Continuously serving Kosciusko County since 1854
Chalk one up for the good guys - the fight against breast cancer just got a little more winnable.
Doctors at the IU Cancer Pavilion in Indianapolis recently began using a new test for breast cancer that can identify problems much earlier than a physical exam or mammogram. Called "ductal lavage," the procedure has been approved by the FDA.
According to Dr. Anna Maria Storniolo, medical director of the High Risk Breast Cancer Screening Clinic at the IU Breast Center, Indianapolis, 90 to 95 percent of breast cancers develop from the cells lining the milk ducts. Ductal lavage can detect breast cancer before it breaks through the duct wall, and it can identify cells that are in the stages that precede breast cancer.
Storniolo said the cells lining the duct go through specific stages on the way to becoming cancerous: a normal milk duct is lined with a single layer of cells. The next stage is hyperplasia, which is a normal increase in cells usually seen during menstruation or breast feeding. The third stage is atypia, which Storniolo said is somewhat difficult to diagnose but is more abnormal than hyperplasia. Next is DCIS - ductal carcinoma in situ - cancerous cells that are still confined to the milk duct. The final stage is malignant cells that have invaded the tissue.
Not every woman who has ductal tissue in one of these stages will progress to the next stage, Storniolo said. For example, a woman with atypia may never progress any further. However, the process is a decades-long progression, she said, and a woman can't have one stage without having gone through the previous ones.
In ductal lavage, a hair-thin tube is inserted through the nipple into a specific duct, and a saline solution is used to "rinse" out the duct and collect cells. The fluid is collected and analyzed to determine if the cells are normal, atypical, suspicious or malignant.
The advantage of ductal lavage is that it can identify a stage, such as atypia, before the cells become malignant. A woman with atypia can then take tamoxifen, a hormonal therapy that is used to reduced the chances of breast cancer developing or recurring.
In other words, ductal lavage can, in some cases, identify conditions that precede cancer and, with the correct medication, the condition may be treated before cancer actually develops.
Because it is a relatively expensive procedure, ductal lavage is recommended for high-risk patients, Storniolo said, such as those with a family history of breast cancer or those who have had cancer in one breast. But it probably will never be used as commonly as a mammogram, she said.
"Ductal lavage will never cost less than $100," she said, "and using it as a routine screen is never gonna fly."
However, she said, doctors are now seeing breast cancer earlier than they used to; one in eight women will develop breast cancer in a lifetime, and most of that breast cancer is not genetic, not handed down in a family, Storniolo said.
"Breast cancer is not an event in time, it's a process," she said. "Ductal lavage has the potential of interrupting the process even before a mammogram could detect a problem. ... Ductal lavage is providing the tool to give us a research arm to a chemo prevention program."
Dr. Robert Goulet, associate professor of surgical oncology at the Breast Center, said he does an average of 10 ductal lavage procedures a week and has for approximately two months. He also said the procedure has been successful with patients who have had breast reductions or implants.
In a recently clinical study, ductal lavage was performed on more than 500 women at high risk for breast cancer. All of the women had normal mammograms and physical exams within a year of the procedure.
In the study, ductal lavage detected atypical cells in 15 percent of the breasts studied and suspicious or malignant cells in 5 percent of the breasts.
"I think personally that this is a landmark for evaluating women with breast abnormalities," Goulet said, but he stressed that it does not replace standard techniques such as mammography.
A problem with ductal lavage is that, though it has been approved by the FDA, it is such a new procedure that most insurance companies don't cover it, and doctors' costs may differ widely. For example, Goulet said, the equipment alone costs an average of $225 per duct, and he usually performs the test on from one to three ducts per breast.
And though just listening to a description of the procedure makes most women wince, doctors and women who took part in the study said that because anesthetic is used, ductal lavage is not as painful as it may sound.
"Ductal lavage is reproducible, relatively painless and provides access to cells that line the duct in much higher concentration than was previously available," Goulet said.
For more information on ductal lavage, call Storniolo at the IU Breast Center at 317-278-7576.
