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Ductal Lavage Helps Determine Best Approach in Patients at High Risk for Breast Cancer: Presented at IBCC

By Alison Palkhivala

BANFF, AB -- August 7, 2003 -- Ductal lavage is a clinically useful technique for assessing patients who may be at high risk of developing breast cancer, offering important information that can be used to select preventive therapy.

Victor G. Vogel, MD, professor of medicine and epidemiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States, spoke about the clinical utility of ductal lavage here August 3^rd at the Second Annual Future of Breast Cancer: An International Breast Cancer Congress.

Ductal lavage is a minimally invasive procedure that can be performed in-office and involves collection of epithelial cells from the breast ducts for cytologic evaluation. The procedure is important clinically in that it helps determine a patients' risk for developing invasive breast cancer. However, Dr. Vogel emphasized that it should not be used as a diagnostic technique because its negative predictive value is not yet established.

The 3 key benefits of developing accurate risk assessment tools are the ability to identify high-risk patients, intervene before invasive disease develops, and ideally, prevent the development of malignancy. Increasingly, research is demonstrating that hormonal agents, notably tamoxifen, can reduce the risk of malignancy in high-risk women. However, this therapy is associated with important risks, particularly in women over 50, including endometrial cancer, stroke, and other thromboembolic events. It is therefore crucial to identify the risk/benefit ratio of taking preventive therapy. Ductal lavage can play an important role in this context, said Dr. Vogel.

Research is making it increasingly clear that as normal breast cells develop into cancerous cells, they pass through the same histological stages. As a result, cytologic methods can be used to identify the early stages of cancer development, and thus identify high-risk patients.

Many studies have assessed the degree to which the presence of atypical hyperplasia, as determined by various cytological methods, can be used to predict the development of invasive disease., All have demonstrated that patients with cytologically demonstrated atypia are at about a 5-fold increased risk of developing invasive disease. The presence of other risk factors further increases this risk. For instance, the presence of family history in addition to atypia confers about a 10-fold increased risk.

According to Dr. Vogel, current indications for use of ductal lavage include women with a previous personal or family history of breast cancer, those with a Gail risk of at least 1.7%, and those with the BRCA1 or 2 mutation. In such women, the results of ductal lavage can be used to help identify optimal future therapy, such as use of tamoxifen or surgery to prevent future cancers. Another potential clinical use of ductal lavage is to track changes in atypical cells over time.

Dr. Vogel said that ductal lavage should be considered as a starting point. It is a useful risk stratification tool, while more specific biomarkers, such as insulin like growth factor I, and estradiol markers are under development.

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