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Breast Cancer and Ductal Lavage
For breast cancer detection, ductal lavage is a procedure for collecting cells from the milk ducts of the breast for analysis. The procedure is used to identify precancerous cells, called atypical cells. Ductal lavage currently is performed only on women who have multiple breast cancer risk factors to try to detect breast cancer before it starts.
Ductal lavage works on the premise that most breast cancers (about 95%) develop in cells that line the milk ducts of the breast. Cancer usually begins in one duct and may be contained to that duct if caught early, making treatment more effective and increasing survival.
By the time breast cancer is detected, however, it often has progressed beyond a single duct. Experts estimate that it takes eight to 10 years for cancer to grow from one cell to a mass large enough to be detected on a mammogram -- about one billion cells.
Doctors hope that performing ductal lavage as a screening tool in women at high risk for breast cancer may catch the disease early when it is most treatable.
How Does Ductal Lavage Work?
Ductal lavage is a minimally invasive procedure that may be performed in a doctor's office or outpatient center. It is performed in three steps:
- An anesthetic cream is applied to numb the nipple area. Gentle suction is used to withdraw a small amount of fluid from the milk ducts. This is done to locate the opening of the ducts on the nipple's surface and to identify ducts to be tested. Ducts that do not produce fluid generally are not tested with the lavage procedure, since atypical cells are more commonly found in ducts that produce fluid. Not all women are able to produce fluid with this test. If fluid is not made, the test is not continued any further.
- A hair-thin catheter (small tube) is inserted into the natural opening of the duct. Additional anesthetic is delivered into the duct. A saline (salt and water) solution is then infused through the catheter to rinse the duct, which loosens cells from the duct lining. The solution containing the loosened cells is withdrawn through the catheter. The word "lavage" is French for "wash" or "rinse."
- The sample is sent to the laboratory for analysis to determine if the cells are normal or abnormal (atypical cells). Women with atypical cells have an increased risk of developing breast cancer.
Who Is a Candidate for Ductal Lavage?
Ductal lavage is recommended only for women who are at high risk for breast cancer. There are several factors that put a woman at high risk for developing breast cancer, including:
- A personal history of breast cancer.
- A family history of breast cancer, particularly in a mother, daughter, or sister.
- Evidence of a specific gene (BRCA1/BRCA2 mutation).
- A Gail Index score of at least 1.66%. The Gail Index uses risk factors such as age, family history of breast cancer, age of first menstrual period and first pregnancy, and number of breast biopsies to calculate a woman's risk of developing breast cancer within the next five years.
WebMD Medical Reference
Breast Cancer Guide
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INDICATION
Vivelle-Dot is used after menopause to: reduce moderate to severe hot flashes; treat moderate to severe dryness, itching and burning in or around the vagina; help reduce your chances of getting osteoporosis (thin weak bones); and treat certain conditions in which a young woman's ovaries do not produce enough estrogens naturally. Vivelle-Dot 0.025 mg/day is only used to prevent osteoporosis from menopause. If you use Vivelle-Dot only to treat your dryness, itching, and burning in and around your vagina or if you use Vivelle-Dot only to prevent osteoporosis from menopause, talk with your healthcare professional about whether a different treatment or medicine without estrogens might be better for you.
IMPORTANT SAFETY INFORMATION
Estrogens increase the chances of getting cancer of the uterus (womb). Report any unusual vaginal bleeding right away while you are taking estrogens. Vaginal bleeding after menopause may be a warning sign of cancer of the uterus (womb).
Do not use estrogens with or without progestins to prevent heart disease, heart attacks, or strokes. Using estrogens with or without progestins may increase your chances of getting heart attacks, strokes, breast cancer, and blood clots. Using estrogens with progestins may increase your risk of dementia (decline in memory and thinking skills).
Vivelle-Dot should not be used if you have unusual vaginal bleeding; currently have or have had certain cancers, including cancer of the breast or uterus; had a stroke or heart attack in the recent past (for example, in the past year); currently have or have had blood clots; currently have or have had liver problems; or think you may be, or know that you are, pregnant.
The most common side effects that may occur with Vivelle-Dot are headache, breast tenderness, and back pain.
You and your healthcare professional should talk regularly about whether you still need treatment with Vivelle-Dot.
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.
Please see Full Prescribing Information for Vivelle-Dot.
October is National Breast Cancer Awareness Month, and a new study reveals why a high number of women with the disease still prefer to have the entire breast surgically removed instead of just the tumor. It's not always because doctors recommend it.
