HLTH - Milk duct test for breast cancer

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http://www.boston.com/dailynews/117/world/New_milk_duct_test_for_breast_:.shtml

New milk duct test for breast cancer shows early promise

By Emma Ross, Associated Press, 4/27/2001 04:29

LONDON (AP) An experimental technique of analyzing milk duct cells might one day be able to detect breast cancers that mammograms miss in younger women, according to preliminary research.

Nearly all breast cancers start in the milk ducts. The method, which involves flushing the ducts to dislodge cells by injecting saline solution through the nipples and drawing it back out again, is described this week in The Lancet medical journal.

While mammograms are good at detecting cancer in post-menopausal women, spotting tumors in the breasts of women under 40 is more challenging because the breast tissue is so dense.

Scientists have therefore been trying to develop new surveillance strategies for women at high risk of developing the disease, hoping to detect earlier-stage tumors, when they're easier to treat. Women with an increased chance of developing breast cancer include those whose mothers or sisters have had the disease and those who have a genetic mutation known to encourage the disease.

''This technique seems to hold promise for detecting early changes in duct cells and could eventually identify pre-malignant conditions,'' said Robert Smith, director of cancer screening at the American Cancer Society.

''It is not clear that just detecting precancerous cells means they will go on to develop breast cancer,'' said Smith, who was not connected with the research. ''But in high-risk women, it could give them the choice earlier of how to handle it.''

Options might include anticancer drugs, having part of the milk duct removed, or more frequent checks to see if they progress to cancer, he said.

The study by scientists at Johns Hopkins University School of Medicine involved looking for genetic indicators of breast cancer in the cells flushed out by the technique, called duct lavage. Lavage is a French word that means ''to wash'' or ''to rinse.''

It involved inserting a threadlike catheter through the nipple to pump in saline solution and draw it back out, a procedure researchers said could cause discomfort, but not pain.

The test detected abnormalities in the breast fluid of 17 out of 20 women with confirmed invasive breast cancer. In a group of 45 healthy women, the test produced five false positives, according to the study.

Two women with normal mammograms whose duct fluid test was positive were subsequently diagnosed with breast cancer.

''This ultimately might prove to be useful, but its going to have to do something that mammograms can't,'' Smith said. ''There's a lot of potential for doing something that mammograms can't.''

Research presented by the American Cancer Society earlier this week revealed that women who get regular mammograms may reduce their risk of dying from breast cancer by more than 60 percent.

But mammograms aren't perfect. Besides missing tumors, they most often flag innocent lumps, which are biopsied only to turn out to be benign.

However, Mitch Dowsett, professor of biochemistry and endocrinology at the Institute for Cancer Research in London, said he did not believe the milk duct test would avert biopsies.

If doctors see a suspicious lump on a mammogram, and a duct flushing test comes back negative, they would still want to make absolutely sure that the lump isn't cancerous. The best way to make a diagnosis is to analyze a sample taken from the lump, he said.

''There are many openings in the nipple,'' added Smith. ''It's not clear that you are always going to be able to home in on the right duct, the duct that has the abnormality. What if you pick the wrong duct?''

On the Net:

Pro-Duct Health, developers of the ductal lavage system,

http://www.ductallavage.com

-- Anonymous, April 27, 2001


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