The procedure involves little to no discomfort. A doctor will apply an anesthetic cream that will numb the nipple area. A breast pump is used to determine which 1-2 ducts will be flushed later in the procedure. When the ducts to be flushed have been located, more anesthetic is put in the duct and a catheter is placed. Salt water is flushed through the catheter into the duct and the cells collected to be looked at by a pathologist.

A recent study published in the November issue of Cancer Epidemiology, Biomarkers & Prevention has shown that the rate of a benign breast condition known as atypical ductal hyperplasia has decreased along with the decline in hormone replacement therapy (HRT) seen since 2002. Atypical ductal hyperplasia is a known risk factor for developing breast cancer, and is suspected of being a breast cancer precursor. According to researchers, women diagnosed with atypical ductal hyperplasia have a 3 to 5 times higher rate of developing cancer in either breast.

It is unfortunate that we still have these "gray" areas where doctors can't universally agree on the need for surgery. This is mainly because most of the studies are small and within one institution so it is difficult to generalize the findings to the public. Larger prospective studies may help us define these "gray" areas better so that we can finally determine whether patients with these findings on core biopsy need to go to surgery.

About a year after the surgery, Gene noticed that the surgical wound became rather hard and with time started to grow in thickness. Gene consulted another surgeon in another private hospital. An ultrasound of her right breast done on 9 June 2005 showed two lesions, one of which was 9 mm x 7.5 mm x 10 mm in size. The radiologist concluded that these could be malignant and suggested a FNAC study. An ultrasound of the left breast showed a 7 x 2 mm simple cyst.

The consensus opinion in the field of breast cancer research is that there is no known cause for this most common disease, with the exception of the BRCA gene, which accounts for a very small percentage of breast tumor cases. While many risk factors for breast malignancy have been identified, risk does not equal cause. In various population studies, some clinically significant risk factors have been identified, including but not limited to first degree family history, atypical ductal hyperplasia (ADH), lobular carcinoma in situ (LCIS), and radiation exposure.

Since these are uncommon tumors in the breast, there are not a lot of large research studies on phyllodes tumors. Generally, pathologists break them down into three different types: benign, border line, and malignant based upon how aggressive the stroma looks under the microscope. All phyllodes tumors, regardless of sub classification, can recur and generally the rate of recurrence increases from benign to borderline to malignant. Most surgeons will try to get a margin of "normal" breast tissue around a phyllodes tumor to reduce the change of the tumor coming back. Phyllodes tumor rarely metastasize and it's usually the malignant variant that does so.

Since women with LCIS have a much higher risk of ending up with breast cancer they must be followed up closely. A lot of times a woman will find out she has LCIS because of a biopsy that was done for something unrelated to the LCIS. While LCIS has been reclassified as a "non-cancer" that is treated differently than Ductal Carcinoma in situ, it is still a worrisome condition. Women who have been diagnosed with this should talk over all their options with their breast specialist to make a well informed decision on what, if any treatment options to follow.

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