Ductal lavage is a screening tool used in women at high risk of breast cancer. During ductal lavage, cells are collected 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 confined to that duct if caught early. Early diagnosis makes treatment more effective and increases 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 -- a size of one cm that contains about one million cells.
Doctors hope that performing ductal lavage as a screening tool in women at high risk for breast cancer may help 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.
- If fluid is made, 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 The solution containing the loosened cells is withdrawn through the catheter.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 1.7%. 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 following five years, from the analysis.
Talk to your doctor about whether you could benefit from this screening procedure.
What Happens if Atypical Cells Are Found?
Not all abnormal cells are destined to become breast cancer. In fact, less than 1% of women have cancerous cells identified by a ductal lavage. Knowing that you have atypical cells can help you and your doctor plan a strategy to reduce your risk of developing breast cancer. A strategy may include:
- A repeat ductal lavage or other tests to confirm previous results
- Increased breast health monitoring, such as more frequent clinical breast exams
- Taking certain medication that may reduce your risk of breast cancer such as tamoxifen (Nolvadex, Soltamox), raloxifene (Evista) or exemestane (Aromasin)
- Surgery such as prophylactic mastectomy (surgery to remove a breast before cancer develops)
What Will I Feel During a Ductal Lavage?
Most women don't find ductal lavage to be painful, saying it is no more uncomfortable than a mammogram. You may feel temporary sensations such as fullness, pinching, and tingling in the breast. However, numbing medications (anesthetics) are used to help reduce discomfort during the procedure.
Is Ductal Lavage Used Instead of a Mammogram to Screen for Breast Cancer?
No. Ductal lavage is used along with other regular breast health practices such as regular breast self-exams, annual clinical exams, and mammography. It is not a replacement for these screening tools. In addition, ductal lavage is not recommended for women with a low risk for breast cancer.
What Risks Are Associated With Ductal Lavage?
There are few risks associated with ductal lavage. Rarely, an infection may develop at the site of the catheter insertion. It is possible to perforate, or puncture, the milk duct, although perforation is rare and generally causes no permanent damage to the breast.