Women's Health

Breast Nipple Discharge

Written by Mark Abell

With the increasing awareness to breast cancer in women, more emphasis is being placed on the practice of teaching women to perform their own monthly breast examinations. Most clinicians can give you literature that not only supports the need to do your own exam, but instructions on how to perform them can be made available to you. There is an increasing awareness to the fact, even among the lay person, that a nipple discharge can be a sign of breast cancer and it would be important to at least know the risks and how to have your breasts examined in the event of a discharge.

According to a recent study, more than seven percent of women who underwent breast surgery for cancer presented initially to the clinician with a nipple discharge. That is a large number, indeed. Through the years, medical science has been able to categorize the type of discharge with relationship to its importance; essentially, there are four different aspects of the discharge your clinician should be ascertaining: The presence of gross or occult (not seen) blood in the discharge; the nature of the discharge; whether one or both breasts are involved; and single versus multiple "duct" secretions as well as any other "clinical findings" that are associated with the discharge, such as pain, etc.

Basically speaking, the breast is a gland. Its purpose, of course, is to produce and secrete breast milk for the young. Inside the breast tissue are a large number of "lobes", each one having their own secretory properties; the end result is the secretion of milk. Most of the breast tissue (at least the functional tissue) is located beneath the nipple and in the upper (outer) quadrant of the breast. For purposes of anatomy and simplification, always try to "separate" your breast into four quadrants. This will divide the breast itself into four sections, the right upper, right lower, left upper and left lower. The nipple, therefore will be in the middle. And the "tail" of the breast is extending into the axilla (or the armpit). For purposes that will aide you in your self-exam, use the four imaginary quadrants to conduct your exam, leaving one quadrant only when you complete the other, and so on. The nipple is checked last.

So, here is the general scoop and what to look for. After completing the breast exam, as in the shower, always stand in front of a mirror with both breasts exposed. Look for symmetry (that is, equal size and shape) - but don't be alarmed if one breast is slightly larger or even higher than the other - that could be normal. But, more important findings in the nipple themselves is a change in the direction - if one nipple, for instance, seems to be going upwards or downwards (and that wasn't true before) - then there could be a reason to see your physician. Other things to look for are dimpling of the skin around one or both nipples (this is why it's important to do your own breast exams once monthly - not while on your period - as you will get to know what is right and what is wrong).

When your physician conducts your breast exam (which should be completed at least once a year along with the pap smear), he or she will be "palpating" or "feeling the texture" of the breast tissue. Usually, when he or she feels a general "lumpiness" with no "one dominant mass" found in the breast - it is referred to as fibrocystic disease - which is relatively common and benign. After the breast tissue is examined, the nipple is gently squeezed to ensure that a discharge is not present. A "bloody show" is usually a good sign of breast cancer.

Always go to your physician for a breast exam while you are off of your period. The nipple and the breast tissue is unusually sensitive during that period of time and a "false positive breast exam" is possible. If you went to your physician for the purpose of being examined for a breast nipple discharge, and the clinician is unable to retrieve or note a discharge, chances are he or she will have you return to the practice very soon for another exam.

Concerning the discharge, if any, the clinician know what to do; there are bank of tests that should be completed with regard to the testing of the discharge. The important issue here is not so much to understand all of the different tests or the types of discharge, but to be sure to let your doctor know if one does in fact, exist. It is important to know and understand that a clear discharge from the breast during pregnancy is common. Even (although rare - less than 1 percent of women) a bloody discharge is possible; nevertheless, have all abnormalities checked by your doctor.

For those who may want to surf the net and find out more about breast discharge, see the following sites on the Internet:

There are a lot more sites available - too many to list here. Search "key words" including Breast Cancer, Breast Nipple Discharge, Breast Self-Exam, etc.

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