Ductal lavage is a diagnostic procedure being developed by
breast surgeon Susan Love, MD and researchers at the company, Pro-Duct Health, to be used
in addition to clinical breast exams and mammography. Ductal lavage helps identify cancerous and
pre-cancerous cells by examining samples of cells from the milk ducts of the breast.
Dubbed the "breast pap smear," Dr. Love believes ductal lavage can help
physicians better understand how breast cancer develops and identify women most likely to
develop breast cancer. However, the test is only recommended for women at high risk of
breast cancer (as determined by family history, etc.).
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What is Ductal Lavage?
Physicians estimate that over 95% of breast cancers begin in the cells lining the
breast ducts. It can take up to eight to 10 years before these cells grow into a tumor
large enough to be detected by mammography (approximately one centimeter in diameter) or
felt during a physical breast exam. The term "lavage" is French and means
"wash" or "rinse." Ductal lavage involves analyzing cells washed out
from the breast ducts to determine whether they have malignant qualities before they
develop into breast cancer.
Ductal lavage is a minimally invasive procedure that involves collecting samples of
breast ducts cells and then examining the cells under a microscope to determine whether
they are normal, atypical, suspicious, or malignant. The idea of testing fluid from the
nipple was first suggested in the 1950s by Dr. Papanicolaou, the physician who developed
the Pap smear to test for cervical cancer.
How is Ductal Lavage Performed?
Most women who undergo ductal lavage experience little to no discomfort during the
procedure. To perform ductal lavage, the physician will apply a small amount of anesthetic
cream to the nipple area. A breast pump (or aspirator) is then used to apply mild suction
to the nipple to draw out tiny amounts of nipple fluid from the milk ducts up to the
nipple surface. Typically, fluid will only be extracted from one or two breast ducts (each
breast contains six to eight ducts). These ducts, according to Dr. Love, are most likely
to contain abnormal cells. Once these ducts have been identified, an anesthetic is infused
into the duct and a catheter is threaded into the duct opening in the nipple for a small
distance. Next, salt water is sent through the catheter into the breast duct to
"wash" the duct and collect cells. The breast cells that are washed out are sent
to the pathology laboratory for analysis.
What are the Possible Benefits and Limitations of
Ductal Lavage?
The goal of ductal lavage is to determine whether breast ducts cells have certain
abnormal characteristics which may cause them to develop into cancer at a later date. If
pre-cancerous cells exist, women may wish to consider preventive measures to help protect
against breast cancer. Since ductal lavage can be repeated, physicians can track changes
in a woman’s cells over time.
Preventive measures may include:
Researchers are also investigating whether ductal lavage may detect breast cancer at a
very early stage, even before it can be seen with mammography
(and often years before a breast lump can be felt). The earlier breast cancer is detected,
the more likely treatment will be successful. According to Dr. Love, ductal cells could
also be used by scientists to study breast cancer genes and environmental factors that
affect breast cells.
Some clinical data have shown that ductal lavage may be beneficial at helping to detect breast cancer in women at
high risk for the disease. At 23rd annual San Antonio Breast Cancer Symposium in December 2000, William Dooley, MD
of the Johns Hopkins Breast Center, shared results of his study. Over 500 women at high risk of breast
cancer (as determined by family history, etc.) underwent ductal lavage. The women also had screening mammograms and
physician-performed clinical breast exams. Of 383 eligible women, ductal lavage detected:
- Atypical cells in 17% of the women (66/383)
- Suspicious/malignant cells in 7% of the women (26/383)
However, the presence of atypical breast cells does not necessarily mean a women will develop breast cancer, and
in fact, most atypical cells do not progress to cancer. Therefore, physicians suggest that ductal lavage only be
performed on women who have already been determined to be at risk for breast cancer.
Women at high risk of breast cancer include:
- Those with a strong family or personal history of breast cancer
- Those who test positive for BRCA1 or BRCA2 gene mutations
- Those with a history of breast biopsies showing non-cancerous conditions (such as lobular carcinoma in situ or
atypical hyperplasia)
More recently, a study appearing in the October 2004 issue of the Journal of the National Cancer Institute found that
ductal lavage was ineffective at detecting breast cancer among women who had already been diagnosed with
the disease. In the study, Seema A. Khan, MD, of the Lynn Sage Comprehensive Breast Center in Chicago, and
colleague performed ductal lavage on 32 women who had been diagnosed with breast cancer, prior
to mastectomy. They also performed ductal lavage on seven high-risk women before having preventive
mastectomies. They found that ductal lavage detected atypical or cancerous breast cells in
only five of the 38 cases. Further research is needed to determine the effectiveness of ductal lavage.
Currently, ductal lavage is available at a handful of locations across the United
States. Ductal lavage is expected to become available at more locations in the future, as
more physicians complete the required special training. Click
here for a list of physicians who perform ductal lavage. Please note, in most cases,
women must meet eligibility requirements to have ductal lavage performed.
Additional Resources and References
- Pro-Duct Health, a company co-founded by Susan Love, MD, provides information on ductal
lavage, including a list of locations that perform the procedure, at http://www.producthealth.com/
- Those interested in learning more about ductal lavage may call Pro-Duct health at
1-866-446-DUCT (for patients) or 1-866-4-LAVAGE (for medical professionals).
- The October 4, 2000 Imaginis.com report, "Testing Nipple Fluid May Help Determine
Women at High Breast Cancer Risk," is available at http://www.imaginis.com/breasthealth/news/news10.04.00b.asp
- The February 24, 2000 Imaginis.com report, "New Breast Cancer Detection Method
Involves Testing Nipple Fluid," is available at http://www.imaginis.com/breasthealth/news/news2.24.00.asp
- Susan Love, MD provides information on ductal lavage on her website at http://www.susanlovemd.com/lavage_frames.html
- Dr. Susan Love's Breast Book (1995) by Susan M. Love, MD and Karen Lindsey contains
substantial information about all aspects of breast cancer, including risk factors,
symptoms, diagnosis, treatment, and survival. Click here for pricing and
ordering information.
Updated: December 17, 2007
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