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New Breast Cancer Detection Method Involves Testing Nipple Fluid (dateline February 29, 2000)


A new study shows that physicians may be able to predict whether breast cancer is likely to return ( recur) after primary treatment by looking for cancerous cells in the patient’s bone marrow (the soft tissue that fills the spaces in the spongy portions of bone cavities). Currently, physicians usually remove one or more of the underarm lymph nodes in breast cancer patients to help stage the cancer and determine whether it has spread past the breast. However, lymph node testing is not perfect; breast cancer tends to return in 20% to 30% of patients with cancer-free nodes. If the experimental test proves reliable in additional studies, more aggressive treatments, such as chemotherapy, may be given after breast surgery to those patients who show cancerous cells in their bone marrow.

The German study, published in the February 24, 2000 issue of The New England Journal of Medicine, followed 552 women with breast cancer. After four years, those women whose cancer had spread to their bone marrow by the time of breast surgery ( lumpectomy or mastectomy) were four times more likely to have died or experienced a relapse of breast cancer than the women who did not have cancer cells in their bone marrow. Lead researcher Stephan Bruan, MD of Ludwig Maximilians University in Munich, Germany suggests that women who are shown to have cancer cells in their bone marrow should be considered for chemotherapy or radiation therapy after surgery to help prevent a recurrence (return) of breast cancer.

To test for cancer cells, physicians biopsy portions of bone marrow in patients from the highest point on the hip bone, placing a needle through the skin and cortical bone. Bone marrow testing is usually done under local anesthesia but can be painful for the patient. In the study, the bone marrow was examined for evidence of cytokeratin, a protein produced by certain cancer cells. The presence of cytokeratin in the bone marrow may indicate bone micrometastases—the spread of breast cancer to the bone. Bone is the most common region of the body to which breast cancer may spread, after the lymph nodes. Researchers said that women who test negative for cancer in the lymph nodes but have cancer cells in their bone marrow are at a high risk of cancer relapse and should consider additional treatment after breast cancer surgery (such as chemotherapy). However, patients in the study were only monitored for four years; breast cancer patient data is usually followed for a 10 to 15 year period, after which patients are considered unlikely to have a relapse.

This latest study on bone marrow is the second large study of the controversial test. Michael Osborne, MD, director of the Strang-Cornell Breast Center in New York, is currently finishing a 10-year follow-up on a few hundred patients from his original study on bone marrow tests. Dr. Osborne believes bone marrow testing has the potential to improve breast cancer treatment .  However, other physicians are skeptical of bone marrow tests. Larry Norton, MD, Chief of Medical Oncology at Memorial Sloan-Kettering Cancer Center in New York noted that researchers have suggested hundreds of possible predictors of breast cancer recurrence over the last 15 years. Dr. Norton believes it is premature to consider the often painful procedure of bone marrow testing on all patients with breast cancer.

The German researchers agree that the results of their study are preliminary. In fact, two of the women in the study tested positive for the cytokeratin protein in their bone marrow even though they did not experience a recurrence of breast cancer. Researcher Wolfgang Janni, MD said he believes more bone marrow tests should be performed on breast cancer patients. However, Dr. Janni said it is too early to determine how to guide a patient’s treatment if she tests positive for cancer cells in the bone marrow.

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