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Examining Cells Near Nipple May Predict Breast Cancer Risk (dateline August 21, 2000)

Sampling breast tissue cells with a needle and syringe near the nipple can help identify women at very high short-term risk of developing breast cancer, according to new research.  The procedure, called fine needle aspiration (FNA), can be used in conjunction with the Breast Cancer Gail Model   to help determine which women would benefit from breast cancer prevention therapies (such as the drug tamoxifen). The Gail risk model is a widely used tool that calculates a woman’s risk of breast cancer based several factors, including age, family history, age when menstruation began, history of breast biopsies , etc.

According to the study published in the August 2, 2000 issue of the Journal of the National Cancer Institute, sampling breast cells using FNA can also help determine which women are at risk of breast cancer.  With FNA, physicians can examine breast cells closely for any developing abnormalities.  Currently, FNA is often used to sample cells of a breast abnormality detected by mammogram or a lump found by a woman or her doctor during a breast examination . FNA is sometimes used to drain a benign (non-cancerous) breast cyst.

In the study, researchers examined 480 women who had a family history of breast cancer, a previous biopsy showing pre-cancerous conditions, and/or previous invasive cancer.  All of the women had a normal mammogram and clinical breast exam before the study.  The researchers performed FNA on each woman (typically eight to 10 needle insertions per breast) and analyzed the breast tissue samples. 

Each sample of cells was classified as being normal, having an increased number of seemingly normal cells (hyperplasia), or having an increased number of abnormal yet non-cancerous cells (hyperplasia with atypia).  After monitoring the women for 45 months, 20 women developed either ductal carcinoma in situ (DCIS, an early stage breast cancer) or a more aggressive breast cancer.  The cancers were predicted by the appearance of hyperplasia with atypia from FNA along with the Gail risk model showing the probability of developing breast cancer within 10 years.  

While the research is promising, study author Bruce Kimler, PhD, professor of radiation oncology at the University of Kansas Medical Center, said that his team did not develop FNA as a clinical tool.  Yet, Dr. Kimler believes that FNA could be a good monitoring approach.  The study could help determine which women should participate in breast cancer prevention clinical trials , in conjunction with the Gail risk model, mammography screening, and clinical breast exams.

However, FNA is not likely to become a routine breast cancer screening tool in the near future.  The FNA procedure requires a highly skilled radiologist and cannot typically be performed in a doctor’s office.  FNA also carries potential risks, such as bruising, scar-tissue build-up, and the risk of infection.  Repeated FNAs could also interfere with mammogram interpretation.

The researchers recommend that further research investigate a less invasive technique for determining breast cancer risk by sampling breast tissue cells.  This technique, called nipple aspiration , involves squeezing the nipple to collect breast cells.  

Some radiologists see pitfalls when an atypical FNA result is produced but physicians cannot determine the cause of the atypical result. Depending on the pathologist and other factors (such as adequacy of the sample), as many as 50% of atypical FNA results do not indicate cancer when, in fact, the patient does have cancer.

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