Contact: Ellen Bank
843.792.2626
Sept. 23, 2003
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 that 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 use 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 assessment
for the patient. “MUSC’s high risk breast cancer team is a truly
multidisciplinary group, representing health professionals from the fields of
breast surgery, medical oncology, cytopathology, 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. Or 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, a drug approved for
osteoporosis treatment which 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.
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 the test. She said that as a result of test, her immediate fear of breast cancer has been allayed, and that gives her a great feeling of relief and wellbeing.
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