Using Organ Specific and Circulatory Biofluids to Screen Individuals at High Risk for Breast Cancer Presents Unique Challenges and Opportunities.

Intraductal assessment of the breast holds the potential to provide useful information regarding breast cancer risk assessment, early diagnosis, and/or response to therapy. Intraductal assessment can be through imaging (ductography), direct visualization (mammary ductoscopy), or evaluation of the intraductal fluid collected. The most common nonradiologic approaches to intraductal assessment that provide intraductal fluid for evaluation include breast nipple aspiration fluid (NAF), spontaneous nipple discharge (SND), mammary ductoscopy, and ductal lavage. The first two approaches are entirely noninvasive while the latter are considered minimally invasive. Nipple aspiration is performed both on women with and without evidence of possible disease in the breast. On the other hand, unilateral SND suggests the presence of a lesion in the incident breast, while bilateral SND is most often physiologic. The focus of the report by Patuleia and colleagues is on challenges, lessons learned, and recommended solutions in the identification of women with increased breast cancer risk who are more likely to develop or invasive breast cancer based on sequential collection and subsequent analysis of biofluids (NAF and serum). The lessons learned that are discussed can also be applied to other types of biofluid studies for cancer early detection and response to treatment..