High-Risk Breast Duct Epithelium

  • STATUS
    Recruiting
  • participants needed
    214
  • sponsor
    National Cancer Institute (NCI)
Updated on 12 September 2021
carcinoma
carcinoma in situ
lobular carcinoma
estradiol
BRCA1/2
BRCA1
ductal carcinoma in situ
mammogram
ductal carcinoma

Summary

Background
  • Breast cancer is the most common malignancy in women, occurring in over 230,000 women annually in the United States.
  • The vast majority of breast cancers originate in the single layer of epithelial cells that line the ductal/lobular system of the breast milk ducts. The premalignant changes which occur in the transformed epithelium are not well understood, however several cytologic or histologic changes have been identified which are associated with an increased risk for breast cancer, including ductal or lobular hyperplasia, hyperplasia with atypia, and lobular or ductal carcinoma in situ.
  • The identification of cytological or histological abnormalities in breast epithelial cells is an important component of risk assessment.
    Objective

Primary objectives are:

  • To determine the incidence and nature of cytologic changes in ductal epithelial cells from the high-risk breast, in specimens collected by breast ductal lavage, and to determine if these cytologic findings are different from those of female normal volunteers not at increased risk for breast cancer.
  • To characterize by breast duct endoscopy, high risk breast ductal epithelium and architecture, and correlate these findings with the cytologic findings referenced in above bullet.
  • To determine what is the global gene expression pattern of high risk breast epithelial cells from the high risk breast, and does this differ from that of breast epithelial cells from female normal volunteersnot at increased risk for breast cancer. The gene expression profile will be determined by cDNA microarray and validated by RT-PCR.
    Eligibility

Eligibility for high risk individuals will include:

  • Women with a unilateral invasive or noninvasive (DCIS) breast cancer of epithelial origin.
  • Women without breast cancer, but with a Gail Index greater than 1.67 percent, or a cumulative lifetime risk greater than or equal to double the age- and race-matched general population risk.
  • Women known to be BRCA1/2 or other hereditary genes mutation carriers.
  • Women with cytologic or histologic evidence of ductal hyperplasia, atypical ductal hyperplasia, or lobular carcinoma in situ.
  • Women may be either premenopausal or postmenopausal. Postmenopausal is defined by the absence of menstrual periods for at least 12 months.
  • Postmenopausal women who have previously undergone a hysterectomy without oophorectomy must have a serum FSH level of > 40 IU/ml, and a serum estradiol level of less than40 pg/ml to document postmenopausal status.

Eligibility for normal volunteers will include:

  • Women who are premenopausal or postmenopausal with a Gail model risk index less than 1.67 percent, and without a cumulative lifetime risk greater than or equal to double the age- and racematched general population risk.
  • Women who have previously undergone a hysterectomy without oophorectomy must have a serum FSH level of >40 IU/ml, and a serum estradiol level of less than 40 pg/ml to document postmenopausal status.
  • Both breasts must be free of any suspicious areas by physical examination and, for women over 30 years of age by mammogram. There must be no history of atypical hyperplasia, invasive or in situ carcinoma.

Both groups must have acceptable white blood cell and platelet counts.

Design

Breast ductal epithelial cells will be collected by breast ductal lavage from (a) the breast in women at increased risk for breast cancer, and (b) the breast of female normal volunteers who are not at increased risk for breast cancer.

Ductal epithelial cell specimens will be analyzed cytologically for the presence of hyperplasia, atypia, or in situ changes.

Breast duct endoscopy will be performed in breast cancer patients and in normal volunteers with cytologic atypia on ductal lavage to determine ductal architectural changes associated with increased risk for breast cancer, and to provide correlation with cytologic atypia.

The gene expression profile of normal and high-risk ductal epithelial cells will be studied by cDNA-microarray to determine changes in gene expression associated with increased risk for breast cancer.

Additional molecular profiling experiments which will be performed as lavage cells are available include DNA whole exome sequencing, Comparative Genomic Hybridization (CGH), proteomic tissue lysate arrays, and identification of mammary stem cells.

A total of 104 high-risk subjects and 110 normal volunteers will be studied, divided approximately evenly between premenopausal and postmenopausal women.

Description

Background

Breast cancer is the most common malignancy in women, occurring in over 230,000 women annually in the United States.

The vast majority of breast cancers originate in the single layer of epithelial cells that line the ductal/lobular system of the breast milk ducts. The premalignant changes which occur in the transformed epithelium are not well understood: however, several cytologic or histologic changes have been identified which are associated with an increased risk for breast cancer, including ductal or lobular hyperplasia, hyperplasia with atypia, and lobular or ductal carcinoma in situ.

The identification of cytological or histological abnormalities in breast epithelial cells is an important component of risk assessment.

Objective

Primary objectives:

To determine the incidence and nature of cytologic changes in ductal epithelial cells from the high-risk breast, in specimens collected by breast ductal lavage, and to determine if these cytologic findings are different from those of female normal volunteers not at increased risk for breast cancer.

To characterize by breast duct endoscopy high-risk breast ductal epithelium and architecture, and correlate these findings with the cytologic findings referenced in above bullet.

To determine what is the global gene expression pattern of high-risk breast epithelial cells from the high-risk breast, and does this differ from that of breast epithelial cells from female normal volunteers not at increased risk for breast cancer. The gene expression profile will be determined by cDNA microarray and validated by RT-PCR.

Eligibility

Eligibility for high-risk individuals will include:

Women with a unilateral invasive or noninvasive (DCIS) breast cancer of epithelial origin.

Women without breast cancer, but with a Gail Index > 1.67 percent, or a cumulative lifetime risk greater than or equal to double the age- and race-matched general population risk.

