By Dr. W. Gifford Jones
November 29, 1992
How ominous a sign is discharge from the nipple? A few weeks ago I received an anxious call from a business woman. A few days earlier she had noted a greenish discharge from one of her nipples. She was convinced she had a malignancy and was finding it impossible to keep her mind on her work.
¡ One thing is certain. No woman ever has discharge from the breasts, except in pregnancy, without spending a sleepless night. But it is not an invariable sign of malignancy.
¡ The ducts of the nipple are normally kept open by a continual secretion of a small amount of mucous. But the amount is so minimal that most women are not aware of it. The secretion either evaporates before being detectable or the tiny crusts are washed away during bathing.
¡ Some women secrete more discharge than others and from time to time they detect a slight amount of discharge on either the inside of their brassiere or nightdress.
¡ Some young women during menstruation may notice a clear or straw©coloured discharge. Breast discharge is also on the increase because of the many women taking oral contraceptives or estrogen during menopause. And women at menopause may accidentally discover that when they squeeze the nipple a small amount of discharge is present.
¡ Discharge from both breasts is normally not a sign of cancer. The discharge may be clear, yellow, milky, grey or green. But if it is present on both sides and not bloody there's usually little to worry about. But be sure to have it checked by your doctor.
¡ What are the chances that this particular business woman has a malignancy? Studies show that about 8 per cent of patients who require surgery for either benign or malignant breast disease have previously noted some breast discharge.
¡ Another statistic is reassuring. Drs. H.P. Leis and S. Grey reported on 1,868 consecutive cases of benign and malignant breast disease. Nipple discharge occurred in 152 cases, but cancer was associated with nipple discharge in only 19 or one per cent of the cases. In another study out of 504 cases of cancer a watery, straw™coloured or bloody discharge was present in 4 per cent of the cases.
The most common cause of a greenish or bloody nipple discharge is an intraductal papilloma of the breast. It's a benign, warty growth arising from one of the major ducts leading to the nipple.
¡ The colour of the discharge varies. Greenish or brown©coloured discharge simply indicates that there is a minimal amount of blood being secreted from the wart growth.
¡ The blood changes from it's normal red colour the longer it remains within the ducts. But when the discharge is frankly red in colour, it indicates that increased bleeding is taking place and it is being more rapidly discharged from the breast.
¡ Mammography is usually of little help in diagnosing this problem. The lesion is so small that it is rarely detected by this procedure. Doctors can sometimes feel a tiny, non©tender lump beneath the nipple that varies in size from a caraway seed to a small pea.
¡ But if a lump cannot be felt the location of the lesion under the nipple is determined by examining the patient under a general anaesthetic. Tiny probes are inserted into the ducts and gentle pressure applied at various points around the circumference of the nipple. Blood will be seen coming out of the involved duct.
¡ Fortunately the operation to remove an intraductal papilloma is not a mutilating operation. The surgeon simply excises the duct containing the lesion which is rarely more than one centimetre (half an inch) deep in the nipple.
¡ Women are understandably anxious to know if the lesion was benign or malignant following the operation. This is often possible when breast cancer is present. The pathologist can perform a quick frozen section of the tissue to make this cancer diagnosis. But frozen section of intraductal papillomas is notoriously hard to interpret. So patients must wait a few days for the tissue to be examined by the routine method.
¡ Intraductal papillomas, however are rarely malignant. So quick diagnosis is not needed. One busy surgeon told me that in 36 years of practice he had only seen one malignant intraductal papilloma.
¡ The moral. Women should never neglect seeing their doctor if they discover any type of discharge from the nipple. Bloody discharge in young women will usually be due to an intraductal papilloma. Bloody discharge in women after the menopause is more often due to a malignancy and demands prompt attention.
W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of Harvard. Dr. Walker's website is: Docgiff.com
My book, �90 + How I Got There� can be obtained by sending $19.95 to:
Giff Holdings, 525 Balliol St, Unit # 6,Toronto, Ontario, M4S 1E1
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