Milk duct lavage is a screening tool for women at high risk for breast cancer. During breast duct lavage, doctors can collect cells from the ducts of the breast for analysis. The test can be used to identify precancerous cells, or atypical cells, and is currently used only in women with multiple breast cancer risk factors to try to detect breast cancer before it develops.
The premise behind the use of ductal lavage is that most breast cancers (approximately 95%) arise in the ductal cells of the breast. Cancer usually begins in one breast duct and can be confined to that breast duct if detected early. However, by the time breast cancer is detected, it has usually spread to more than 1 duct. Experts estimate that it usually takes 10 years for a cancer to grow from 1 cell to a size that can be detected on a mammogram (a 1-cm sized mass usually contains 1 billion cells).
Doctors hope that the use of ductal lavage as a screening tool for women at high risk for breast cancer will help detect the disease early, when treatment is optimal.
How does breast duct lavage work?
Milk duct lavage is a minimally invasive procedure that can usually be performed on an outpatient basis. The procedure is divided into 3 steps.
- Anesthetic is applied to the nipple area to numb it. A small amount of fluid is withdrawn from the breast ducts by gentle aspiration. This maneuver determines the location of the duct opening on the nipple surface and identifies the ducts to be examined. For breast ducts that do not produce fluid, the lavage method is not usually used for examination because atypical cells are most common in fluid-producing breast ducts. Not all women will produce fluid during this examination. If no fluid is produced, the test will not be continued.
- If fluid is produced, the doctor will insert a small catheter into the natural opening of the breast duct. Additional anesthetic is injected into the breast duct and then saline is instilled through the catheter to flush the duct. After the flush, some cells are removed from the duct with the flushing fluid. “The term “lavage” stands for “cleaning” or “flushing.
- The sample is sent to the lab for analysis to determine if the cells are normal or abnormal (atypical cells). Women with atypical cells are found to have an increased risk of breast cancer.
Who is a candidate for breast duct lavage?
Doctors only recommend breast duct lavage for women at high risk for breast cancer. Some of the factors that contribute to a woman’s increased risk of breast cancer include:
- Personal history of breast cancer;
- A family history of breast cancer, especially if the mother, daughter, or sister had cancer;
- Evidence of a specific genetic (BRCA1/BRCA2) mutation;
- Gail Index score of at least 1.7% The Gail Index uses risk factors such as age, family history of breast cancer, age at menarche and age at first pregnancy, and number of breast biopsies to calculate a woman’s risk of developing breast cancer in the next 5 years.
Consult your doctor about whether you would benefit from screening.
What will I feel during breast duct lavage?
Most women do not feel pain during breast duct lavage, and the discomfort does not exceed that of a mammogram. The breast may feel temporarily swollen, squeezed, and tingling. However, the use of anesthetic medication can reduce discomfort during the exam.
What does it mean to find atypical cells?
Fewer than 1% of women will have abnormal cells detected by ductal lavage, but not all abnormal cells will develop into breast cancer. Finding atypical cells can help develop strategies to prevent breast cancer, which may include the following.
- Repeat ductal lavage or other tests to confirm previous results.
- Enhanced monitoring of breast health, such as more frequent mammograms.
- Take certain medications that may reduce the risk of breast cancer, such as tamoxifen, raloxifene, or exemestane.
- Surgery, such as preventive mastectomy (surgical removal of the breast before cancer appears).
Is breast duct lavage an alternative to x-ray screening for breast cancer?
It is not a substitute. Ductal lavage can be used in combination with other routine breast health exams, such as breast self-exams, annual physical exams, and mammograms. Ductal lavage is not a substitute for these screening tools. In addition, doctors do not recommend ductal lavage for women at low risk for breast cancer.
What are the risks of ductal lavage?
The risks associated with breast tube lavage are minimal. Infection at the catheter insertion site is rare. Although perforation is extremely rare and usually does not cause permanent damage to the breast, it is still possible to have a perforated milk duct.