Detecting Breast Cancer: Ductoscopy
The sooner breast cancer can be detected, the better the chances for successful treatment. Women are advised to perform monthly breast self-exams to look for possible signs of cancer, such as a breast swelling or lump, nipple discharge, dimpling of the skin, or pain, redness, or scaling of the nipple area. In addition, health care experts recommend regular clinical breast exams and, after 40, annual mammograms.
Breast lumps and nipple discharge can be caused by other conditions and are not necessarily a sign of cancer. Currently, the standard method of making a definitive diagnosis is a breast biopsy. Researchers are looking for better ways to diagnose or rule out breast cancer, which may help many women avoid an unnecessary biopsy. One method that is becoming more popular is ductal lavage. A small amount of fluid is withdrawn from the milk ducts to collect cells for analysis. Since most breast cancers start out in the milk ducts, the technique allows doctors to look for cellular changes that may indicate possible cancer. If cancerous cells are found, a biopsy is still needed to confirm the presence of breast cancer.
A newer technique is called ductoscopy (breast endoscopy), in which a very fine endoscope (called a ductoscope) is inserted into the milk duct. The lighted, fiberoptic instrument allows doctors to examine the duct by looking for tumors, blockages, and other signs of disease.
Ductoscopy is currently recommended for women who have an abnormal nipple discharge and those found to have abnormal cells after a ductal lavage. For women undergoing a lumpectomy for breast cancer, ductoscopy can also be used to determine which milk duct(s) is affected and how far the cancer has spread into the ducts, sparing as much healthy breast tissue as possible.
Currently, women who are found to have tumors or other abnormalities by ductoscopy must still undergo surgery. However, researchers expect that as technology evolves, doctors will one day be able to perform some degree of surgery through the endoscope. Ductoscopy is a new technique and not yet widely available. Experts say the procedure requires a great deal of training to prevent accidental perforation of the milk duct with the endoscope. Therefore, ductoscopy will most likely be available only in medical centers dealing with a large volume of patients.