Women's Information Network
Against Breast Cancer

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Posted by Betsy Mullen on 3/31/2001 from 152.163.213.46:

In reply to: Nipple discharge posted by Michele on 3/30/2001 from 64.12.105.168:

Dear Michelle:

I am glad that you posted your question and can understand first-hand your frustration and fear. As you will see from the information below, you are not alone in experiencing the emotions you are feeling in response to a nipple discharge. I am glad that you are performing breast self-exams and taking charge of your health.

The good news is that approximately 95% of women who are examined for nipple discharge have a benign (noncancerous) cause for the discharge. Similarly, the majority (over 80%) of breast lumps are also benign.

I have compiled and posted below, several messages in response to other women’s questions and experiences regarding nipple discharge that have been posted and responded to in this message board. There is a lot of information here for you to sort through, so please feel free to contact us directly with any questions, concerns and to take advantage of our services which are free of charge.

We will be happy to send you educational materials, free of charge regarding breast self-exam, breast health and breast anatomy, understanding breast changes, questions to ask your health plan about exemplary care (found on our web site under help yourself – 10 key questions for women to ask their health plans), breast cancer myths and more depending upon your needs.

We have trained information specialists in our offices that can speak with you one on one to determine the best materials to send you (all free of charge). WIN ABC has an in-depth resource guide with great resource listings and suggested reading. You are more than welcome to call us at (626) 332-2255. If it is a long distance call for you, just ask us to call you right back so that the call is "on our dime."

You are also welcome to fill out the special Personal Profile Form (blue link at the top of this page) with your specific information and with requests for some of the information and resources I have outlined here. Your e-mailed form will remain confidential.

AN IMPORTANT REMINDER: It is very difficult to render an opinion without knowing all the facts of any one particular case. But one strong recommendation we would like to make is that you pursue your question(s) with your own physicians. You should feel fully empowered to obtain a satisfactory answer and feel free to seek a second opinion. We have some great tips on partnering with your health care team and key questions to ask your doctors, communication tips and informed decision-making tips to help you get the information you need.

I look forward to hearing from you, Michelle, with an update on how you are doing.


All my best,
Betsy



Posted by zelda on 9/13/2000 from 63.214.94.163:
Please help. Noticed spontaneous unilateral bloody discharge (one duct?) six mnths prior. Seeing surgeon in two days. Normal mammograms past two years. Anyone out there experience this? Fam history of bc - mat. grndmthr.
I'm getting quite nervous and could use some more info. Am in Boston area.

Posted by Shelly Blechman on 9/13/2000 from 216.246.34.217:
In reply to: unilateral nipple discharge posted by zelda on 9/13/2000 from 63.214.94.163:

Let me first begin by saying that I am not a healthcare provider, and it is very difficult to render an opinion without knowing all the facts of any one particular case. However, I have spent of number of years in the field of breast cancer and have some knowledge in this area.

First, the good news is that approximately 95% of women who are examined for nipple discharge have a benign (non-cancerous) cause for the discharge. Similarly, the majority (over 80%) of breast lumps are also benign.

Since the breast is a gland, secretions from the nipple of a mature woman are not unusual nor even necessarily a sign of disease. If a disease is causing the discharge, it is more likely to be benign than cancerous.

Are you lactating or on birth control pills or other medications? This may cause nipple discharge.

What is the color and texture?

Milky discharge can be traced to thyroid malfunction, oral contraceptives or other drugs. Women with generalized lumpiness may have a sticky discharge that is brown or green.

A discharge may be caused by an infection that requires antibiotics.

Mastitis and mammary duct ectasia are types of benign breast conditions.
Mastitis often occurs during breast feeding when a duct gets blocked, becoming infected. Mammary duct ectasia occurs closer to menopause when ducts beneath the nipple become clogged and inflamed.

