Ductal Lavage May Not Show Breast Cancer
But Test May Still Be a Useful Risk Assessment Tool
While experts widely agree that the evidence does not support the use of ductal lavage as a procedure to diagnose breast cancer, experts disagree on its present value for assessing breast cancer risk. Breast cancer specialist Freya Schnabel, MD, of Columbia University Medical Center, says she performs the test in high-risk patients who want as much information as they can get about their individual risk.
"High-risk women in this day and age have a lot of options in front of them," she tells WebMD. "They can undergo intensive surveillance, take [the preventive therapy] tamoxifen, or take part in a prevention study. This test can help them make better decisions about which option is best for them."
But Carol Fabian, MD, of the University of Kansas Medical Center, says she does not recommend ductal lavage to her high-risk patients because it is not clear that the procedure offers advantages over more established nipple aspiration procedures.
Ductal lavage yields more cells from the area of the breast in which cancers typically begin than the other methods, leading to the belief that it is more sensitive for identifying atypical cells. But the studies needed to show this have not been completed.
"With the other procedures I can tell a woman exactly what the findings mean because the studies have been done," she tells WebMD. "I can say to a woman with atypical cells found with fine needle aspiration that her risk of developing a noninvasive or invasive cancer is between 3% and 5% a year. I can't give her a solid figure with ductal lavage because we don't know it." That is because not finding atypical cells does not necessarily reflect a reduced risk; it may simply reflect a lack of cells being flushed out by the procedure.
Recent studies show that combining magnetic resonance imaging (MRI) with mammography may be an important advance for detecting breast cancers early in women at high risk. Fabian says she now recommends the dual-imaging approach to her high-risk patients, with each test being done annually, six months apart.
"In my mind this is the best way to detect cancer early in patients at high risk," she says.