Ductal lavage collects cells from the milk ducts of the nipple, where most breast cancers begin. If cytologic study shows abnormal cells, this is an indication of increased risk for breast cancer development. Ductal lavage is used to assess breast cancer risk and for ongoing surveillance. A statistical model computes a Gail index score in a woman of a given age and with the presence of certain factors that indicate risk for developing breast cancer over a specified interval. The Gail index score is based on risk factors (e.g., late age at menarche, late age at first live birth, number of previous biopsies, and number of first-degree relatives with breast cancer).
Apply a local anesthetic agent cream to the nipple area using a special kit; use a suction device to draw tiny amounts of fluid droplets from the milk ducts to the nipple surface. These droplets locate the milk ducts’ natural opening on the surface of the nipple.
Insert a very fine (hair-thin) catheter into the periareolar duct. Administer local anesthetic agent into the duct. Use a saline wash to separate the cells. Place the specimen in a special collector vial; label with the patient’s name, date, and test(s) ordered; and send for examination in a biohazard bag.
Abnormal findings include atypical hyperplasia and evidence of proliferative breast disease. The presence of atypical cells increases the risk for breast cancer by four to five times compared with women who do not have atypical cells.
Relative risk is increased even further in the presence of a family history of breast cancer (mother, daughter, sister, or two or more close relatives with history of breast cancer), specific genetic change (BRCA1 and BRCA2 mutations), and a Breast Cancer Risk Assessment score over 1.66%.
The age-specific composite evidence rate of the Gail model increases rapidly with age, although the conversion model changes little with age.
Later relative risk (percentage) or estimate of developing breast cancer within 10, 20, or 30 years of follow-up is based on projected probability.
Pretest Patient Care
Explain the lavage purpose, procedure, benefits, and risks.
Be aware that high-risk women of any age may be good candidates for ductal lavage. Obtain and document history and risk factors.
Describe sensations that might be experienced: feelings of fullness, pinching, and gentle tugging on the breast, which is uncomfortable but not usually painful.
Follow guidelines in Chapter 1 for safe, effective, informed pretest care.
Posttest Patient Care
Review test results; report and record findings. Modify the nursing care plan as needed. Counsel the patient appropriately about the chance of breast cancer development, follow-up, close monitoring (yearly examinations), and preventive drug treatment (e.g., tamoxifen) or surgery (oophorectomy or bilateral mastectomy).
Remember that test outcomes are interpreted in conjunction with mammogram and physical examination findings.
Follow guidelines in Chapter 1 for safe, effective, informed posttest care.