What are your thoughts on new breast cancer screening tests HALO and BREVAGen?

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Expert Answers

MelanieBoneMD (Physician - OBGYN - Obstetrics-Gynecology (Verified) ) - 01 / 26 / 2012

The HALO test is based on data that showed that women with nipple discharge had a higher risk of breast cancer over the course of their lives. A machine that looks and acts a lot like a breast pump massages the breast and uses a vacuum-like action to seek fluid. Unfortunately, a large number of women will have nipple fluid in this circumstance, some say as high as 50%. Trying to figure out what to do with them afterward is a challenge. Data have shown that send nipple aspirated fluid for cytologic evaluation is not particularly helpful in figuring out who is at risk, nor does it diagnose or rule out cancer definitively. I have found that it makes women more anxious. The theory is that these women will be followed more closely, but that is a double-edged sword. They undergo more testing and probably more biopsies, but ultimately I have not seen data proving that more lives are saved.

As for BREVAGEN, it is a model based on combining the Gail Model (a risk assessment tool that is known to be inaccurate for many reasons) with a mouth swab looking for 7 single nucleotide polymorphisms (SNPs) which can modify the Gail risk upward or downward. In the fine print of the test, it acknowledges that it works best in Caucasians over the age of 35. It doesn't take into account breast cancer in the father's side, second- and third-degree relatives with cancer, nor does it consider other related cancers as risk factors. The idea is an interesting one, but needs to be developed further.

DrAttai (Physician - Surgery - Breast (Verified) ) - 01 / 28 / 2012

I use the HALO test fairly often in my practice. It is true that approximately 50% of women will produce fluid. Those that do not produce fluid are considered to have had a normal test, and it is unlikely that they have any abnormality of their milk ducts. If fluid is produced, it is sent for cytology evaluation to see if there are abnormal cells present. Some studies have suggested that if a condition called atypia is present, it has the same significance of atypical ductal hyperplasia found on needle biopsy, which leads to an increased risk of breast cancer in the future.

As the women undergoing the HALO test are often younger than 40 and not undergoing routine mammogram screening, if a patient has atypia found on the HALO test, I would likely recommend that she begin screening, possibly with ultrasound and MRI in addition to mammogram, earlier than age 40. However as pointed out by Dr. Bone, this can open up a whole host of other issues, including radiation exposure and false positive test results.

It is important to remember that the HALO test is not meant to detect breast cancer or to be a screening test for breast cancer. It is a form of risk assessment, meant to help us sort out if a woman should undergo screening when she normally would not. I generally do not recommend that the HALO test be performed on women over age 45.
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