Nipple Discharge

Abstract

Despite inclusion in the American Cancer Society’s list of symptoms indicating possible malignancy, most women who present for evaluation of a nipple discharge will be found to have benign breast conditions or a cause extrinsic to the breast. Although approximately 5% of women presenting for breast evaluation will have a nipple discharge as their primary symptom, in most healthy women variable amounts of fluid can be obtained from the nipple with manual or mechanical stimulation. Of those presenting for evaluation of a nipple discharge, approximately 10–15% will be found to have an underlying breast malignancy. Patient age, characteristics of the discharge, and associated clinical and radiographic findings can be used to distinguish those who require specific evaluation to exclude carcinoma. To aid in this distinction, nipple discharge has been classified in the literature as secretion, which must be expressed, versus discharge, which is spontaneous (also termed provoked versus spontaneous). A classification of galactorrhea (milky) versus physiologic versus pathologic discharge has also been used. In the final analysis, the point of any classification is to identify patients whose symptoms indicate intrinsic breast pathology that requires a histologic diagnosis.