage procedure begins with the application of a topical anesthetic to the nipple and removal of keratin formation, followed by breast massage. Next, a suction device is applied to the nipple to identify fluid-yielding ducts; any duct that yields fluid can be lavaged. To perform the lavage procedure, the duct is cannulated with a catheter that is attached to two separate ports, one for infusion and the other for aspiration. Once the catheter is in place, saline is infused into the duct; the duct is then aspirated. The aspirated fluid is sent to a lab for analysis. Using a new catheter, the procedure is repeated on the next fluid-yielding duct.
Watch a video to learn more about how ductal lavage is performed here.
Researchers
Research studies using ductal lavage are currently exploring topics such as knowledge of the normal breast, the conditions under which breast cancer develops, and the relationship between atypia and breast cancer risk.
Learn more about the research currently being conducted by the Dr. Susan Love Research Foundation here.
Learn more about the research the Foundation has funded here.
See a list of published research studies using ductal lavage here.
Clinicians
Factors known to increase a woman's breast cancer risk include: a first-degree family history of breast cancer, a Gail risk score of 1.66 or greater, and a BRCA genetic mutation. Another known risk factor is the presence of atypical hyperplasia in breast tissue. The presence of atypical cells in nipple aspirate fluid is believed to confer the same increased risk. Studies have found a five-fold increase in the relative risk of developing breast cancer.
in women who have cellular atypia and an 11 to 22-fold increase in relative risk in women with a first-degree family history of beast cancer and cellular atypia. By combining a patient's personal history with her cytologic findings from ductal lavage, clinicians are in a better position to assess an individual woman's risk of developing breast cancer. In April 2003, the American Society of Breast Surgeons issued a statement in support of the use of ductal lavage as a risk assessment tool in high-risk or borderline-risk women. The information obtained through a ductal lavage procedure can be used to help women make decisions regarding risk reduction. Currently, these options include close surveillance, prophylactic mastectomy, or taking the hormone therapies tamoxifen or raloxifene for risk reduction. An additional option is enrollment in the ExCel Trial, a phase III breast cancer prevention clinical trial designed to determine if the aromatase inhibitor exemestane (brand name Aromasin), can prevent breast cancer in healthy postmenopausal women who are at increased risk for developing the disease.
Ductal lavage can be performed by trained obstetrician/gynecologists, radiologists, and breast surgeons and is used in conjunction with mammography, clinical exams, breast self-exam, and other standard breast cancer detection methods. Clinicians who offer ductal lavage must know how to counsel patients about the findings, discuss risk-assessment, and be familiar with all available options for breast cancer risk reduction.
Find a list of physicians currently offering ductal lavage here.
Patient information on ductal lavage is available here.
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