O'Shaughnessy identified a number of indications for performing ductal lavage on a woman. This procedure may identify a woman who may have an occult breast malignancy. The author is from Baylor-Sammons Cancer Center in Dallas, Texas.
A woman is a candidate for ductal lavage if both of the following are present:
(1) the finding of atypical cells would change clinical management
(2) the patient has one or more of the following:
(2a) a 5-year Gail score >= 1.7%
(2b) >= 2 first and second-degree relatives with breast cancer, both maternal and paternal
(2c) has been taking combined hormone replacement therapy for more than 10 years
(2d) remote history of atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH), lobular carcinoma in situ (LCIS) and/or ductal carcinoma in situ (DCIS) on biopsy
(2e) BRCA mutation present or suspected
(2f) high level of irradiation to the breast before the age of 20
Clinical management may include closer monitoring and/or treatment with anti-estrogenic drugs.
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