Glossary

Absolute personal risk: Absolute personal risk is the percent probability that a woman will develop breast cancer during a defined time period.

Atypical ductal hyperplasia (ADH): A histologic diagnosis made from breast biopsies, which indicates an approximate four-fold increased relative risk for the future development of breast cancer (though that cancer may occur anywhere in either breast). Although sometimes called "pre-malignant," most women with this change do not develop breast cancer.

Atypical cells: A distinct term from ADH (above). This diagnosis is based on cytology alone rather than thin slices of tissue (histology). A diagnosis of atypical cells, imparts an increased relative risk for future breast cancer development. In the breast, cytology specimens can be generated through spontaneous nipple discharge, nipple aspiration, fine needle aspirations and the FirstCyte® Breast Test.

Baseline Risk: The absolute risk that a woman without identifiable risk factors will develop breast cancer during a defined period of time. This percent probability is age-dependent, and will vary widely depending on the length of time chosen. Establishing this number is an early step in the risk assessment counseling process.

Chemoprevention: The relatively new concept that certain drugs (called SERMS) can cut the risk of breast cancer.

Claus Model: Mathematical tables for risk assessment that can be used when a strong family history is the only (or dominant) risk factor. (Pronounced Clowse, as in house, as opposed to Santa Claus.)

Cumulative lifetime risk: The chance of getting breast cancer from age 0 to age 90 (or 100 or 110). Cumulative lifetime risk is the origin of the famous "1 in 10," "1 in 9," or "1 in 8" statistic about a woman's chance of developing breast cancer in her lifetime. This number has little use in clinical risk assessment.

Cytology: Cytology is the study of cells. In contrast, the study of tissue is called histology.

Ductal lavage: A new methodology applied to an old concept of collecting cells that line the milk ducts (the site of origin of most breast cancers). Without the use of a special procedure and devices, the number of cells retrieved from the nipple is likely to be as low as 50 to 100, representing only the large ducts near the nipple. By repeatedly "lavaging" (washing) the duct system, thousands of cells can be collected for analysis.

Ductography (also called galactography): The traditional X-ray method of evaluating milk ducts in women who have spontaneous drainage of clear or bloody fluid from the nipple. A contrast agent is injected into the responsible duct, then mammography is performed. If a "filling defect" is seen, it might be benign growths (called papillomas) or cancer.

Ductoscopy: If markedly atypical or malignant cells are found on ductal lavage, a tiny fiberoptic scope can be placed into the same nipple opening. The goal is to see the abnormal cells inside the duct in order to help guide a surgical intervention. The procedure involves the insertion of a hollow metal tube containing an optical fiber into the milk ducts. The ductoscope is advanced as far as it can travel, generally through the larger branches of the ductal system. It is connected to a monitor to enable visualization of the cells inside the duct. The procedure usually is done in the operating room, using local anesthesia.

First, second and third degree relatives: Count how many people you are removed from your relative with breast cancer. First degree has to be mother, sister, or... don't forget... daughter. Second degree examples are aunt and grandmother (it doesn't matter maternal or paternal... only the number of people-steps you take in a pedigree). Third degree examples include great grandmother, great aunt and first cousin.

Gail Risk Model: The Gail Risk Model is a computer program that estimates a woman's chance of developing breast cancer within a certain period of time. To use the program, you must enter information about factors including the number of first-degree relatives with breast cancer, current age, age of first menstrual period, number of breast biopsies and age at first live birth. As an example, a Gail Risk Model score of 1.7% means a woman has a 1.7% chance of developing breast cancer within the next 5 years.

Histology: The study of tissue. For example, after a biopsy is performed, a pathologist will perform a "histological" evaluation, which means the tissue collected will be analyzed for any abnormalities.

Historical risks: All risk factors for the development of breast cancer that are based on anything besides actual tissue abnormalities. Examples of historical risks include: family history of breast cancer, reproductive/endocrine risks, dense mammography, exposure to carcinogens, etc.

