Women's Information Network
Against Breast Cancer

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Posted by Betsy Mullen on 4/4/2001 from 64.12.105.172:

In reply to: cysts - dr says do nothing posted by chris on 4/2/2001 from 216.244.12.8:

Dear Chris and Sandy:

If you have not done so already, I encourage you 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 below. All of your personal information will remain confidential.

Also, if you have not contacted our office directly yet, we have trained information specialists that can speak with you one on one to determine the best materials to send you (all free of charge), including a booklet entitled "Understanding Breast Changes" and an in-depth WIN ABC 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."

We will be happy to send you educational materials, free of charge regarding breast anatomy, breast health, 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), various videos including nutrition during cancer treatment, dealing with side effects of treatment, tamoxifen, breast reconstruction and much more depending upon your individual needs.

In addition, WIN Against Breast Cancer has published a very extensive Breast Health/Breast Cancer Resource Guide. We will be delighted to send these materials to you (all of which are free of charge to patients and the public).


Sandy, I so appreciate your visiting our message board again and reaching out to Chris – you are a wonderful advocate. I am not sure who have you the feedback regarding having a cyst removed with respect to mammography. Scar tissue from prior surgeries can themselves make mammograms more challenging to read and interpret. It is important to visit an accredited facility and to communicate your medical history and concerns clearly with the health care professionals you see for a mammogram as well as your other health care providers. For clarification of the feedback that I did give you, I have included your original message and my response below as well as a response that you received from a woman named Sue who was faced with similar questions.

Chris, WIN ABC is based in Southern California and you are welcome to visit our office and make use of our resource library. While I am not a health care provider, I do have some questions that come to mind; have you met with a surgeon and has the option of cyst aspiration Been discussed with you? Do you have a family history of breast cancer? What is your age? Are you pre, peri or post-menopausal?; Are you currently on hormone replacement therapy (HRT)? These are all worthwhile questions to discuss with your health care team. If you have not done so yet, we are strong advocates of second opinions. We are here to help so I do encourage you to give us a call.


Sandy, I am sorry that you are still going through this and do encourage you to also seek another medical opinion. Did you ever have the cyst aspirated? Have you looked into additional health care institutions closer to your home? Please let us know how we can help facilitate a resolution to your situation that will help you gain the peace of mind that you deserve.

Again, please bear in mind that I am not a physician, but on a personal note, several years ago I had a breast lump on my one remaining natural breast, that by all accounts (I was examined by a 2-3 surgeons with whom I worked) the lump was a change in breast tissue but nothing that they were concerned about. Although I had faith in their expertise, I did not have peace of mind and worried about the area for several weeks until I finally decided to have the area removed/biopsied. The biopsy was completely negative, the surgeons were right, but for me personally, the peace of mind was worth it. 3 centimeters of healthy tissue was removed through a very small and clean incision and I was able to relax and move on. When I go in for mammograms, I always let the mammography personnel know the precise area of the biopsy to help ensure as accurate a reading as possible.


Here are the messages that I referenced earlier in their entirety:

Posted by Sandy on 6/2/2000 from 205.188.199.38:
I am 41, and have had a partial hysterectomy, (2 years ago). I go every year for exams. I recently noticed that I have been having a clear discharge from my left nipple. Sometimes it just appears on its own. It's not a large amount of discharge, but I am very concerned. I recently have moved to Colorado and I do not have a doctor out in this area that I'm seeing. I live near the Boulder area. If you or anyone else knows of a good doctor, (prefer a female) that I could be referred to, I would greatly appreciate it. Maybe I am worrying for nothing, but breast cancer does run on my father's side of the family.

Thanks again for any information you can offer me.

Sandy

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Re: Nipple Discharge


Posted by Sue on 6/13/2000 from 207.18.9.46:
In reply to: Nipple Discharge posted by Sandy on 6/2/2000 from 205.188.199.38:
Sandy,
I just came across this board looking for something else and noticed your post. Wish I had seen it a little sooner.
I strongly encourage you to see a doctor ASAP. Not to be an alarmist, but that was my only symptom when I was diagnosed. The good news is they caught it very early.
Good luck! (Sorry I can't help you with the name of a doctor -- I live in Pennsylvania!)
Sue

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Information Re: Nipple Discharge

Posted by Betsy Mullen on 8/12/2000 from 205.188.198.48:
In reply to: Nipple Discharge posted by Sandy on 6/2/2000 from 205.188.199.38:

Dear Sandy:

I wanted to check in with you to see how you are doing. Have you been able to find a good doctor and go in for a clinical breast examination since you last contacted our message board? I would love to get an update from you on how you are doing so that we can best be of help to you.

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 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 and register for monthly breast self-exam reminders right on our web site (www.winabc.org)

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

5. Are you current on having regular Pap smears? (I ask that 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.

6. Are you currently lactating? Are you currently breastfeeding?

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

We would 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 much, much 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 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.

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

My best regards,

Betsy Mullen
Founder, President/CEO
WIN Against Breast Cancer
www.winabc.org
(626) 332-2255

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Back to this new message:

RESOURCES TO HELP YOU

There is a great book out entitled "Be a Survivor" written by Vladimir Lange, M.D. My plastic surgeon and I served as consultants on the project (there is also a corresponding video and interactive CD-ROM). There are full color pictures including my breast reconstruction in the book, video and CD-ROM, as well as description of the various reconstructive surgical procedures and all major breast cancer types, stages, treatments and other important information. You can purchase the book through our site’s bookstore. An additional book that I highly recommend was written by Michael Lerner, the Founder of Commonweal. There is a link to Commonweal in the Resources Section of this site. The book is entitled "Choices in Healing: Integrating the Best of Conventional and Complementary Approaches to Cancer". Another good book that extensively covers breast cancer and reconstruction is entitled "A Woman’s Decision" which is also highlighted in our "virtual bookstore". The books can be purchased on line in our virtual bookstore via Amazon.com. Another book I think will be helpful to you is entitled "The Road to Immunity: How to Survive and Thrive in a Toxic World" by Kenneth Bock, MD and Nellie Sabin. It covers in depth information about the immune system and how to keep our immune systems functioning at peak capacity. Dr. Susan Love’s Breast book is also a valuable resource.


I will close with this thought and a saying of mine: "When in doubt, check it out." You know your bodies well and are your own best advocates. Pursue any concerns with your health care teams. And remember, we are strong advocates of second opinions.

I am holding you both in my thoughts and look forward to hearing from you with an update on how you are doing and how WIN ABC can best be of help and support to you. Please keep us "posted".


My warmest personal 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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