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For women with a high risk of breast cancer, an experimental procedure that retrieves cells from the milk ducts may help guide difficult decisions about preventive treatment.

High-risk women include those with certain genetic mutations or family histories of breast cancer, and women who have already had cancer in one breast and are worried about the other. They face a variety of choices, like whether to undergo increased monitoring and mammograms, take the drug tamoxifen or even have their breasts removed.

The procedure, ductal lavage, washes cells from the milk ducts, where 95 percent of breast cancers start. Tests can then be performed to look for atypical or abnormal cells. Such cells are not necessarily cancerous, but in women who are already at high risk the cells indicate that the breast cancer risk over the next decade is 18 times as high as that of the average woman of the same age.

A recent study, published in the Nov. 7 Journal of the National Cancer Institute, found ductal lavage to be useful for certain women. The study included 507 high- risk women at 19 medical centers. Atypical cells were found in 24 percent of the women, with 6.5 percent of the samples described as markedly atypical; two women had malignant cells, said the study's chief investigator, Dr. William C. Dooley, medical director of the Institute for Breast Health at the University of Oklahoma. Some of the women have already had further testing.

The women, who had histories of cancer in the opposite breasts or family histories of the disease, had had normal mammograms and physical exams within the previous 12 months. ProDuct Health of Menlo Park, Calif., which makes the testing equipment, helped pay for the study.

Experts say that unlike the annual Pap test for cervical cancer, ductal lavage is intended only for high-risk women.

The procedure can be done in a doctor's office or outpatient clinic and takes about an hour. First an anesthetic cream is applied to numb the nipple area. A suction device helps draw tiny amounts of fluid from the milk duct to the nipple surface, indicating the duct's opening. Next a catheter is inserted into the duct and releases anesthetic fluid. Saline is then delivered though the catheter to rinse the duct and collect cells, which are sent to a laboratory. The test can be repeated once or twice a year.

Forty-nine percent of the women in the study rated the discomfort of ductal lavage as about equal to that of a mammogram. The procedure is available at about 126 centers around the country and costs $400 to $700.

Dr. Joyce O'Shaughnessy, an author of the recent study and a cancer specialist at the Baylor-Sammons Cancer Center in Dallas, said: "At the very least, finding atypical cells may motivate women to become more vigilant. It's important to say to a woman, `Your risk is elevated, and you need to do something.' "

This was true for Pat Dote of Palatine, Ill. Ms. Dote, 54, had had two benign breast tumors removed, and four of her aunts, her maternal grandmother and several cousins had had breast cancer. "Although my mammograms were normal, I was worried," she said. "I wanted a definite answer."

Her doctor recommended ductal lavage, and atypical cells turned up in both breasts. "At that point," Ms. Dote said, "my doctor advised stopping hormone replacement therapy and going on tamoxifen for the recommended five years as a preventive."

She will be tested again in six months, then again in a year. In between, she will have a mammogram. "The procedure pinched and was a little uncomfortable," she said. "It was fully worth it."

Some experts question the true significance of atypical cells, and caution that women may be pushed to act on equivocal evidence.

"Today ductal lavage is a tool with potential for a small group of high-risk women," said Dr. Debbie Saslow, director of the breast and cervical cancer division of the American Cancer Society. "One problem is that the definition of high risk can vary from having a modest family history to being a breast cancer survivor."

Dr. Robert Smith, director of cancer screening at the cancer society, said: "Even though ductal lavage offers a personalized risk assessment, it's still a risk, not a guarantee. It will help women with a very elevated risk, but may not be useful if the risk is less elevated. And in some cases, we may be finding cell changes that will never become malignant. Above all, the use of this tool must be accompanied by very sophisticated counseling."