Breast Cancer Prevention

An intraductal approach is gaining ground as a way to evaluate and clear out precancerous changes in the breast ducts

Parsemus Foundation encourages research on simple approaches that could have a big impact, including the intraductal approach to early breast cancer– preventing, or eliminating, early cellular changes in the milk ducts (where the great majority of breast cancers start). When these changes are detected, the condition is called ductal carcinoma in situ (DCIS) and is the most common noninvasive lesion of the breast. With mammography becoming standard practice, the diagnosis of DCIS has skyrocketed. Surgery, radiation and hormone therapy are standard therapies, despite the fact that only a portion of DCIS cases progress to invasive cancer.

But aggressive traditional treatment of DCIS might be changing. Increasing evidence suggests that evaluating and even treating DCIS through the breast ducts offers a nonsurgical alternative. Dr. Susan Love has been an advocate of the intraductal approach for years, with current research studies focused on mapping the breast ducts with 3D ultrasound. Ductal lavage, ductoscopy and intraductal infusion of therapeutic agents may enhance breast cancer treatment. See details below and More Info for references.

  • Intraductal lavage involves flushing the mammary ducts and collecting the fluid for analysis of the cells. This method is becoming more common, especially for women at high risk of breast cancer. While the sensitivity to detect abnormal cells visually is not ideal, evaluation of molecular indicators in the fluid is proving to be a useful diagnostic tool.
  • Mammary ductoscopy (threading a tiny endoscope into the breast ducts) is a noninvasive method that can help to visualize and sample lesions. Ductoscopes have now been developed with fiber optics to aid visualization. This method can also be used to guide lumpectomy surgery, helping to avoid additional surgeries when lesions are missed with traditional methods.
  • Intraductal infusion is a method to provide therapeutic agents directly into the duct system, where most breast cancers originate. It has less likelihood of causing systemic toxicity since the physician is targeting a specific area. A number of clinical trials of intraductal chemotherapy have indicated safety and feasibility of this method.
DCIS

Advanced ductal carcinoma in situ. Photo credit www.breastpathology.info

Parsemus Foundation encourages research on infusions into the breast ducts through the nipple openings as an alternative to surgery. The idea is that like a drain cleaner in pipes, the fluid goes right to where the problem is found– and if caught early, before they have broken out of the ducts, precancerous changes could be treated without subjecting women to lumpectomy surgery.

Ethyl alcohol shows promise to achieve a therapeutic effect and should be compared head-to-head with more expensive and less readily available chemotherapy drugs. If successful, this approach would be an instantly-available alternative to surgery for women in resource-limited settings around the world.

More Information

Balci FL, Feldman SM. Exploring breast with therapeutic ductoscopy. Gland Surg. 3(2): 136–141, 2014. (full text link review article).

Do Canto LM, et al. MicroRNA analysis of breast ductal fluid in breast cancer patients. Int J Oncol. 48(5): 2071–2078, 2016. (full text link)

Flanagan M, Love S, Shelley Hwang ES. Status of intraductal therapy for ductal carcinoma in situ. Curr Breast Cancer Rep, 2:75–82, 2010. (full text link review article)

Love SM, Zhang W, Gordon EJ, Rao J, Yang H, Li J, Zhang B, Wang X, Chen G, Zhang B. A feasibility study of the intraductal administration of chemotherapy. Cancer Prev Res (Phila). 6(1):51-8, 2013. (full text link –Phase I study of intraductal chemotherapy)

Mahoney ME, Gordon EJ, Rao JY, Jin Y, Hylton N, Love SM. Intraductal therapy of ductal carcinoma in situ: A presurgery study. Clin Breast Cancer. 13(4): 280–286, 2013. (full text link)

Stearns V et al. Preclinical and clinical evaluation of intraductally administered agents in early breast cancer. Sci Transl Med. 26: 3(106), 2011. (full text link)

Zielinski J, Jaworski R, Irga-Jaworska N, Haponiuk I, Jaskiewicz J. The significance of ductoscopy of mammary ducts in the diagnostics of breast neoplasms. Wideochir Inne Tech Maloinwazyjne. 10(1): 79–86, 2015. (full text link)