One of the most common sources of bloody or sticky discharge is an intraductal papilloma – a small, wartlike growth that projects in to breast ducts near the nipple. Any slight bump or bruise in the area of the nipple can cause a papilloma to bleed. Single (solitary) papillomas usually effect women nearing menopause. If the diseased duct becomes bothersome, it can be removed surgically without damaging the appearance of the breast. Multiple intraductal papillomas are more common in younger women. They often occur in both breasts and are more likely to be associated with a lump. *

Your physician will have the discharge analyzed to determine the cause. After examination, your doctor will recommend the best course of treatment for you.
We would be glad to send you information and/or speak to you in greater detail if you would like. You may email me with your phone number or call our office at 626-332-2255


Posted by Pat Rice on 9/28/2000 from 152.163.194.208:
In reply to: Re: unilateral nipple discharge posted by zelda3025 on 9/14/2000 from 63.214.126.252:
…I understand how you feel and it very worrisome when you see that blood-tinged discharge. I experienced this about 7 or 8 years ago, and since my mother had breast cancer, I assumed the worst. However, after many tests and ductograms and cytology, I finally had the entire duct removed back to the chest wall. A small 5-6 mm papilloma was found to be the source of the bloody discharge. I'm sure you have read that the vast majority of case of blood nipple discharge are not from cancer, and in fact, rarely are. I have had blood-tinged nipple discharge x 2 since then. I had another surgery and a foreign body (probably retained suture) was found and the next time, nothing. You certainly need to check it out, of course, like you are doing, but I have known other women with the same problem and no one I know has had cancer. Best of luck to you.


Posted by zelda3025 on 9/30/2000 from 63.214.126.130:
In reply to: Re: unilateral nipple discharge posted by Pat Rice on 9/28/2000 from 152.163.194.208:
Dear Shelly and Pat,
Thank you so much for giving me more info. When I went to the surgeon, unfortunately he couldn't express anything. I tried also but must have been too worried and nothing came out. Soo... he told me to come back a week after my next period, to leave everything alone until then, and he'd try again. He did a very thorough breast exam and found nothing otherwise, so that is good news. I'm feeling silly about going back - I'll have to go some time this week - feeling like I'm wasting his time, but also feel something should be done, just in case. I'd like something to be seen so that my worries can be reassured, but in a way I'd like it to just all go away. (Denial??) The info you gave me helped me feel better. If no discharge is seen this time, do I just let this go, or do I ask for some other test or study or biopsy?? I'm going to have doubts in my mind if nothing is seen. Or should I just be glad and get on with my life?
Thanks again for all your help.

Posted by Shelly Blechman on 9/14/2000 from 216.246.34.217:
In reply to: Re: unilateral nipple discharge posted by zelda3025 on 9/14/2000 from 63.214.126.252:
Dear Zelda,
I can feel your anxiety through the internet and I wish I could be there to help allay some of your fears. But I know that until you have a definitive biopsy, you will not be able to relax.
The color of your discharge will require a work-up by your physician. But as I stated in my previous message, there can be a number of benign breast conditions that could cause this type of discharge.
A milky discharge might be from an underlying hormonal problem or pituitary gland-such as a prolactinoma (a tumor producing the hormone responsible for making milk.)*
I would wait to see if the doctor cannot express any fluid in the exam before you start worrying about that possibility. The doctor might do a test called a galactogram, where a needle is inserted into the duct to pinpoint the source of discharge.
The other symptoms you mentioned could also have various causes - including being peri-menopausal. I would definitely discuss these symptoms with your doctor.
Remember that there are many resources available to help you on any range of situations and we certainly are here for whatever you may need.
I am anxious to hear the results of your visit. Please stay in touch.

Shelly

*source: Deborah Axlerod, MD, FACS



breast discharge


Posted by sheila on 3/28/2001 from 63.61.116.245:
I have had a yellowish,white,somewhat stickey discharge from my left breast for the past year. It is only out of one duct. It only comes out when I squeeze it. I have been to 2 different doctors and had a mammogram which was fine,they have not at all been concerned. But everything I read says if your discharge is from only one duct in one breast it is more serious. I do feel that the breast specialist I went to knows what he's doing, it is just the paranoid part of me that would like to get some feedback from you. Thank you



Dear Sheila:

I have a saying that I personally adhere to: "When in doubt, check it out!" I am a strong advocate of second opinions.

Here is some good basic information regarding nipple discharge from a very reliable resource*:

First, the good news is that approximately 95% of women who are examined for nipple discharge have a benign (noncancerous) cause for the discharge. Similarly, the majority (over 80%) of breast lumps are also benign.

