Nov. 3, 1999 GAINESVILLE, Fla.---A simple method that packs the diagnostic power of the Pap smear and the ease of a blood draw accurately predicts breast cancer risk in women with suspicious lumps or lesions, a University of Florida pathologist reported today (11/3) at the American Society of Cytopathology meeting in Sacramento, Calif.
The test, fine needle aspiration biopsy, is an increasingly popular method of detecting malignancies, but Dr. Shahla Masood's research shows it also is a highly precise tool that helps determine which patients should be closely monitored -- or even treated -- when a growth is considered abnormal but not yet cancerous. The same predictive power is available with standard excisional biopsy, but that approach involves cutting the breast and removing a much larger amount of tissue.
In contrast, fine needle aspiration biopsy - commonly called FNAB -- is no more invasive, uncomfortable or time-consuming than drawing blood, said Masood, associate chair of the department of pathology at the UF Health Science Center/Jacksonville. Doctors use a tiny needle to remove a sampling of breast tissue cells, which then are screened for malignancy.
The method, Masood says, also can be used to look for the early cellular changes that sometimes lead to cancer in women who have one of an array of breast lesions, enabling practitioners to assess risk based on the degree and type of changes.
"Basically what we are trying to mimic is very similar to the Pap smear for the detection of cervical cancer," said Masood, who presented findings from a UF study of FNAB in 869 patients with breast lesions. "The Pap smear, since its introduction, has reduced mortality from cervical cancer by up to 75 percent. The reason that has occurred is because the cervix is an organ that is easily accessible and can be sampled. The breast is not. You cannot convince many women to go in for an excisional biopsy to see whether they have cancer or not when there is a lesion that cannot be felt by touch or seen by mammogram.
"FNAB requires no anesthesia and is so atraumatic, it's just like drawing blood. That is the whole beauty of the procedure," she added. "And now we have demonstrated that the grading system we have developed is capable of identifying patients who might be at increased risk for development of cancer. That, naturally, is a very important message at a time when early detection and the use of chemotherapy to try to prevent breast cancer have become very important issues."
Masood, who also serves as chief of pathology and laboratory medicine and director of the tumor analysis laboratory at the Shands Jacksonville medical center, said patients identified as being at high risk benefit from closer monitoring. Some may even opt to participate in chemoprevention studies to see whether cancer can be prevented.
Breast cancer rates second only to skin cancers as the most common malignancy in women. In 1999, about 175,000 new cases of invasive breast cancer will be diagnosed among American women, according to the American Cancer Society.
In the UF study, Masood studied FNAB specimens taken from patients with breast lesions who were examined between 1990 and 1997, categorizing the samples using the standard criteria employed to assess cellular changes associated with breast cancer development. The patients did not have breast cancer, and the lesions ranged from normal to highly atypical. Masood then tracked the patients' medical histories over time to see who went on to develop breast cancer.
Statistical tests revealed a strong correlation between the incidence of breast cancer and the degree of abnormality. Family history also strongly correlated with the degree of abnormality and breast cancer development.
Masood said she hopes her research will pave the way for an expanded study involving multiple academic medical centers. Ultimately, her goal is to save lives. Detecting cancer at an earlier stage is associated with an improved prognosis, she said.
"Like increased public awareness and screening mammography -- a very fantastic advance -- our efforts aim to detect cancer much earlier so patients have a better outcome," she said.
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