C-reactive protein in nipple aspirate fluid associated with Gail model factors.

C-reactive Protein in Nipple Aspirate Fluid Associated With Gail Model Factors Biological Research Nursing Volume 9 Number 2 October 2007 108-116 © 2007 Sage Publications http://brn.sagepub.com hosted at http://online.sagepub.com Diana Lithgow, PhD, FNP, Adeline Nyamathi, PhD, ANP, FAAN, David Elashoff, PhD, Otoniel Martinez-Maza, PhD, and Chandice Covington, PhD, RN, CPNP Background: The majority of breast cancers originate in the epithelial lining of the breast ductal system. Premalignant cell damage in this lining may produce biochemical signals that deliver inflammatory proteins to the site. The presence of C-reactive protein (CRP) in nipple aspirate fluid (NAF) may reflect an inflam- matory state indicative of a premalignant breast microenvironment. This study ascertained CRP’s pres- ence in NAF and evaluated if risk factors, as identified by the Gail model, were associated with NAF CRP lev- els among healthy women. Design: NAF CRP levels were assayed in 59 women. Results: CRP was present in NAF and significantly (p = .04) and positively related to breast cancer risk as predicted by the Gail model. Conclusion: CRP is differentially present in NAF and varies by Gail model risk factors. CRP in NAF holds promise as a noninvasive biomarker that detects a precarcinogenic breast ductal microenviron- ment and may contribute to the diagnosis of breast can- cer early in the course of the disease when prognosis is most favorable. B detects changes in the breast only after cellular malig- nancy has been initiated, and typically fails to identify 20% to 40% of breast cancers (Institute of Medicine, 2000). Clearly, improved diagnostic technologies efficient in the detection of premalignant changes are needed. Noninvasively acquired nipple aspirate fluid (NAF), a physiological substrate that is present in all patent ductal microenvironments, holds promise as a clinical diagnostic tool to detect precarcinogenic states in epithelial cells (Dooley et al., 2001; Sauter, Ehya, Schlatter, & MacGibbon, 2004; Shao & Nguyen, 2001; Wrensch et al., 2001). The epithelial cell lining of the terminal duct lobular unit (TDLU) operates as a “protein factory” (Romagnolo & DiAugustine, 1994), synthesizing proteins and delivering them into the breast fluids that subsequently bathe the ductal lining (Mallon et al., 2000). As the ductal epithelial cells per- sist in the proliferative growth associated with car- cinogenesis, proteins (and potentially inflammatory reast cancer is the most commonly diagnosed cancer in women in the United States. Women without a history of breast cancer have a 1 in 8 lifetime risk of developing this disease (American Cancer Society, 2005). Early detection of a precancer- ous state is key to reducing breast cancer incidence and related morbidity and mortality. Yet mammography— which, along with clinical and self–breast examination, is the screening modality currently available—has poor specificity and sensitivity for precancerous states, From the College of Graduate Nursing at Western University of Health Sciences, Pomona, California (DL); the School of Public Health (DE) and the Department of Obstetrics and Gynecology and Microbiology, Immunology, and Molecular Genetics (OMM) at the School of Nursing, University of California, Los Angeles (AN); and the College of Nursing at the University of North Dakota, Grand Forks, North Dakota (CC). Address for correspondence: Diana Lithgow, PhD, FNP, 19841 Flagstone Lane, Huntington Beach, CA 92646; phone: (714) 962-4145; fax: (714) 964-3635; e-mail: LithgowNP@aol.com. Key words: biomarkers; breast cancer; C-reactive pro- tein; Gail model; inflammatory proteins; precancerous