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Department of Surgery Referrals Patient Clinician Researcher

Clinical Breast Cancer Program
Breast Disease  Breast Cancer

Atypical Ductal Hyperplasia (ADH) and Ductal Lavage

Atypical (precancerous) cells detected in the milk ducts of one or both breasts may indicate an increased risk of developing cancer. Women determined to be at high risk, including those with a prior history of breast cancer, a mother, daughter or sister or two close relatives with breast cancer, a history of two or more benign breast biopsies or a positive test for the BRCA1/BRCA2 gene mutation may be advised to undergo a Ductal Lavage. This tool is used to identify patients with Atypial Ductal Hyperplasia (ADH): a condition which significantly increases a woman's risk of developing breast cancer. In a recent clinical study, ductal lavage was performed on over 500 high-risk women at 19 prestigious breast cancer centers. All the women had normal mammograms within the 12 months of being enrolled in the study. In this group, ductal lavage detected:

  • Atypical/precancerous cells in 15 percent of the breasts studied
  • Suspected or unequivocal cancerous cells in 5 percent of the breasts studied

Gentle suction is used to help draw a tiny amount of fluid from the milk ducts up to the nipple surface. If fluid appears, a hair-thin catheter is inserted into the milk duct's natural opening on the surface of the nipple. Saline is infused through the catheter to rinse the duct and collect cells. The sample is then analyzed to detect normal, pre-cancerous and cancerous cells.

If pre-cancerous cells are detected through ductal lavage, it does not necessarily mean that breast cancer will follow. However, studies show that women with atypical/pre-cancerous cells and a family history of breast cancer have an 11 to 22 times greater chance of developing breast cancer than women who do not share these risk factors. This procedure, in conjunction with standard breast cancer detection methods, can be used to regularly re-test and check the status of cells lining the milk ducts, which is where most breast cancers begin to form. It is a minimally invasive procedure that has proven comfortable for the patient.

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