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Experts Issue Clinical Guidelines for Ductal Lavage (dateline February 13, 2002)


A group of breast cancer experts has published the first clinical guidelines for using ductal lavage to test for suspicious cellular changes in women at high risk for breast cancer. Ductal lavage is a new procedure that involves analyzing cells from the breast ducts—the area of the breast where an estimated 95% of breast cancers begin. The guidelines help physicians interpret the results of ductal lavage and manage women at high risk of breast cancer.

Ductal lavage appears to be an accurate method of determining breast duct cell activity in women at high risk of breast cancer, according to study co-author Joyce A. O'Shaughnessy, MD of the Baylor-Sammons Cancer Center in Dallas, Texas. While ductal lavage is not designed to replace mammography, physical breast exams, or other methods of breast cancer detection, it can be useful in determining whether high-risk women are likely to develop the disease in the near future. ("High-risk" women include those with a strong family history of breast cancer or those with a genetic mutation that increases their cancer risk).

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. To perform ductal lavage, a physician uses a breast pump 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 to two breast ducts (each breast contains six to eight ducts). Physicians believe that these ducts are most likely to contain abnormal cells. Once the suction identifies the opening on the nipple surface, a catheter is inserted into the duct opening, and saline solution is used to "wash" the duct and collect cells. The cells are then sent to the pathology laboratory for microscopic examination.

The goal of ductal lavage is to determine whether breast duct cells have certain abnormal characteristics which may cause them to develop into cancer at a later date. The new guidelines help physicians perform ductal lavage and interpret the results. According to the guidelines:

  • If a specimen obtained with ductal lavage is interpreted as "Inadequate Cellular Material for Diagnosis (ICMD), the procedure should be repeated.
  • If the specimen yields benign, non-cancerous results, the procedure should be performed again in one to three years.
  • Finally, if abnormal cells are discovered with the ductal lavage procedure, women should consider taking the drug tamoxifen*(brand name, Nolvadex) to help reduce their risk of breast cancer. In this case, ductal lavage should be repeated again every six to 12 months to confirm previous findings.

*Tamoxifen is a drug found to reduce breast cancer risk by nearly 50% in post-menopausal women at high risk for the disease. However, tamoxifen is associated with a number of side effects (most notably hot flashes) and is not appropriate for all high-risk women. Tamoxifen is also associated with a slight increased risk for endometrial cancer—cancer of the uterine lining.

Other options to help prevent breast cancer in women at high risk for the disease:

While ductal lavage can help determine whether women have pre-cancerous ductal cells that increase their risk of breast cancer, most atypical breast cells do not progress to cancer. Therefore, mammography, clinical breast exams, and breast self-exams remain most important in helping to detect breast cancer.

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