Tolerability of breast ductal lavage in women from families at high genetic risk of breast cancer.
BACKGROUND
Ductal lavage (DL) has been proposed as a minimally-invasive, well-tolerated tool for obtaining breast epithelial cells for cytological evaluation of breast cancer risk. We report DL tolerability in BRCA1/2 mutation-positive and -negative women from an IRB-approved research study.


METHODS
165 BRCA1/2 mutation-positive, 26 mutation-negative and 3 mutation unknown women underwent mammography, breast MRI and DL. Psychological well-being and perceptions of pain were obtained before and after DL, and compared with pain experienced during other screening procedures.


RESULTS
The average anticipated and experienced discomfort rating for DL, 47 and 48 (0-100), were significantly higher (p < 0.01) than the anticipated and experienced discomfort of mammogram (38 and 34), MRI (36 and 25) or nipple aspiration (42 and 27). Women with greater pre-existing emotional distress experienced more DL-related discomfort than they anticipated. Women reporting DL-related pain as worse than expected were nearly three times more likely to refuse subsequent DL than those reporting it as the same or better than expected. Twenty-five percent of participants refused repeat DL at first annual follow-up.


CONCLUSIONS
DL was anticipated to be and experienced as more uncomfortable than other procedures used in breast cancer screening. Higher underlying psychological distress was associated with decreased DL tolerability.
Loud
Jennifer T
JT
Clinical Genetics Branch, National Cancer Institute, NIH, Rockville, MD, USA. LoudJ@mail.nih.gov
Beckjord
Ellen Burke
EB
Nichols
Kathryn
K
Peters
June
J
Giusti
Ruthann
R
Greene
Mark H
MH
D000328:Adult; D000704:Analysis of Variance; D014408:Biomarkers, Tumor / Q000032:analysis*; D001826:Body Fluids / Q000166:cytology; D001940:Breast / Q000473:pathology*; D001943:Breast Neoplasms / Q000235:genetics* / Q000473:pathology* / Q000523:psychology; D003581:Cytodiagnosis / Q000379:methods; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D020022:Genetic Predisposition to Disease; D006801:Humans; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods; D012044:Regression Analysis; D013315:Stress, Psychological / Q000175:diagnosis / Q000209:etiology; D007507:Therapeutic Irrigation
D014408:Biomarkers, Tumor