Breast Cancer Research and Treatment

, Volume 98, Issue 1, pp 63–70 | Cite as

Presence of Epithelial Cells in Nipple Aspirate Fluid is Associated with Subsequent Breast Cancer: a 25-Year Prospective Study

  • Gertrude Case Buehring
  • Amy Letscher
  • Kathleen M. McGirr
  • Shruti Khandhar
  • Lisa H. Che
  • Christine T. Nguyen
  • Adeline J. Hackett
Epidemiology

Summary

Fluid and epithelial cells obtained from the breasts of non-pregnant, non-lactating women by nipple aspiration, can be used for early diagnosis of breast neoplasms. However, since nipple aspirate fluid (NAF) with cells is obtainable from less than half of women sampled, the question arises: Is this method capable of targeting the women most likely to develop breast cancer? We approached this question with a 25-year prospective study to determine if subjects yielding NAF with or without epithelial cells were more likely to develop breast cancer during the follow-up period than subjects from whom no NAF or epithelial cells were obtained. Logistic regression analysis was used to determine relative risk (RR) with 95% confidence intervals (CI). The follow-up cohort of 972 was representative of the eligible cohort of 1605 for factors related to breast cancer risk and nipple aspiration outcome, and representative of the general population for breast cancer risk. After a mean follow-up period of 25 years, women with epithelial cells in NAF were significantly more likely to develop breast cancer (RR=1.92; CI=1.22–3.01; p≤0.005), especially invasive breast cancer (RR=2.27; CI=1.27–4.03; p≤0.005), than women with no NAF, or NAF without epithelial cells. These risks were higher for women <55 years of age at the time of sampling (RR=2.1 for any breast cancer, 2.5 for invasive breast cancer). We conclude that presence of NAF with epithelial cells is associated with subsequent breast cancer risk and may be a useful marker for women at higher risk.

Key words

breast cancer risk epithelial cells nipple aspirate fluid 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Notes

Acknowledgements

We are grateful to the women who volunteered as subjects for this study and without whom it would not have been possible. We thank the following at the University of California, Berkeley: Maureen Lahiff, Biostatistics Division for consultation on biostatistics; Katherine Miller, Janice Casamina, Rhonda Kropp, Jessica Kirschbraun, Kelly Fujikawa, and Hua Min Shen for locating subjects and/or data entry and processing. We thank David Harris and Robert Schlag of the California Cancer Registry, Sacramento, CA for help with the Registry database. This research was supported by a grant from the Dr Susan Love Research Foundation.

