New test aids in breast cancer prevention
A new procedure offered at MUSC’s Hollings Cancer Center combined with existing tests will give physicians important information needed to determine which at-risk women should receive therapy to prevent breast cancer.“This is an extremely important diagnostic advance,” said William E. Gillanders, M.D., one of the MUSC breast cancer surgeons who perform the new ductal lavage procedure. “We now have therapies for women found to be at high risk for breast cancer who have proven to significantly reduce this risk.”
Major advances have been made in the area of breast cancer prevention, he explained. In the past prophylactic mastectomy was considered to be the only proven method for risk reduction. “Now very compelling data suggest that the drug tamoxifen and other anti-estrogen medications can significantly decrease the risk of developing breast cancer in high-risk women,” said Gillanders.
Ductal lavage is a minimally invasive procedure for collecting cells from the breast milk ducts where the vast majority of all breast cancers originate. The cells are analyzed in the laboratory to determine whether they are normal or atypical.
Ductal lavage is one of several risk assessment tools used by members of the MUSC Hollings Cancer Center high-risk breast cancer team. It is used in conjunction with the Gail model, a computerized breast cancer risk assessment tool. This provides an estimate of a woman’s risk based on age, age when menstruation began, age at first live birth, number of breast biopsies, family history of breast cancer, and atypical cells found in breast biopsy.
In addition, those patients whose medical and family histories suggest an inherited predisposition to breast cancer can be referred to the breast team genetic counselor to discuss genetic testing.
“Five to 10 percent of breast cancers are of an inherited type and alterations in two breast cancer susceptibility genes may account for 85 percent of these,” said Lyn Hammond, genetic counselor. Hammond is the member of the Hollings high-risk breast cancer team who works with patients to determine genetic risks and the feasibility of genetic testing.
The combination of the three tools gives the patient and members of the Hollings Cancer Center’s high-risk breast cancer team a personalized risk assess-ment for the patient.
“MUSC’s high-risk breast cancer team is a truly multidisciplinary group, representing health pro-fessionals from the fields of breast surgery, medical oncology, cyto-pathology, genetics, radiology and nursing” said Rayna Kneuper-Hall, M.D., a medical oncologist on the team. “Team members work closely with high risk women to make appropriate decisions based on the women’s individual circumstances.”
The personal risk assessment is vital in making a decision on screening and prevention therapy. As a result of the risk assessment, the woman may be reassured that she is not at increased risk of developing breast cancer. If she is at increased risk, and depending on the level of risk, she might consider the following options:
- Maintaining vigilance for early signs of breast cancer. This may include diagnostic imaging such as mammography, ultrasound and magnetic resonance imaging.
- Preventive mastectomy
- Chemoprevention—Tamoxifen has been clinically proven as a breast cancer preventive measure. It works by binding to the estrogen receptor located in the nucleus of each breast cell. Tamoxifen blocks estrogen from “landing” on the receptor, which in turn, prevents a cascade of reactions that stimulate various tumor growth factors. But there are some risks associated with the drug.
- Chemoprevention—Clinical trial. Patients may enroll in a clinical trial comparing tamoxifen with a similar drug, raloxifene, which was approved for osteoporosis treatment and is probably effective in reducing the chance of developing breast cancer with fewer side effects than tamoxifen. The trial compares the risks and benefits of the two compounds.
Drs.
Rana Hoda and William E. Gillanders review slides of patients who have
had the new ductal lavage procedure. This test, combined with a variety
of other factors, helps determine which at-risk women should receive therapy
to prevent breast cancer.
The ductal lavage procedure is performed at MUSC in an office setting in less than an hour. The procedure begins with the application of an anesthetic cream to the nipple to numb the area. Next, a small suction cup is used to help draw tiny amounts of ductal fluid up to the nipple surface to determine the duct’s natural opening. A tiny plastic tube is inserted into the ductal opening and an anesthetic is delivered to numb the inside of the duct. Then the duct is rinsed with saline to collect cells. The cell specimen is then sent to the laboratory. Once the cells are processed, Rana Hoda, M.D., director of cytopathology and member of the Hollings Cancer Center’s high-risk breast cancer team, determines whether the cells are normal or atypical.
Ductal lavage has been performed at Hollings on a small number of patients during the past few weeks under a study protocol. The test will now be offered to women whose family and medical history put them at risk of breast cancer.
Elaine Charpia of Summerville was one of the women who had the ductal lavage procedure under the study protocol. She was considered at risk for breast cancer because of her previous history and age. For Charpia, the ductal lavage procedure resulted in peace of mind. Her health care team determined, based on the ductal lavage combined with other risk assessment tools, that her likelihood of getting cancer was extremely small.
She said she experienced very minor discomfort during the procedure,
and she was able to return to normal activities after the test. She
said that as a result of the test, her immediate fear of breast cancer
has been allayed, and that gives her a great feeling of relief and well-being.
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