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Breast and Nipple Problems
Is nipple discharge a sign of breast cancer? I have been having discharge from my left nipple. A small amount shows up in my bra daily, and it also will come out if the nipple is squeezed.
Most nipple discharge is benign and not related to an abnormality. Discharge can range in color from white to yellow to green and even bluish green. This is known as physiologic discharge and is not associated with breast cancer. If the discharge is clear and thick, like mucus, this should be investigated as thoroughly as if it were bloody.
A key question is whether the discharge is spontaneous, or whether it occurs only when the nipple is squeezed. It is less of a concern if the discharge occurs only when the nipple is squeezed, since most women can elicit discharge if they squeeze their nipple.
If the discharge is spontaneous, rather than go to your internist or ob-gyn, you should consider going directly to see a breast specialist, meaning a surgeon who specializes in breast diseases. The specialist will perform a clinical breast exam and, if appropriate, a mammogram and an ultrasound. The discharge should also be examined to see if it contains blood. This is done with the same kind of test that is used to test for blood in stool. It should be done as part of the breast exam, as opposed to sending the sample to pathology.
If the breast exam is negative, but the discharge tests positive for blood, a ductogram should be done. This is a procedure in which dye is inserted through the duct and then X-rays of the duct system are taken. A ductogram allows the surgeon to identify which duct system the bleeding is coming from and to determine whether there is a blockage in the duct that might be causing the discharge. (Think of a pipe that is rusty on the inside and gets blocked; when the rust breaks off it will come out the end of the pipe, making the water discolored.) It is best to have the ductogram done at a breast imaging center that has experience in doing this type of breast X-ray. Some breast centers are also now doing ductal lavage (washing out the milk duct to look for abnormal cells) and even ductoscopy (threading a very tiny catheter into a milk duct through the nipple to see what is causing the discharge).
It is possible that the surgeon will find that you have an intraductal papilloma—a benign growth. This is most often identified by the presence of a spontaneous bloody nipple discharge. On rare occasions the discharge can be due to a precancerous condition called ductal carcinoma in situ (DCIS). But this really is rare. Only 4 percent of spontaneous bloody nipple discharge is found to be related to breast cancer. Even so, it is important and necessary to have the discharge examined by your physician.
It is also worth noting that smoking, hypertension, birth control pills, and some tranquilizers can influence nipple discharge because they stimulate prolactin, the hormone that influences lactation. So if you smoke, take the pill or tranquilizers, or have hypertension, you should mention this to the breast specialist.
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