First Clinical Practice Guidelines for Ductal Lavage Issued

NEW YORK (Reuters Health) Jan 15 – A team of leading breast specialists has issued the first clinical practice guidelines for ductal lavage in the management of women at high risk for breast cancer. Their report appears in the January 15th issue of Cancer.

"With ductal lavage, we now have a reliable method for collecting information about ductal cell activity in women at high risk for developing breast cancer," lead author, Dr. Joyce A. O'Shaughnessy, from Baylor University Medical Center, Dallas, said in journal statement.

"On the basis of the ductal lavage results, physicians have additional information to determine which women are at highest risk and to help guide them in making breast cancer management decisions," she added.

While not designed to replace mammography, the guidelines provide a framework for assessing treatment options for women who are at high-risk of developing breast cancer. The guidelines recommend that:

if a specimen from any fluid-yielding duct is interpreted as Inadequate Cellular Material for Diagnosis (ICMD), the procedure should be repeated at the next available opportunity;

if the specimen in a high-risk women contains benign cells, it is reasonable to repeat the procedure every 1 to 3 years;

if atypical cells are found, tamoxifen treatment should be considered to reduce risk. It is then recommended that the procedure be repeated at 6- to 12-month intervals to confirm the findings;

if malignant cells (rare with ductal lavage) are found, the procedure should be repeated to confirm the finding and intensive breast imaging should be conducted to look for actual cancer.

"Cytology results from ductal lavage help the patient and her physician decide how aggressively they need to pursue treatment approaches to reduce her risk of developing breast cancer," Dr. O'Shaughnessy said.
"Specifically, this information helps us weigh the risks and benefits of a variety of management options ranging from or including closer surveillance, hormone replacement therapy, anti-estrogen therapy (tamoxifen), and in very high-risk women, even prophylactic mastectomy," she noted.

Cancer 2002;94:292-298.

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