Mehra Golshan, MD, (right) shown with patient Kerry Silvestro, is testing a novel method of examining the lining of the milk ducts for early signs of breast cancer
The inside story
Ductal lavage is just one method of whisking abnormal cells away from the walls of the milk ducts for study. Surgical oncologist Mehra Golshan, MD, is preparing to test another.
Known as ductoscopy, the procedure gives surgeons a close-up view of the lining of the ducts. A fiberoptic tube called a cannula, narrower than the tip of a ballpoint pen, is threaded into a duct through the nipple. A tiny camera in the cannula's tip displays a live, magnified image of the duct's interior on a video monitor. Patches of abnormal tissue can be snipped away with cannula-mounted scissors so cells can be examined for signs of precancer.
In a clinical study scheduled to open this year, Dr. Golshan will offer ductoscopy to women whose ductal lavages have turned up atypical cells. "Ductoscopy enables us to examine an entire duct, the central portion as well as its branches," he says. "It's a safe procedure that can be done on an outpatient basis."
As with ductal lavage, however, it remains an open question of which women can benefit from the procedure. Since doctors do not yet know which atypical cells will advance to cancer—or how quickly—there is no definitive treatment plan when such cells are discovered.
For women requiring a mastectomy, Dr. Golshan, an unusually talented surgeon in the eyes of his colleagues, is using a procedure that may ease the process of breast reconstruction. Called skin-sparing mastectomy, it involves extracting all the breast tissue through a small hole created by temporarily removing the nipple and areola, leaving an "envelope" of skin that can then be filled with a breast implant or tissue reconstruction.
"Many of my patients want to know why they developed breast cancer and what they could have done to avoid it," Dr. Golshan reports. "While the causes of breast cancer aren't always clear, I want to be able to offer them treatments that improve long-term survival, a lower cancer recurrence rate, and a better cosmetic result."
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