Here are some key factors that need to be taken into consideration when evaluating nipple discharge:

Whether or not the discharge is associated with significant underlying pathology.

Whether or not the discharge arises from a single duct.

Whether or not the discharge is persistent or troublesome.

If the discharge is bloodstained or contains blood on testing.

Do you notice the discharge after a warm bath or after nipple manipulation?

Additional factors to consider include:

The frequency of the discharge. Persistent discharge occurring on at least two occasions per week is significant.

The amount of the fluid. This assessment is important for milky discharge.

Physicians need to establish:

Whether the discharge is spontaneous or induced.

If the discharge arises from a single or multiple ducts.

If the discharge is from one or both breasts.


In evaluating nipple discharge, the characteristics of the discharge need to be defined:

Is the discharge viscous (viscous characteristics are sticky, gummy, gelatinous) or watery?

Whether the discharge is serous, serosanguinous, bloody, clear, milky, green or blue-black.

During physical examination, the physician should apply firm pressure around the areola (the round area of pigment surrounding the nipple) to identify the site of any dilated duct. Pressure over the dilated duct will produce the discharge. The nipple should be squeezed with firm digital pressure, and if fluid comes out, the area and character of the discharge will be documented.

The discharge will be tested for hemoglobin to determine whether blood is present. Less than 10% of patients who have a bloodstained discharge or a discharge that contains moderate or large amounts of blood have an underlying malignancy.

Age is an important predictor of malignancy, with younger women (younger than 40 years old) at the lowest risk.

If you would like additional information in terms of various tests including ductography, galactography, and biopsy, you can either locate the reference below or feel free to contact us (WIN ABC) and we will be pleased to assist you.

Also, if you would like information on the various causes of nipple discharge, the book referenced below is a great resource as is WIN ABC! Causes of nipple discharge include: physiologic secretion that varies in color from white to yellow to green to brown to blue-black; intraductal papilloma; multiple intraductal papillomas; galactorrhea; periductal mastitis and duct ectasia.

*Source and Suggested Resource: Diseases of the Breast, Second Edition; Editors: Jay R. Harris, Marc E. Lippman, Monica Morrow, C. Kent Osborne; Publisher: Lippincott Williams & Wilkins; 2000; ISBN #: 0-7817-1839-2.

Here is another piece of information that may be helpful:

Ductography is an examination that allows detailed evaluation of the breast milk duct and is indicated when there is a bloody nipple discharge or persistent discharge from a single duct in the nipple. There are approximately 15 to 20 major milk ducts that converge to the nipple. If the discharge is noted from multiple ducts or from both nipples, a ductogram is not indicated. The cause for multiduct discharge is usually related to a systemic cause (hormonal effect, pituitary disorder, etc.) and is not cancerous. The examination is usually performed by inserting a small cannula (thin tube) directly inside the duct ostium in the nipple and contrast (X-ray dye) is injected to fill the duct. If the cannula cannot be placed through the ostium, the abnormal duct (which is usually enlarged) can frequently be filled percutaneously with ultrasound guidance.*

*Source: Richard L. Ellis, M.D.; Memorial Medical Center, Department of Radiology
Division of Breast Imaging, Springfield, Illinois 62794


Here are some questions and information that perhaps you should discuss with your doctors:

1. Do you have a family history of breast cancer?

2. Do you have known risk factors?; Do you know what some of the other breast cancer risk factors are?

3. Do you know how to do a proper breast exam? You can receive this information on our web site (www.winabc.org)

4. Are you current on having regular clinical breast exams? Mammograms?

5. Was this most recent mammogram compared with any previous mammograms?

6. Did you receive a copy of the radiologist’s report from this most recent mammogram?

7. Are you current on having regular Pap smears? I ask this question because I want to make sure that you focus on your overall health care and regular Pap smears are a very important part of taking care of yourself.


Here is some additional information that I hope you find helpful:


Excerpts from: Breast Imaging Questions

Source: Richard L. Ellis, M.D.
Memorial Medical Center, Department of Radiology
Division of Breast Imaging. Springfield, Illinois 62794


Q: Why is ultrasound performed in addition to mammography?

