A cancer cell is a normal cell that has acquired mutations that cause it to grow and divide uncontrollably. Then, through a series of genetic changes, these cells acquire mutations that lead them to become atypical, or abnormal, cells. Some of these abnormal cells may go on to acquire even more abnormalities and, ultimately, to become cancer cells.
It is believed that breast cancer cells start as normal cells that line the breast ductal system. The ductal system includes the ducts (the tubes that carry milk and fluid to the nipple openings) and the lobules (the parts of the ductal system where milk is made). (See Figure Below.)
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Ductal lavage is a washing procedure that can remove fluid found in the breast ducts. This fluid is referred to as nipple aspirate fluid (NAF). The procedure has been dubbed "a Pap smear for the breast" because, like the test for cervical cancer, it is a way to find cells that are abnormal but have not yet become cancerous. The procedure involves inserting a small catheter into the ductal openings in the nipple and washing out cells from inside the duct. (See Figure Below.) The cells are then analyzed to assess if they are normal or abnormal.
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Ductal lavage, when used alone or in conjunction with other intraductal approaches, allows us to examine and understand the conditions inside the breast duct that support or block the development of cancer. The Dr. Susan Love Research Foundation believes that it is these insights that will bring us to the beginning of the end of breast cancer.
We envision that—within our lifetime—ductal lavage will lead to the identification of a blood or fluid test that can screen for cells that are just "thinking" about becoming cancerous some day. We will know which duct those cells came from, and that duct will simply be washed or be treated with an agent, through the nipple to stop cancer in its tracks. This will be true prevention, and the beginning of the end of breast cancer as we know it today.
Although we still have much to learn about the relationship between abnormal cells in ductal fluid and breast cancer, we are already putting what we have learned to use in the clinical setting. Studies indicate that women whose NAF contains atypical cells are at increased risk for developing breast cancer. Acting on this knowledge, doctors are now using ductal lavage along with mammography and breast exam to help women at high risk for breast cancer assess their risk and make risk-reduction treatment decisions. (Ductal lavage is currently only approved for use in women at high risk for breast cancer. It is not a replacement for mammography or breast exam.)
ProDuct Health, a company founded by Dr. Love, developed the catheter used to perform ductal lavage. It was acquired in 2001 by Cytyc Health Corporation, where Dr. Love serves as a consultant.
To find information about research on ductal lavage, click here.
To learn more about the ductal lavage research being conducted by the Dr. Susan Love Research Foundation.
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