The Future of Breast Cancer Detection

By: Seema A. Khan, MD
Breast cancer treatment has made great advances in recent years, and breast cancer screening techniques have made great strides as well.
Below, Dr. Seema Khan, Associate Professor of Surgery at Northwestern University Medical School, discusses the latest developments in screening techniques for breast cancer.

What are the risk factors associated with breast cancer?
SEEMA KHAN, MD: The most important risk factor for breast cancer is age. Two thirds of breast cancer cases are in women over 50 years of age. The other risk factors have to do with lifetime hormonal exposure, so women who start their periods early have an increased risk. Women who have their first child at a later age, over 30 or so, are at increased risk. With a late menopause, the risk increases again. If a woman has direct family members -- mother, sister, or daughter -- who have been affected with breast cancer, she is at an increased risk. And finally, a history of prior benign biopsies also puts a woman at an increased risk for breast cancer.

Lifestyle behaviors can also affect breast cancer risk. Excessive alcohol can pose a risk, and obese women, particularly after menopause, are at increased risk for breast cancer.


Some women feel because they don't have a family history of breast cancer they don't need to be screened. Is this true?
No. Most women who develop breast cancer, in fact, do not have a family history, so the absence of a family history does not mean that breast cancer will not happen, and screening is important for every woman over 40.

What are some emerging diagnostic tools to further assess risk in high-risk women?
There is a new twist on mammography now. Instead of recording imaging information on film, as we've been used to doing for many decades, the image can be recorded digitally on a computer. It's called digital mammography, and it offers some advantages, particularly for women with dense breasts that are hard to see through. It's available in many centers.

As yet, MRI (magnetic resonance imaging) is not a screening tool, but it's very helpful in making diagnoses, particularly, again, in high-risk women with dense breasts, and also in establishing the extent of the cancer in a woman who has been diagnosed with breast cancer. MRI as a screening tool for breast cancer is an evolving technology that will probably impact the treatment as well as the diagnosis of breast cancer.

What is the technology that is allowing us to retrieve cells for screening through the nipple?
There are two emerging technologies that help to get cells directly from the ducts of the breast. The breast ducts are the tubes that carry the milk to the nipple from the lobules where the milk is made, and the breast ducts are probably the origin of breast cancer cells, or where the cancers begin.
Having access to cells from the breast ducts can be very helpful. They help us assess risk, for one. The presence of certain benign lesions in the breast ducts implies increased risk for breast cancer, and if those cells look atypical or abnormal, that implies a higher risk for developing breast cancer.

Until the last two or three years, there was no applicable technique for retrieving breast cells. Now we have a very fine catheter -- a little plastic tube -- that can be inserted into the nipple duct. Salt water or saline is introduced through the tube and the breast is massaged to release some of these duct lining cells. They are retrieved through the fluid and spun out and examined by the cytopathologist. The procedure is called ductal lavage, and it's a very promising screening technique for women who have normal breast exams and normal mammograms but may be at increased risk for developing breast cancer. The test helps to further stratify their risk. At the moment, ductal lavage is a risk assessment tool, but in the future it may have diagnostic implications as well.

The second development in the examination of breast ducts that's come about recently is the development of a very tiny endoscope. Endoscopes are lighted tubes that are introduced into body cavities to look at the inside lining, and there hasn't been one available for the breast so far, partly because the ducts are so small. But a very tiny ductoscope has been developed that can be introduced into the breast duct to directly examine the inside lining of the ducts to look for early lesions. Again, it's not widely available yet and the information is just being developed on ductoscopy, but it is a tool that may enable us to detect breast cancer earlier, particularly in women who have dense breasts and can't be examined otherwise.


When should women get screened for breast cancer?
The time to start screening in high-incidence countries such as the United States is age 40. An annual mammogram starting at age 40 is the most important screening test, and has been shown to reduce risk of death.