Breast Cancer Prevention Clinic
Clinical Research
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Random Periareolar Fine Needle Aspiration
The cervical “pap-smear” has revolutionized our ability to prevent cervical cancer. While mammograms have improved our ability to detect breast cancer, they have limited sensitivity in young women with dense breast tissue. Random Periareolar Fine Needle Aspiration (RPFNA) is a research technique that was developed originally by Dr. Carol Fabian [Fabian et al. JNCI, 2000]. RPFNA 1) is analogous to a cervical “pap-smear” in its ability to provide a representative sampling of cells from the entire breast and 2) works best in women with dense breast tissue. The goal of this trial is to improve the sensitivity and specificity of RPFNA so it can be better used to predict short-term risk of breast cancer and to track response to prevention agents.
It is thought that one of the first steps that breast cells take when they start becoming cancerous it to become resistant to vitamin A through loss of expression of the retinoic-acid-receptor-beta2 (RARbeta2). We and other investigators have found that in many women at high-risk for breast cancer that RARbeta2 does not work because of a process called methylation. Methylation is a process that the body uses normally to turn on and off genes. Methylation is important for keeping cells normal. But it is also thought that the body can methylate genes at the wrong time and that this can put breast cells at risk for becoming cancerous. In this trial, we will test whether RARbeta2P2 methylation in breast cells obtained by RPFNA in women at high risk for developing breast cancer predicts atypical hyperplasia, a short-term marker of breast cancer risk.
Since RARbeta2P2 methylation can be detected in as few as 5 cells, we predict that RARbeta2P2 methylation in breast RPFNA can be used as a highly sensitive way to test for breast cancer risk and response to chemoprevention. If RARbeta2P2 methylation predicts short-term breast cancer risk, we can use this test as a predictor of response to prevention drugs, dietary changes, and complementary agents.