Women known to be BRCA1/2 or other hereditary genes mutation carriers.

Women with cytologic or histologic evidence of ductal hyperplasia, atypical ductal hyperplasia, or lobular carcinoma in situ.

Women may be either premenopausal or postmenopausal. Postmenopausal is defined by the absence of menstrual periods for at least 12 months.

Postmenopausal women who have previously undergone a hysterectomy without oophorectomy must have a serum FSH level of > 40 IU/mL, and a serum estradiol level of < 40 pg/mL to document postmenopausal status.

Eligibility for normal volunteers will include:

Women who are premenopausal or postmenopausal with a Gail model risk index < 1.67 percent, and without a cumulative lifetime risk greater than or equal to double the age- and race-matched general population risk.

Women who have previously undergone a hysterectomy without oophorectomy must have a serum FSH level of > 40 IU/mL, and a serum estradiol level of < 40 pg/mL to document postmenopausal status.

Both breasts must be free of any suspicious areas by physical examination and, for women over 30 years of age, by mammogram. There must be no history of atypical hyperplasia, invasive, or in situ carcinoma.

Both groups must have acceptable white blood cell and platelet counts.

Design

Breast ductal epithelial cells will be collected by breast ductal lavage from (a) the breast in women at increased risk for breast cancer, and (b) the breast of female normal volunteers who are not at increased risk for breast cancer.

Ductal epithelial cell specimens will be analyzed cytologically for the presence of hyperplasia, atypia, or in situ changes.

Breast duct endoscopy will be performed in breast cancer patients and in normal volunteers with cytologic atypia on ductal lavage to determine ductal architectural changes associated with increased risk for breast cancer, and to provide correlation with cytologic atypia.

The gene expression profile of normal and high-risk ductal epithelial cells will be studied by cDNA microarray to determine changes in gene expression associated with increased risk for breast cancer.

Additional molecular profiling experiments which will be performed as lavage cells are available include DNA whole exome sequencing, comparative genomic hybridization (CGH), proteomic tissue lysate arrays, and identification of mammary stem cells.

A total of 104 high-risk subjects and 110 normal volunteers will be studied, divided approximately evenly between premenopausal and postmenopausal women.

Details
Condition Breast Cancer, Breast Cancer Diagnosis, breast carcinoma, cancer, breast
Clinical Study IdentifierNCT00028340
SponsorNational Cancer Institute (NCI)
Last Modified on12 September 2021

Eligibility

Yes No Not Sure

Inclusion Criteria

Inclusion Criteria for Breast Cancer and High-Risk Patients
Age greater than or equal to 18 years and less than or equal to 74 years
Women with a unilateral invasive or noninvasive (DCIS) breast cancer of epithelial origin
Women without breast cancer, but with a Gail Index greater than 1.67 percent, or a cumulative lifetime risk greater than or equal to double the age- and race-matched general population risk
Women known to be BRCA1/2 or other hereditary genes mutation carriers
Women with cytologic or histologic evidence of ductal hyperplasia, atypical ductal hyperplasia, or LCISl
Women may be either premenopausal or postmenopausal. Postmenopausal is defined by the absence of menstrual periods for at least 12 months
Postmenopausal women who have previously undergone a hysterectomy without oophorectomy must have a serum FSH level of greater than 40 IU/ml, and a serum estradiol level of less than 40 pg/ml to document postmenopausal status
Breast cancer may be invasive or noninvasive, and in the past or the present
The contralateral breast of women with breast cancer, or the normal breast of high-risk subjects, must be free of any suspicious areas by physical examination and mammogram, and without a history of invasive ductal or in situ ductal carcinoma. History of atypia or LCIS on a previous biopsy is acceptable
Women who are from a family with heritable breast cancer with a known deleterious BRCA1/2 or other hereditary genes mutation, who themselves have been tested and to not carry this mutation. These women are not at increased risk for breast cancer due to the familial mutation and are eligible to participate as normal volunteers
WBC greater than 2,500
Platelets greater than 50,000
Inclusion Criteria for Normal Volunteers
Age greater than or equal to 18 years and less than or equal to 74 years
Women who are premenopausal or postmenopausal with a Gail model risk index less than 1.67 percent, and without a cumulative lifetime risk greater than or equal to double the age- and race-matched general population risk
Women who have previously undergone a hysterectomy without oophorectomy must have a serum FSH level of greater than 40 IU/ml, and a serum estradiol level of less than 40 pg/ml to document postmenopausal status
Both breasts must be free of any suspicious areas by physical examination and, for women over 30 years of age by mammogram. There must be no history of atypical hyperplasia, invasive or in situ carcinoma
WBC greater than 2,500
Platelets greater than 50,000

Exclusion Criteria

Exclusion Criteria for Breast Cancer Patients
Contralateral breast prosthesis
Pregnancy
History of radiation therapy to the contralateral breast
Lactating breasts
Chemotherapy within the past 1 month
Current antiestrogen therapy
Current hormonal replacement therapy or oral contraceptives
Concurrent infection
Previous contralateral major duct excision
Exclusion Criteria for High-Risk Paitents
Bilateral breast prosthesis
Pregnancy
Lactating breasts
Current antiestrogen therapy
Current hormonal replacement therapy or oral contraceptives
Concurrent infection
Previous bilateral major duct excision
History of therapeutic mediastinal radiation
Exclusion Criteria for Normal Volunteers
Bilateral breast prosthesis
Pregnancy
Lactating breasts
Current antiestrogen therapy
Current hormonal replacement therapy or oral contraceptives
Concurrent infection
Previous bilateral major duct excision
History of therapeutic mediastinal radiation
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