© 2001 by Oxford University Press
Journal of the National Cancer Institute, Vol. 93, No. 23, 1761,
December 5, 2001
© 2001 Oxford University Press
MEMORANDUM FOR: Science Writers and Editors on the Journal Press List
Increased Breast Cancer Risk Related to Abnormal Cells Found in Nipple Aspirate Fluid
November 29, 2001 (EMBARGOED FOR RELEASE 4 P.M. EST December 4)
Extended follow-up of a previously published cohort of women shows that abnormal cells found in fluid collected by nipple aspiration are associated with an increased risk of breast cancer. This extended follow-up, along with independent confirmation of this observation in another group of women, is presented in the December 5 issue of the Journal of the National Cancer Institute.
Margaret Wrensch, Ph.D., and Nicholas Petrakis, M.D., at the University of California at San Francisco, and colleagues collected nipple aspirate fluids from women in the San Francisco Bay Area between 1972 and 1991. They classified the women according to the most severe abnormalities of cells found in the fluid specimens. Compared with women whose breasts gave no fluid, those whose fluid contained cells showing atypical hyperplasia were twice as likely to develop breast cancer.
More than half of the 7,673 women followed in the study were recruited from 1972 through 1980, and a second group was enrolled from 1981 to 1991. For each participant, up to three attempts were made to obtain breast fluid with a modified manual breast pump (a small plastic cup attached to a 10-mL syringe) placed over the nipple. While the woman gently compressed her breast with both hands, the plunger on the pump was pulled back to create suction on the nipple approximately equivalent to the pressure created by a nursing infant. Overall, about 60% of women produced fluid during these attempts.
Cells in each fluid specimen were classified by the project pathologist as normal, mild hyperplasia, moderate hyperplasia, or atypia. The median follow-up time for the first group was 21 years. In that group, women from whom normal breast fluid was obtained were about 60% more likely to develop breast cancer than women who yielded no breast fluid. Women with cells classified as hyperplasia or atypia were 2.4 to 2.8 times as likely, respectively, to develop breast cancer.
In the second group (median follow-up, 9 years), women who produced normal breast fluid were 20% more likely to develop breast cancer than women who yielded no breast fluid, and women who produced cells classified as hyperplasia or atypia were twice as likely to develop breast cancer. The results of this second group of women independently confirms the results of the first group of women, the authors conclude.
In an editorial, Carol Fabian, M.D., and Bruce Kimler, Ph.D., at the University of Kansas Medical Center, note that several minimally invasive techniques are being used in a study setting to detect occult precancerous cells. Detection of atypical hyperplasia by nipple aspiration or random fine needle aspiration is associated with an increased risk for breast cancer. However, the negative predictive value of attempts that do not yield a satisfactory specimen or specimens that do not contain atypia is less clearly defined. Studies correlating risk of breast cancer with the new technique of ductal lavage have not yet been completed. Thus, they advise caution concerning the introduction of these procedures into routine clinical practice for breast cancer risk assessment.
Contact: Eve Harris, University of California at San Francisco, (415) 885-7277; fax: (415) 885-7393; eharris{at}pubaff.ucsf.edu. Editorial: Bob Hallinan, University of Kansas, (913) 588-5246; fax: (913) 588-1225; bhallina{at}kumc.edu.
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Wrensch MR, Petrakis NL, Miike R, King EB, Chew K, Neuhaus J, et al. Breast cancer risk in women with abnormal cytology in nipple aspirates of breast fluid. J Natl Cancer Inst 2001;93:1791–8.
Editorial: Fabian CJ, Kimler BF. Breast cancer risk prediction: should nipple aspiration fluid cytology be incorporated into clinical practice. J Natl Cancer Inst 2001;93:1762-3.
Note: This memo to reporters is from the Journal staff and is not an official release of the National Cancer Institute (NCI) or Oxford University Press (OUP) nor does it reflect NCI or OUP policy. In addition, unless otherwise stated, all articles and items published in the Journal reflect the individual views of the authors and not necessarily the official points of view held by NCI, any other component of the U.S. government, OUP, or the organizations with which the authors are affiliated. Neither NCI nor any other component of the U.S. government nor OUP assumes any responsibility for the completeness of the articles or other items or the accuracy of the conclusions reached therein.
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