Nipple discharge: a sign of breast cancer?
BACKGROUND
Nipple discharge is regarded a sign of breast cancer. Type of discharge and cytology are unreliable for diagnosis. Most malignant cases have a detectable breast mass. The aim of this study was to assess the association between nipple discharge and breast cancer.


METHODS
Patients who underwent operation for nipple discharge at a district general hospital (population 460,000) over a 3-year period were included. All had normal clinical, radiological and cytological examination. Operation and histopathology reports were reviewed.


RESULTS
Eighty-six patients underwent operation for nipple discharge. Median age was 54 years (range, 32-84 years). Analysis of nipple discharge revealed red blood cells (RBCs) in 35 patients (40%). At operation, 81 patients underwent radical sub-areola duct excision (Hadfield's procedure) and five microdochectomy. Histopathology reported duct ectasia in 59 patients and benign ductal papilloma in 25. Two patients had occult malignancy - DCIS (1) and LCIS (1). No invasive cancer was found.


CONCLUSIONS
Nipple discharge alone is not usually a sign of breast cancer. Occult malignancy is rare. A period of 'watchful waiting' may prevent patients undergoing unnecessary surgery.
Richards
T
T
Department of Surgery, Royal Berkshire Hospital, Reading, UK. tobyrichards@btinternet.com
Hunt
A
A
Courtney
S
S
Umeh
H
H
D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000378:metabolism*; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000378:metabolism / Q000601:surgery; D005122:Exudates and Transudates / Q000378:metabolism*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009558:Nipples / Q000378:metabolism* / Q000601:surgery; D012189:Retrospective Studies
D014408:Biomarkers, Tumor