Ultrasound is an excellent adjunctive examination to mammography, but it cannot be a substitute for the screening mammogram. As noted above, ultrasound is the primary examination in young, pregnant, or lactating women with palpable abnormalities. It is also routinely performed on women with clinical findings whose mammograms are unrevealing and on those whose mammograms show an area that requires further evaluation. Ultrasound is also used to guide interventional procedures, such as needle localization, fine needle aspiration, core biopsy, and percutaneous ductography.

A reliable aid in the diagnoses of most breast cysts, ultrasound can be used to guide benign cyst puncture for those who are symptomatic or do not meet stringent criteria for diagnosis of a benign cyst on ultrasound. In addition, it can provide reassurance that no mass underlies a questionable palpable area. According to recent evidence, ultrasound can aid in the benign-malignant differentiation of solid breast masses and prevent biopsy for many noncancerous masses, such as fibroadenomas.


Q: What other diagnostic procedures are performed in mammography?

Once an abnormality (abnormal mass, calcifications, distortions, etc.) is detected on the screening mammogram, a diagnostic mammographic examination is generally performed in order to obtain special views of the abnormality allowing a more detailed evaluation. This additional mammographic examination may include the use of special X-ray maneuvers and magnification of the abnormality in question as mentioned previously.

Ductography is an examination that allows detailed evaluation of the breast milk duct and is indicated when there is a bloody nipple discharge or persistent discharge from a single duct in the nipple. There are approximately 15 to 20 major milk ducts that converge to the nipple. If the discharge is noted from multiple ducts or from both nipples, a ductogram is not indicated. The cause for multiduct discharge is usually related to a systemic cause (hormonal effect, pituitary disorder, etc.) and is not cancerous. The examination is usually performed by inserting a small cannula (thin tube) directly inside the duct ostium in the nipple and contrast (X-ray dye) is injected to fill the duct. If the cannula cannot be placed through the ostium, the abnormal duct (which is usually enlarged) can frequently be filled percutaneously with ultrasound guidance.

Magnetic resonance imaging is a special radiologic scanning method that is extremely accurate for evaluation of breast implants when there is a suspicion of implant rupture or leakage due to trauma or implant breakdown due to age. In addition, MRI is beginning to show promise as a tool that in the future may allow differentiation of benign and malignant lesions in the breast and provide better demarcation of the size of the lesion to assist surgery. In addition, MRI may help determine recurrence of cancer in the breast after treatment.

Nuclear Medicine Imaging, using sestimibi (Miraluma), is currently available as an additional diagnostic examination for selective patients. We are also using monoclonal antibodies for breast cancer under clinical research trials to evaluate their efficacy in selected patients with the hope of helping to differentiate between benign and malignant breast lesions.


These are all things to think about and discuss with your health care team.


We will be happy to send you educational materials, free of charge regarding breast self-exam, breast health and breast anatomy, understanding breast changes, questions to ask your health plan about exemplary care (found on our web site under help yourself – 10 key questions for women to ask their health plans), breast cancer myths and more depending upon your needs.

We have trained information specialists in our offices that can speak with you one on one to determine the best materials to send you (all free of charge). WIN ABC has an in-depth resource guide with great resource listings and suggested reading. You are more than welcome to call us at (626) 332-2255. If it is a long distance call for you, just ask us to call you right back so that the call is "on our dime."

You are also welcome to fill out the special Personal Profile Form (blue link at the top of this page) with your specific information and with requests for some of the information and resources I have outlined here. Your e-mailed form will remain confidential.

AN IMPORTANT REMINDER: It is very difficult to render an opinion without knowing all the facts of any one particular case. But one strong recommendation we would like to make is that you pursue your question(s) with your own physicians. You should feel fully empowered to obtain a satisfactory answer and feel free to seek a second opinion. We have some great tips on partnering with your health care team and key questions to ask your doctors, communication tips and informed decision-making tips to help you get the information you need.

Sheila, I look forward to hearing from you with an update on how you are doing.


My best regards,
Betsy



Elizabeth ("Betsy") Mullen
Founder, President/CEO
WIN Against Breast Cancer
Main Office:
536 S. Second Avenue, Suite K
Covina, California 91723
Telephone: 626-332-2255 Fax: 626-332-2585
San Diego Office:
Telephone: (619) 284-4900 Fax: (619) 284-7900
Web Site: www.winabc.org

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