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Administering cancer-fighting agents directly into breast ducts rather than intravenously may be safer and less painful than standard chemotherapy for controlling early breast cancer. 

An investigative team led by Vered Stearns, MD, PhD, codirector of the Breast Cancer Program at the Johns Hopkins Kimmel Comprehensive Cancer Center in Baltimore, Maryland, theorized that because most breast cancers originate in the epithelial cells lining the breast ducts, intraductal administration of anticancer medications would lead to high drug exposure to ductal cells and eliminate preinvasive neoplasms while limiting systemic exposure. The researchers compared the effects of 5-fluorouracil (5FU), carboplatin, nanoparticle albumin-bound paclitaxel, and methotrexate to the efficacy of pegylated liposomal doxorubicin (PLD) on the treatment of early and established mammary tumors in rats. The drugs were administered both intravenously and directly into the primary duct of the animals’ mammary glands.

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Drugs delivered either way were beneficial relative to untreated control rats; only the rats treated with PLD exhibited extensive epithelial destruction. However, intraductal 5FU prevented the most cancers compared with no drug or with IV delivery, shrank established breast tumors, and completely eliminated tumors in 10 of 14 treated rats, spared breast ducts the kind of damage caused by PLD, and even showed a strong effect in preventing tumors in the untreated mammary glands of the animals. 

Stearns’ group also administered intraductal dextrose or PLD in 17 women awaiting mastectomy, infusing the breast ducts through a small catheter placed on the nipple. This method was successful in 15 of the patients (the intention was not to treat the tumors but to test the intraductal delivery system) with no serious adverse events. Mild side effects included nipple pain and breast fullness (Sci Transl Med. 2011;3[106]:106ra108). ONA