Ductal
Lavage Patient Vignettes
Rosalyn*
Rosalyn,
53, has long been aware that she is at high risk. Her mother,
grandmother, four aunts and five cousins all have had breast cancer.
Rosalyn has had several previous biopsies, which were negative.
Her most recent mammogram and clinical breast exam were normal.
Given
her high-risk status, Rosalyn was counseled on the risks and benefits
of two risk reduction strategies - avoiding hormone replacement
therapy (HRT) and taking tamoxifen. After weighing the pros and
cons with her doctor, she decided to begin HRT to alleviate menopausal
symptoms, and decided not to take tamoxifen at that time.
As another step toward better understanding her risk, Rosalyn's
doctor also recommended she undergo ductal lavage. Rosalyn's ductal
lavage was performed on two different ducts. The lab report afterward
showed that atypical cells were present in both ducts.
Based on this new biological information, and the increased risk
that atypical cells confer, Rosalyn chose to stop HRT, and reversed
her initial decision about drug therapy. She started on tamoxifen
immediately in order to help reduce her risk.
Barbara*
Barbara
is 46 years old, and recently was diagnosed with invasive cancer
in her right breast. Her left breast showed nothing suspicious
on mammography and clinical examination. However, given her higher
risk of left breast cancer development, Barbara was considering
whether to have preventative left breast mastectomy in conjunction
with the mastectomy she was about to undergo on her right breast.
Although
preventative mastectomy has been shown to reduce the risk of breast
cancer by 90%, it is an extremely difficult decision for any woman
to make. Barbara decided to have ductal lavage on her left breast
to get cellular information about her risk that might help her
in the decision-making process. Ductal lavage was performed on
two ducts.
Barbara's
laboratory report revealed that the cells from one of the ducts
were normal. However, atypical cells were present in the other
duct that had been lavaged. Barbara discussed her ductal lavage
results at length with her doctor, and after much consideration,
decided to proceed with the preventative mastectomy.
Susan*
Forty-four
year old Susan recently discovered that her sister (age 46) had
been diagnosed with breast cancer. Her mother died of lung cancer
in her mid-forties, but was not known to have had any breast disease.
Susan talked with several doctors about her concerns over her
breast cancer risk, and had both a physical exam and mammogram,
which were normal. She also had her Gail risk score calculated
and found out it was 2.6%, indicating an increased risk for breast
cancer.
Given
her risk factors, Susan's doctors counseled her to consider closer
surveillance and/or starting a drug called tamoxifen in order
to help reduce her risk. Susan was advised that tamoxifen reduces
breast cancer risk in high-risk women, but that it could have
some rare, but potentially serious side effects. To help her decision-making,
Susan's doctor suggested she have ductal lavage to determine whether
the cells inside her breast would give any indication of further
risk. Susan decided that if atypical cells were found through
ductal lavage, it would impact her consideration of tamoxifen,
and so she decided to have ductal lavage.
The
results of her ductal lavage revealed that Susan had atypical
cells in one of her breasts. After further consideration, and
on the counsel of her doctor, Susan decided to begin tamoxifen
in order to reduce her risk.
*All
names have been changed to protect patient privacy
