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Breast Cancer Screening Modalities

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One study reported results of nipple aspiration followed by ductal lavage in 507 women at high risk for breast cancer.[82] Nipple aspirate fluid was obtained from 417 women, but only 111 (27%) were adequate samples. Ductal lavage samples were evaluated in 383 women, 299 (78%) of which were adequate for diagnosis. Abnormal cells were found in 92 (24%) ductal lavage samples, including 88 (17%) with mild atypia, 23 (6%) with marked atypia, and 1 (<1%) malignant. The corresponding numbers and percentages for nipple aspiration fluid were 16 (6%), 8 (3%), and 1 (<1%). Although ductal lavage was associated with some discomfort, it was judged by participants to be comparable to mammography. Whether this procedure led to the detection of any cancers earlier than mammography alone would have done is not known, and no data are available to determine the efficacy or mortality reduction of ductal lavage use as a screening or diagnostic tool. Therefore, the use of this procedure as a screening tool remains investigational.

Thermography

Thermography of the breast looks for temperature hot spots on the skin as an indicator of vascular proliferation induced by an underlying tumor. Thermographic devices use infrared imaging techniques to detect changes in the temperature of the skin surface and displays these changes in color patterns. Thermographic devices have been approved by the FDA under the 510(k) process, which does not require evidence of clinical effectiveness. There have been no randomized trials of thermography to evaluate the impact on breast cancer mortality or the ability to detect breast cancer. Small cohort studies do not suggest any additional benefit for the use of thermography as an adjunct modality for breast cancer screening.[83,84]

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