References

  1. 1.
    Koss LG, Diagnostic Cytology JB Lippincott Philadelphia 1968, p. 541Google Scholar
  2. 2.
    Haagensen CD, Diseases of the Breast (2nd edition) WB Saunders Philadelphia 1971Google Scholar
  3. 3.
    Vorherr H, The Breast Academic Press New York 1974, pp. 218–246Google Scholar
  4. 4.
    Papanicolaou GN, Holmquist DG, Bader FM, Falk EA, Exfoliative cytology of the human mammary gland and its value in the diagnosis of cancer and other diseases of the breast Cancer 1: 377–409, 1958CrossRefGoogle Scholar
  5. 5.
    Sartorius OW, Smith HS, Morris P, Benedict D, Friesen L, Cytological evaluation of breast fluid in the detection of breast diseases J Natl Cancer Inst 59: 1073–1108, 1977PubMedGoogle Scholar
  6. 6.
    Petrakis NL, Mason L, Lee R, Sugimoto B, Pawson S, Catchpool F, Association of race, age, menopausal status, and cerumen type with breast fluid secretion in nonlactating women, as determined by nipple aspiration J Natl Cancer Inst 54: 829–834, 1975PubMedGoogle Scholar
  7. 7.
    Buehring GC, Screening for breast atypias using exfoliative cytology Cancer 43: 1788–1799, 1979PubMedCrossRefGoogle Scholar
  8. 8.
    Wrensch MR, Petrakis NL, King EB, Miike R, Mason L, Chew K, Lee MM, Ernster VL, Hilton JF, Schweitzer R, Goodson WH III, Hunt TK, Breast cancer incidence in women with abnormal cytology in nipple aspirates of breast fluid Am J Epidem 135: 130–1411992Google Scholar
  9. 9.
    Wrensch MR, Petrakis NL, King EB, Lee MM, Miike R, Breast cancer risk associated with abnormal cytology in nipple aspirates of breast fluid and prior history of breast biopsy Am J Epidem 137: 829–833, 1993Google Scholar
  10. 10.
    Wrensch MR, Petrakis NL, Miike R, King EB, Chew K, Neuhaus J, Lee MM, Rhys M, Breast cancer risk in women with abnormal cytology in nipple aspirates of breast fluid J Natl Cancer Inst 93: 1791–1798, 2001PubMedCrossRefGoogle Scholar
  11. 11.
    Papanicolaou GN, New procedure for staining vaginal smears Science 95: 438–439, 1942 PubMedCrossRefGoogle Scholar
  12. 12.
    Fitzgibbons PL, Henson DE, Hutter RVP, for the Cancer Committee of the College of American Pathologists. Benign breast changes and the risk for subsequent breast cancer: an update of the 1985 consensus statement. Arch Pathol Lab Med 122: 1053–1055, 1998Google Scholar
  13. 13.
    Coleman EA, O’Sullivan PO, Racial differences in breast cancer screening among women from 65–74 years of age: trends from 1987–1993 and barriers to screening J Women Aging 13:23–39. 2001PubMedCrossRefGoogle Scholar
  14. 14.
    Harris DM, Miller JE, Davis DM, Racial differences in breast cancer screening, knowledge and compliance J Natl Med Asscoc95: 693–701, 2003Google Scholar
  15. 15.
    Katapodi MC, Faclone NC, Miakowski C, Dodd MJ, Waters C, The influence of social support on breast cancer screening in a multicultural community sample Oncol Nurs Forum 29: 845–852, 2002PubMedCrossRefGoogle Scholar
  16. 16.
    Vernon SW, Vogel VG, Halabi A, Jackson GL, Lundy RO, Peters GN, Breast cancer screening behaviors and attitudes in three racial/ethnic groups Cancer 69: 165–174, 1992PubMedCrossRefGoogle Scholar
  17. 17.
    Zou G, A modified Poisson regression approach to prospective studies with binary data. Am J Epidemiol 159: 702–706, 2004PubMedCrossRefGoogle Scholar
  18. 18.
    MacMahon B, Cole P, Brown J, Etiology of human breast caner: a review J Natl Cancer Inst 50: 21–42, 1973PubMedGoogle Scholar
  19. 19.
    California Cancer Registry: Breast Cancer in California, 2003Google Scholar
  20. 20.
    Ganguli M, Lytle ME, Reynolds MD, Dodge HH, Random vs. volunteer selection for a community-based study J Gerontol: Series A, Biol Sci Med Sci53: M39–M46, 1998 Google Scholar
  21. 21.
    King E, Barrett D, Petrakis NL, Cellular composition of the nipple aspirate specimen of breast fluid. II. Abnormal findings Am J Natl Clin Pathol 64: 739–748, 1975Google Scholar
  22. 22.
    Fournier DV, Weber E, Hoeffken W, Bauer M, Kubli F, Barth V, Growth rate of 147 mammary carcinomas Cancer 45: 2198–2207, 1980CrossRefGoogle Scholar
  23. 23.
    Lundgren B, Observations on growth rate of breast carcinomas and its possible implications for lead time Cancer 40: 1722–1725, 1977PubMedCrossRefGoogle Scholar
  24. 24.
    Wellings SR, Jensen HM, Marcum RG, An atlas of subgross pathology of the human breast with special reference to possible precancerous lesions J Natl Cancer Inst 55: 231–273, 1975PubMedGoogle Scholar
  25. 25.
    Page DL, The woman at high risk for breast cancer: importance of hyperplasia Surg Clin N Am 76: 221–230, 1996PubMedCrossRefGoogle Scholar
  26. 26.
    Fabian CJ, Kimler BF, Mayo MS, Khan SA: Breast-tissue sampling for risk assessment and prevention. Endocr-relat Cancer12: 185–213, 2005PubMedCrossRefGoogle Scholar

Copyright information

© Springer 2006

Authors and Affiliations

  • Gertrude Case Buehring
    • 1
    • 2
  • Amy Letscher
    • 1
  • Kathleen M. McGirr
    • 1
  • Shruti Khandhar
    • 1
  • Lisa H. Che
    • 1
  • Christine T. Nguyen
    • 1
  • Adeline J. Hackett
    • 1
  1. 1.Division of Infectious DiseasesSchool of Public Health, University of CaliforniaBerkeleyUSA
  2. 2.Division of Infectious DiseasesSchool of Public Health, University of CaliforniaBerkeleyUSA

Personalised recommendations