What is it and why women should include it in their annual health check-up.
As early as in 1947, the world-known physician cytologist Georgios Papanikolaou had talked extensively about the value of cytological examination of breast nipple discharge, which, as the Pap test at the uterine cervix, detects cancer cells or any kind of atypical cells many years before the development of malignancy.
A lot of women may experience breast nipple discharge during their lifetime.. However, only 6-8% of women with this discharge (fluid) will eventually prove to have breast cancer. The extraction of this fluid and its cytological study is necessary, in combination with other imaging methods, such as Magnetic Resonance Imaging, Digital Tomography, Ultrasound Elastography, etc., depending on the age of the patient. Therefore, the cytological study of the discharge offer us important information as it contains epithelial cells from breast milk pores, which are often the starting points for a suspicious process.
The same applies to asymptomatic women who have not yet had any discharge (fluid) from the breast nipple.
The fully automated HALO device, which simultaneously massages, produces heat and causes gentle aspiration, enables us to extract fluid from the breast milk pores and analyze it cytologically.
It is the only non-invasive method (without surgery), totally non-traumatic and harmless, through which with no real pain nor radiation, and the possibility to repeat it as many times as it is needed, we can check our breasts health before we even detect something visible or palpable in mammography or ultrasound. This means at a very early stage, thus often completely curable.
As with cervical cancer, several types of breast cancer develop slowly, averaging 8 years before they can be detected through mammography or 10 years before a breast lesion becomes palpable. We realise then how important the screening is in the life of each woman, especially those in the young ages of 25 to 35, who, if there is no strong individual history of cancer, are not doing an annual mammogram.
Extensive studies confirm that women under the age of 55 with positive results for the NAF test for epithelial cells, i.e. positive results from the extraction of breast nipple discharge (fluid), are at a significantly higher risk of developing breast cancer, compared to women with negative test results from NAF.
The BREAST PAP TEST detects women at increased risk for developing breast cancer.
HISTORY OF CYTOLOGY IN BREAST NIPPLE DISCHARGE
1958 – Doctor George Papanikolaou and his associates demonstrated that cytology examination of breast nipple discharge is valuable in the diagnosis of breast disorders, including breast cancer.
1977 – The National Cancer Institute correlated NAF cytological detection data with breast disorders.
1992 – A broad prospective study of 2,701 women directly correlated the cytological atypia of the NAF test, with increased risk of developing breast cancer.
2006 – 25-year prospective study confirmed the NAF test correlation as a useful indicator for determining the future risk of developing breast cancer.
2007 – Food and Drug Administration (FDA) approves and licenses the automated Breast PAP Test with the Halo device.
2009 – More than 100 publications and studies associate atypia in breast tissue with increased risk of developing breast cancer.
WHAT IS THE BREAST PAP TEST?
Breast Pap test is a simple, 5-minute long suction and nipple aspiration fluid collection test.
BREAST PAP TEST – THE FIRST NON-INVASIVE AUTOMATIC DEVICE FOR NIPPLE ASPIRATION FLUID (NAF)
EVALUATION OF RISK-RESULTS
All people have a relative risk of developing cancer. This risk, which is equal to the risk of developing breast cancer in the general population, is considered to be the normal risk x 1, increasing by 1 the possibility of developing cancer.
Women with no fluid during the exam, therefore, have a low risk, equal to that of the general population (x1 time)
With fluid containing normal cells, then the risk for cancer development is doubled (x2 times).
If there is a family history, the risk is increased by 2-3 times.
With Fluid with atypical cells / Atypical Epithelial Hyperplasia, then the risk is 4.3-6.3 times higher than that of the general population.
If there is a Family History + Atypical Epithelial Hyperplasia in the aspiration fluid, the risk is increased x 11 times.
WHICH WOMEN CONCERNS
- Asymptomatic women aged over 25 years,
- Women with a positive family history
- Women with positive BRCA1 K BRCA2
- Women with increased Body Weight, increased alcohol consumption, smoking
- Women who have received hormonal substitution for years
- Women who have taken contraceptives for years
- Women who have undergone mastectomy (to check the other breast)
- Women with benign breast diseases
The test is done using a state-of-the-art device which, by applying two small silicone cups to the breasts, it causes hyperaemia (mild warmth) and gentle massage in the breast to cause discharge from the milk ducts and collect fluid for the cytological test.
Easy to perform, painless, repeatable, is performed by specialised and trained staff in the use of the device.
80% of women would recommend Breast Pap Test to other women.
WHAT ATYPICAL CELLS MEAN
What we are looking for in this test is whether there is some form of atypia in the epithelial cells of the milk ducts.
Only 1-2% of women with nipple fluid discharge have atypical cells, i.e. one or some cells show a change in their DNA strand. So the cancer cell that will be created is considered “immortal” and multiplies continuously and uncontrollably, resulting in taking more and more space creating a tumour in long term. We then evaluate the type of cellular atypia, of low, high or zero risk and decide on the approach that we will follow.
Thus, atypia detection activates early investigation and / or preventive treatment, such as diagnostic or localising digital mammography, ultrasound elastography, tomosynthesis, magnetic resonance imaging, gene control, chemoprophylaxis etc.
WHAT ELSE YOU SHOULD KNOW
70% of women who develop cancer have no detectable risk factors other than age.
Women with breast cancer who have a family history are no more than 8-9 out of 100 total cancer cases.
The test does not replace mammography or ultrasound, nor is it done to diagnose cancer.
Besides, finding atypical cells does not necessarily mean malignancy. Injuries, inflammations, and precancerous conditions may produce atypical cells.
Early and timely diagnosis of breast cancer means cure in most cases.
So do not neglect it!
Dr. Stephanos Georg. Valantasis
Surgeon – Gynaeccologist – Obstetrician