Friday, July 30, 2010


Breast cancer is the leading cause of cancer death in women aged 20-59. Cancer of the breast will happen in 15% of all women during their lifetime. Approximately 200,000 new cases of breast cancer are diagnosed in the U.S. each year, resulting in 40,000 deaths annually. An early diagnosis may be helpful, but a before time indication may be curative! A PAP test for the Breast is the ultimate early warning that the lady is in harm's way. In the past this procedure called for a needle aspiration of the milk duct for NAF (Nipple Aspirate Fluid) and was not only uncomfortable but occasionally elicited pain.

A newer, more comfortable test can be performed in the physician’s office using a small device called the HALO with two adjustable cups that go over the ends of the breasts. Unlike a Mammogram, these do not cause much, if any, discomfort. There is a compression at the end of the breast to help elicit the fluid and then suction, which actually draws the fluid out. After five minutes, the practitioner will check to see if any fluid has been elicited, it will be put into a non-gynecological cytology container then sent to the lab doing the cervical paps. The results are usually given back to the patient or doctor, within 24 to 36 hours.

Dr. Papanicolaou discovered the “pap” in 1938 to look at the epithelial cells in the lining of a woman’s milk ducts and the cervix for precancerous predispositions. At that time cervical cancer was the number one cancer found in women. Doctors and women marched in lock step to eradicate this scourge. As a result of the cervical pap, that cancer now kills less than 3,000 women a year in the U.S. So few women have cervical cancer, I no longer do cervical paps. With the advent of the papilloma vaccine, there will be even less of this venereal disease. The cervical smear is relatively easy to obtain through a pelvic exam, but not so with a breast smear, unless the women have an abnormal discharge.

In 1958 Dr. George Papanicolaou et al., first demonstrated the ability to find abnormal cells in NAF with the purpose of identifying women at high risk for breast cancer. NAF and the Pap test are both based on the cytological examination of changes in epithelial cells to determine risk for developing cancer. The presence of abnormal cells, or atypia, in NAF, which is secreted from the milk ducts where nearly all (95%) of invasive breast cancers begin, is a trait proven to increase a woman's chance of developing breast cancer. Multiple studies have concluded that atypia increases a woman's likelihood of developing breast cancer four to five fold.

The examination of NAF can provide insight into a woman’s breast health. Finding atypia (abnormal changes) years before it might develop into a lesion enables a woman and her doctor to develop the appropriate "care path" for optimal management of her breast health. The problem is finding an easy non-invasive way to collect the breast fluid. Historically it has been gathered in three ways. One is the Sartorius Method, which is warm towel’s compression and that takes at least a half hour and is successful in only 25% of the cases. Another way of eliciting the fluid is a fine-needle procedure going into the nipple to draw out the fluid. The third way was a product that came out a few years ago called ductal lavage, or First Cyte. This involved putting a small tube or cannula, into the nipple, lavaging the milk ducts then analyzing the fluid and the epithelial cells cytologically as we do for atypia. The HALO is a wonderful collection device. By having a fully automated, five-minute, non-invasive procedure, we can now get nipple aspirate fluid in an efficient way. In a 500 patient trial, women rated the pain of the HALO procedure as a three to four on a scale of 1 to 10. A mammogram was rated 8!

The best current screening to assess a woman’s breast health and risk of developing breast cancer is review of family history, personal history, physical breast exam, plus the new guidelines of regular mammography for women over 50. Mammograms have 30% false positives and 38% false negatives. Some scientists even believe that putting the breast under pressure and irradiating it can cause cancer. Also clinical experience has shown that the vast majority of women who develop breast cancer have no risk factors that are identifiable with these methods and go unnoticed for years until an abnormality, a lump, is accidently discovered.

Mammography is often not as effective for women on Hormone Replacement who tend to have dense breasts that make it harder to detect abnormalities. Though young women do not develop breast cancer as often as women over 50, the disease in this population tends to be more advanced and have less favorable outcomes. A recent study found that younger women’s tumors tend to have a set of biological and genetic factors that made them more aggressive and more difficult to treat than cancers in older women. Digital Imaging Thermography has only limited utility and is not accepted by the majority of practicing physicians.

The medical community’s focus has traditionally been on detection and treatment. But by the time an abnormality can be identified via mammography, it has been growing for approximately eight years. As a result, more emphasis is now being placed on individualized “risk assessment and prevention.” Taking bio-identical progesterone, and testosterone eating broccoli sprouts or taking supplements such as DIM or I3Carbinol, limiting alcohol, fat and smoking will go a long way in reversing early atypia and preventing breast cancer.

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