You know the mantra: Regular mammograms could save your life. But when scientists at the National Cancer Institute (NCI) expressed doubts about mammography's worth earlier this year, you had to wonder if you should abandon the test and depend on a hand in the shower or at the doctor's office to detect a lump. In the end, the NCI, along with the American Cancer Society and the American Medical Association, came down in favor of mammograms; in fact, the feds updated their guidelines: Women 40 and older should get mammograms every one to two years (previously recommended for women 50 and older). Promising new screening methods add to the mix of new breast-cancer detection options.

     "For now, the mammogram is the best screening tool for women over 50," says Susan Love, M.D., an adjunct professor of surgery at University of California at Los Angeles and Medical Director of the Susan Love M.D. Breast Cancer Foundation. "But we desperately need something better for younger women and women at higher risk -- those who have the breast cancer gene, a family history of the disease, or who have already had cancer in one breast.

     "That desperate need could be met with another test that's being developed -- one that analyzes breast fluid. A University of California at San Francisco study of more than 7,000 women found that the fluid, when extracted from the milk ducts (where breast cancer starts) and analyzed, could help predict who would and wouldn't get the disease. Women who produced breast fluid with abnormal cells were 60 percent more likely to develop breast cancer than women with normal cells in their fluid.

     Several methods of collecting breast fluid have been developed in recent years, but the most widely used is ductal lavage, a technique pioneered by Love. "There's no question in my mind that being able to get to where breast cancer starts -- the milk duct -- will be the key to figuring out and eradicating breast cancer," Love says.

    The notion of suctioning fluid from the breast may sound intimidating, but the technique is noninvasive and generally painless, exerting no more pressure than that of a nursing infant, says Margaret Wrensch, Ph.D., the study author and a professor of epidemiology and biostatistics.

     The U.S. Food and Drug Administration has approved the technique ductal lavage and, in January, a group of the nation's leading surgical oncologists issued the first clinical guidelines to help women and their doctors understand how to use it. For now, Love says, it's a great tool for women who are at increased risk and need to make decisions such as whether to undergo further tests, have a preventive mastectomy, or start treatment with estrogen-blocking tamoxifen. It's currently recommended only for women at high risk. "Until we have more data, we don't want to do this on everyone and risk overtreating people," Love cautions. Many insurance companies cover the procedure, which costs about $500 to $800 and is currently offered at about 135 centers nationwide. To find out more about it, or to search by state for doctors offering ductal lavage,

Eventually, scientists hope to use breast fluid to chart the progress of atypical cells, as well as identify potential markers for the disease, and even carcinogens, such as PCBs, that may play a role in the disease. It's a long way off, but researchers hope the new techniques will become as commonplace as the routine Pap smear.