Lavage: Lavage means "to rinse." Ductal Lavage is a method of rinsing the milk duct to obtain cells for analysis.

NAF: NAF stands for Nipple Aspirate Fluid. Originally, researchers used NAF to look for abnormal cells in the breast milk ducts. Unfortunately, NAF alone (without ductal lavage) contains too few cells from too close to the nipple. In today's context of the FirstCyte® Breast Test procedure, a tiny drop of NAF is obtained with an aspirator (suction device) for a new purpose - it helps physicians target which duct(s) to lavage.

NSABP: The National Surgical Adjuvant Breast and Bowel Project is a multi-institutional, international consortium based in Pittsburgh. The organization is responsible for many of the landmark clinical studies dealing with all aspects of breast cancer treatment today. The NSABP conducted the P-1 study on Tamoxifen®, and is currently conducting the STAR trial.

P-1: P stands for Prevention. 1 stands for the first... one. This is the shortened title of the NSABP P-1 Tamoxifen chemoprevention trial. Tamoxifen was tested against placebo (meaning no drug was taken) in high-risk women with a Gail Risk Model score of 1.7 or greater. The study found that Tamoxifen cut breast cancer development by approximately 50%. Among high-risk women who had atypical ductal hyperplasia, Tamoxifen reduced the incidence of breast cancer by 86%.

Relative risk: A woman's risk of developing breast cancer compared to women who do not have the same risk factors. If you hear a report stating that "breast cancer was found to be increased 10-fold... or by 76%... or 5 times as common" you are listening to relative risks.

Risk assessment: The process of evaluating whether a woman has any traits that increase her chance of developing breast cancer within a certain number of years.

Risk factor: A risk factor is a trait or characteristic that increases your chances of developing a disease. Risk factors do not cause the disease, and not everyone who has a risk factor will get the disease. Doctors use risk factors to help focus risk reduction efforts on the people who are most "at risk" for the condition.

SERM: SERM stands for Selective Estrogen Receptor Modulator. SERMS are drugs that can act like an estrogen in some tissue and not like estrogen in other tissue. The two commonly used SERMs today are Tamoxifen and Raloxifene®. These drugs act as "anti-estrogens" (i.e., does not act like an estrogen) in the breast. However, they are "estrogenic" (i.e., work like estrogen) when it comes to cholesterol levels and bone density (though they are not as powerful as "real" estrogens for bone density). Neither drug works like an estrogen for the brain, nor in the body's "hot flash" thermostat control.

STAR Trial: Study of Tamoxifen and Raloxifene. STAR is the acronym for the official NSABP P-2 (Prevention 2) trial that was the natural sequel to NSABP P-1 (Tamoxifen vs. placebo). After the benefit of Tamoxifen was established after just four years, the P-1 study was concluded. At this same time, data on Raloxifene (another SERM) was emerging to indicate perhaps greater safety with regard to endometrial cancer. The NSABP started a clinical study to compare the ability of Tamoxifen vs. Raloxifene to reduce the risk of breast cancer in high-risk women. In the STAR trial, participants take either Tamoxifen or Raloxifene. There is no placebo group. Unlike the P-1 study, the STAR trial only includes post-menopausal women since the FDA has not yet approved Raloxifene for use in pre-menopausal women.

Tamoxifen: Tamoxifen is a SERM that has been clinically proven to help prevent breast cancer from recurring. It was studied in the NSABP P-1 trial to determine whether it could reduce breast cancer development in high-risk healthy women. The FDA approved the use of Tamoxifen to reduce breast cancer risk in high-risk women with a Gail Risk Model score of 1.7% or greater. Tamoxifen works by binding to the estrogen receptor located near the surface of each breast cell. Tamoxifen blocks estrogen from "landing" on the receptor, which in turn, prevents a cascade of reactions that stimulate various tumor growth factors.