Abstract
Background and aims
The aim of this study was to assess management strategies for patients with nipple discharge (ND).
Patients and methods
The records of 13,443 women with breast-related complaints who were examined by the same surgeon between 1 January 1960 and 31 December 2000 were retrospectively assessed. Patients with ND were grouped according to whether they had had a spontaneous or provoked discharge. The parameters investigated in each group were age, physical findings, number of pregnancies, duration of lactation, duration of discharge, colour of discharge, and histopathological features. Chi-square and Mann–Whitney U-tests were used for statistical analysis.
Results
ND was the presenting symptom in 603 (4.5%) of the cases. Two hundred and eighty-seven (48%) of the 603 patients showed spontaneous nipple discharge (SND group) and the other 316 (52%) showed provoked nipple discharge (PND group). In the SND group, 124 (43%) tissue specimens were obtained by either biopsy or sub-areolar exploration. Histopathological examination revealed that the most frequent causes of ND in these cases were intraductal papilloma (49 patients; 40%), intraductal carcinoma (35 patients; 28%), and cystic disease (15 patients; 12%). Twenty tissue specimens were obtained from the group with PND. In these cases, the most frequently identified causes of ND were cystic disease (seven patients; 35%), intraductal papilloma (six patients; 30%), ductal ectasia (two patients; 10%), and carcinoma (one patient; 5%). The SND and PND groups differed significantly with respect to age (P=0.001) and duration of ND (P=0.008). The incidence of cancer was higher in the SND specimens than in the PND specimens (28% vs 5%, respectively; P=0.01). The number of pregnancies was significantly higher and the duration of lactation was significantly longer in the SND group (P=0.03 and P=0.02, respectively).
Conclusion
The study confirms previous reports that patients with SND have a higher incidence of carcinoma than those with PND. The results suggest that older age, higher number of pregnancies, and longer duration of lactation may predispose to cancer development in patients with SND. The possibility of breast cancer should also be kept in mind when one is assessing patients with PND. Careful physical examination and close follow-up is the optimal management strategy for patients with any type of ND.
Similar content being viewed by others
Notes
Data obtained from the personal series of Dr Husnu A. Goksel with his permission
References
Leis HP (1989) Management of nipple discharge. World J Surg 13:736–742
Gulay H, Bora S, Kilicturgay S (1994) Management of nipple discharge. J Am Coll Surg 178:471–474
Dawes LG, Bowen C, Venta LA, Morrow M (1998) Ductography for nipple discharge: no replacement for ductal excision. Surgery 124:685–691
Piccoli CW, Feig SA, Vala MA (1998) Breast imaging of the day. Radiographics 18:783–786
McLaughlin CW, Coe JD (1963) A study of nipple discharge in the non-lactating breast. Ann Surg 157:810–816
Shen KW, Wu J, Lu JS (2001) Fiberoptic ductoscopy for breast cancer patients with nipple discharge. Surg Endosc 15:1340–1345
Orel SG, Dougherty CS, Reynolds C (2000) MR imaging in patients with nipple discharge: initial experience. Radiology 216:248–254
Morrow M (2000) The evaluation of common breast problems. Am Fam Physician 61:2371–2378
Jardines L (1996) Management of nipple discharge. Am Surg 62:119–122
Flario MG, Manganaro T, Pollicina A (1999) Surgical approach to nipple discharge: a ten-year experience. J Surg Oncol 71:235–238
Haagensen CD, Bodian C, Haagensen DA (1981) Breast carcinoma, risk and detection. Saunders, Philadelphia, pp 146–149
Devitt JE (1989) False alarms for breast cancer. Lancet 2:1257–1258
King TA, Carter KM, Bolton JS, Fuhrman GM (2000) A simple approach to nipple discharge. Am Surg 66:960–965
Azzopardi JG (1979) Problems in breast pathology. Saunders, London, pp 150–239
Kraus FT, Neubecker RD (1962) The differential diagnosis of papillary tumours of the breast. Cancer 15:444–455
Haagensen CD (1986) Diseases of the breast. Saunders, Philadelphia, pp 136–174
Carter D (1977) Intraductal papillary tumors of the breast: a study of 78 cases. Cancer 39:1689–1692
Page DL, Salhany KE, Jensen RA, Dupont WD (1996) Subsequent breast carcinoma risk after biopsy with atypia in a breast papilloma. Am Cancer Soc 78:258–266
Zheng T, Holford TR, Mayne ST (2001) Lactation and breast cancer risk: a case control study in Connecticut. Br J Cancer 84:1472–1476
Purwanto H, Sadjimin T, Dwiprahatso I (2000) Lactation and the risk of breast cancer. Gan To Kagaku Ryoho 27[Suppl 2]:474–481
Wohlfahrt J, Andersen PK, Mouridsen HT, Melbye M (2001) Risk of late-stage breast cancer after a childbirth. Am J Epidemiol 153:1079–1084
Peck JD, Hulka BS, Poole C (2002) Steroid hormone levels during pregnancy and incidence of maternal breast cancer. Cancer Epidemiol Biomarkers Prev 11:361–368
Surbone A (2001) Too early to say that pregnancy has an antitumor effect on breast cancer. J Clin Oncol 19:3707–3708
Surbone A, Petrek JA (1997) Childbearing issues in breast carcinoma survivors. Cancer 79:1271–1278
Surbone A, Petrek JA (1998) Pregnancy after breast cancer. The relationship of pregnancy to breast cancer development and progression. Crit Rev Oncol Hematol 27:169–178
Fentiman IS (2001) Fixed and modifiable risk factors for breast cancer. Int J Clin Pract 55:527–530
State D (1991) Nipple discharge in women. Is it cause for concern? Postgrad Med 89:65–68
Cheung KL, Alagaratnam TT (1997) A review of nipple discharge in Chinese women. J R Coll Surg Edinb 42:179–181
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Goksel, H.A., Yagmurdur, M.C., Demirhan, B. et al. Management strategies for patients with nipple discharge. Langenbecks Arch Surg 390, 52–58 (2005). https://doi.org/10.1007/s00423-004-0515-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00423-004-0515-6