What are the limitations of mammography?
The problem is that mammography is not perfect. We would love it to be perfect, but what it does is take a picture of the breast. It looks at shadows, and depending on how dense your breast tissue is it can see through it better or worse. In some women their tissue is so dense that it misses the cancers. It is like looking for a polar bear in the snow; you just can't see it.
In other people their cancers are so aggressive that they have already spread even by the time you can see it on a mammogram. And in some people their cancers are so slow that you are not going to find them. Now mammography in women over fifty will change their survival by thirty percent. That is a lot but it is not a hundred percent. And in the other seventy percent it is not really making much of a difference.
It is the best tool we have. I think women should be getting it, but we also should be working as hard as we can to get something better, something that really will work in not just thirty percent but eighty, ninety, a hundred percent.
In comparison to mammography, what are the benefits of ductal lavage?
The problem with mammography is that by the time you can see a lump or feel it it has been there eight to ten years, so what we call early detection is really only slightly earlier detection, it is not early detection.
What we really need to do is get much, much earlier in the process, not finding cancers but finding cells that are just thinking about being cancer someday so that we can head them off at the pass and never get the cancer.
All breast cancer starts in the lining of the milk ducts—all of it — so if we could get to the lining of the milk ducts we have the opportunity to find cells early in the process of developing cancer, before they are cancer, and maybe do something to reverse it.
And ductal lavage is a way to do that. It is a tiny catheter that you can thread into the milk duct, squirt in some salt water, wash out the cells and look at them under a microscope and see what they are doing. Sort of the way we do with a Pap smear.
