Jefferson University Hospital Breast Surgeon Studies Promising Noninvasive Breast Cancer Screening Detection Method 

A new screening and detection method being studied at Thomas Jefferson University Hospital offers a promising noninvasive approach to breast cancer screening and detection for women and physicians.

Edward Sauter, MD, PhD, who recently joined Jefferson Medical College as an Assistant Professor of Surgery, has developed an improved method for retrieving fluid from the breast to be tested for biologic markers (biomarkers) of cancer, including the protein, prostate-specific antigen, or PSA. PSA, previously thought to be produced only by the prostate gland, is now also known to be made by the breast and is associated with breast cancer risk.

“Nipple aspirate fluid (NAF) contains cells and secreted proteins, such as PSA, from the breast ducts – the site of most breast cancers,” Dr. Sauter said. “It has been studied for more than 20 years, but previous NAF collection methods were rather imperfect in that the success rate for obtaining fluid was only about 50 percent, and only about 20 percent of the expressed fluid contained enough cells to be studied.”

Although most women are not aware of it, the nonlactating breast secretes fluid. This fluid, when aspirated for research reasons, is called nipple aspirate fluid, or NAF.
Dr. Sauter also found that when a lower level of prostate-specific antigen is detected in the breast fluid, women may be at higher risk for developing breast cancer – or may have already begun to develop it. Similarly, research has shown that breast tumors that contain higher amounts of PSA are indicative of an earlier cancer stage, are less aggressive, and are associated with lower mortality rates.

Detecting Breast Cancer Early
There are many ways to detect breast cancer early, including mammography, breast self-exam, and physical exam. These methods – although extremely valuable – are not perfect, as they miss approximately 10 to 40 percent of early cancers. Breast cancer is 90 percent curable when detected in its earliest stages. Still, the death rate from breast cancer is high. According to the American Cancer Society, about 44,000 women die of breast cancer each year.

Dr. Sauter and his colleagues designed a modified breast pump that is successful in aspirating fluid from the breasts of 99 percent of pre- and post-menopausal women. The breast is gently compressed by hand, while the pump surrounds and applies suction to the nipple. 

In 1997, Dr. Sauter was the lead investigator of a study published in The British Journal of Cancer, which described the relationship between precancerous and cancerous cells in NAF and breast cancer risk. A study in the December 1999 issue of the same journal expands on his earlier findings by determining if breast aspiration can identify those women who, after undergoing a biopsy, which contains cancer, have residual cancer in the breast. He found that women who had cancer cells in NAF always had residual cancer in the breast. This information, if confirmed by additional similar studies, may prove helpful in assuring a doctor and patient that further surgery should be performed. 

Dr. Sauter stressed that although the findings thus far obtained are promising, they are preliminary, need to be confirmed in larger clinical trials, and do not replace standard screening for or treatment of breast cancer.

NAF Studies Under Way
A variety of NAF studies are currently under way at Jefferson under Dr. Sauter’s direction. One such study will evaluate the NAF of high risk women who are taking part in the STAR trial, a nationwide study funded by the National Cancer Institute to evaluate the effectiveness of the drugs tamoxifen and raloxifene in preventing breast cancer. 

A second study of women at increased breast cancer risk compares biomarkers (PSA) in fluid obtained via nipple aspiration to that obtained from the breast with a fine needle, to evaluate whether the material in each sample provides complementary information. A third study, funded by the National Cancer Institute, evaluates the biomarkers in newly diagnosed breast cancer patients between the time of diagnosis and definitive surgery.

Yet a fourth study enrolls all women – regardless of breast cancer risk or history – to test in general whether NAF analysis can effectively identify those at risk for developing cancer or those who have developed it

Supplement to Screening Methods
Dr. Sauter hopes that NAF analysis will eventually be used to supplement – and not take the place of – the currently available screening methods by allowing doctors and patients insight into breast cancer risk or presence. He also expects it will be used to evaluate breast-cancer patients’ response to chemotherapy and cancer-preventive agents.

“The great thing about NAF is that the test is totally noninvasive,” he said. “The patient is made comfortable during the procedure, and feels in control.”

About Dr Sauter
Dr. Sauter is a surgical oncologist with a special interest in breast cancer prevention. He received his doctor of medicine degree in 1986 from Louisiana State University in New Orleans, and a doctoral degree in molecular biology from the University of Pennsylvania in 1998.

He completed a surgical residency at the Ochsner Clinic, also in New Orleans, and a fellowship in surgical oncology at Fox Chase Cancer Center in Philadelphia. Prior to joining Jefferson in July, he served as an assistant member in the Division of Population Science at Fox Chase.

Women interested in finding out more about the NAF studies may call 215-955-4031.

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