Nipple discharge is a relatively common symptom of breast diseases. However, although it worries the patient a lot, it is one of the rare symptoms of breast cancer. Only 10% of patients who consult a physician due to nipple discharge are related to cancer.
For this reason, the basic clinical approach is to accurately reveal the underlying cause. A careful and detailed history and careful examination by the breast surgeon are at the forefront.
Nipple discharge, which has a serious underlying pathological cause, occurs unilaterally and spontaneously. Considering that the patient is pre- and post-menopausal, the presence of a unilateral and spontaneous nipple discharge as well as the presence of a lump are important factors that make the decision for surgical intervention. In addition, the color of the discharge and whether it contains blood are also issues that should be taken into consideration in the differential diagnosis of a possible cancer.
In a study, it was found that only 2.7% of patients with complaints of nipple discharge who were followed for many years could develop cancer. Especially unilateral, single-channel and bloody nipple discharge often necessitates a breast biopsy. However, especially in post-menopausal women, clear and colorless nipple discharge should be approached with suspicion.
Although nipple discharge is one of the symptoms that should warn about cancer, the most common cause of bloody nipple discharge is benign. intraductal papillomas. The second most common is enlargement of the milk ducts. In this case, smoking should be questioned, and some vitamin deficiencies and rheumatic diseases should be kept in mind. Studies have shown that smoking, in particular, weakens the support tissue around the milk ducts under the nipple and causes expansion in these ducts. It is known that sometimes cysts of the breast also cause nipple discharge. During breastfeeding, attention should be paid to the presence of milk sacs called galactoceles, and if necessary, they should be emptied, but breastfeeding should not be interrupted. Breast infections should be questioned in the history, attention should be paid to shrinkages and deformities in the nipple, and cancer should be ruled out.
Post-menopausal disease. With the help of conventional methods such as breast ultrasonography and mammography in patients with family history and hormone use, a surgeon who is experienced in breast diseases can detect the channel where the discharge occurs, find the channel or channels where the discharge from the nipple occurs, and easily perform a biopsy for tissue diagnosis. .
Despite many complex diagnostic methods provided by technological progress (ductoscopy, ductal lavage, ductography), clinical history still has the most important place in revealing the real cause of nipple discharge. Although smear and cytological examination of nipple discharge are performed in centers, it should not be considered as a widely used test due to the high false negative rate.
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