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Topic: Nipple Discharge

Forum: Not Diagnosed But Worried —

Meet others worried about developing breast cancer for the first time. PLEASE DO NOT POST PICTURES OF YOUR SYMPTOMS. Comparing notes, symptoms, or characteristics is not helpful here, as only medical professionals can accurately evaluate and assess your individual situation.

Posted on: Jul 29, 2017 07:43AM

djmammo wrote:

from the American College of Radiology

"Nipple discharge is a common complaint that leads patients to breast imaging evaluation. At least 80% of women will experience at least 1 episode of nipple discharge during their reproductive years. Nipple discharge is the third most common breast complaint after breast pain and breast mass, with a prevalence of 4.8% to 7.4%, and accounts for 5% of all breast symptoms. It is categorized as physiologic or pathologic.

Pathologic nipple discharge tends to be unilateral, from a single duct orifice, spontaneous, and serous or bloodstained. Nipple discharge that exhibits any one of these features may be considered pathologic.

Physiologic nipple discharge tends to be bilateral, from multiple duct orifices, and white, green, or yellow in color. In a study by Goskel et al, nonspontaneous nipple discharge, which was frequently colored or milky, was differentiated from spontaneous nipple discharge, which was considered pathologic. In this study, none of the patients with nonspontaneous nipple discharge developed cancer on follow-up examination. In another study by Bahl et al, no in situ or invasive cancers were found in patients whose nipple discharge did not exhibit any of the pathologic features. If patient history and physical examinations demonstrate physiologic nipple discharge and routine screening mammography is up to date, no radiologic investigation is needed.

Board Certified Diagnostic Radiologist specializing in Breast Imaging helping members understand their health care provider's reports and recommendations.
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Sep 1, 2017 06:02AM - edited Sep 1, 2017 06:08AM by analisa

This Post was deleted by analisa.
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Sep 1, 2017 06:07AM analisa wrote:

if nipple discharge just over 2 nights in bed, without waking me, but then only very little bloody discharge for next 3 days , then nothing - is that still serious?? I am 54 and it was just one nipple.


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Sep 1, 2017 09:14AM djmammo wrote:

analisa

Bloody discharge is always abnormal and always needs to be evaluated. See your doctor.

Board Certified Diagnostic Radiologist specializing in Breast Imaging helping members understand their health care provider's reports and recommendations.
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Sep 1, 2017 01:14PM analisa wrote:

Ok - hav seen dr and hav appointment at breast clinic on tues - just trying to keep calm

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Sep 5, 2017 04:53PM analisa wrote:

hi - just to let you know - had mammogram and ultra sound and nothing abnormal detected which is good. In for op to remove all milk ducts next week - not so good. Think it is duct ecstasia but going to do histology on ducts to make sure - sister had inflammatory breast cancer and died within 6 months - she had a kidney transplant at 16 so was immuno suppressed - so little worrie

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Sep 27, 2017 12:43AM Mins_Mum wrote:

@analisa - did you get results from your duct excision? Was it duct ecstasia

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Sep 27, 2017 07:02PM - edited Sep 27, 2017 07:04PM by Lala-44

It's about 3 years that I have nipple discharge, since having kids. My third baby was born 16 months ago and both breasts if squeezed have a milky to clear discharge equally. Many Drs have seen it and if my nipples are squeezed it can spray across a room! It's As though my milk never dried up. It's not spontaneous and only when provoked. Never breastfed only pumped and this was 16 months ago now. Had countless breast ultrasounds all normal. This month dr did a breast MRI to appease me since I also have an itchy nipple and it was normal. Should i investigate the discharge further? Would an MRI also rule out pagets

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Sep 27, 2017 07:11PM djmammo wrote:

Lala-44

Everything in your history points to a benign physiologic cause: bilateral, non-spontaneous, non-bloody and normal imaging.

Board Certified Diagnostic Radiologist specializing in Breast Imaging helping members understand their health care provider's reports and recommendations.
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Oct 1, 2017 03:41PM GypsyKat wrote:

Hello .

As for the breast pain that surfaced Friday leading me to think it was a hormonal issue escalated through the day in towards the night I started having bloody nipple discharge from my right breast . The pain is a noteable amountand escalating . Leading me to actually go to the ER where I had an US . The findings were a 4mm cyst at 11 oclock discoloration on my outside breast and center , no noted abcesses and the referral to a breast center within 1-2 days .

A Bi rads 0 .

Is there any thing that you can tell me more of this ?

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Oct 2, 2017 12:19AM djmammo wrote:

GypsyKat

Bloody nipple discharge is often caused by an intraductal papilloma, a small nodule in a duct usually located in a duct not to distant from the nipple. I would hazard a guess and say the 4mm cyst is not the cause of the bloody nipple discharge. The cause needs to be determined as a malignancy can cause bloody discharge also. Let us know what happens at your appotintment at the breast center.

Board Certified Diagnostic Radiologist specializing in Breast Imaging helping members understand their health care provider's reports and recommendations.
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Oct 3, 2017 04:50PM Lizmax76 wrote:

41 year old,have not breastfeed in over 3 years. Have been having a sensation of "let down" off and on for a while now. Today I have the feeling in my left breast, and actually have a colustrum looking fluid come out spontaneously. I take and ace inhibitor and antidepressants, I wonder if it could be a side effect? I have a mammogram scheduled for Friday the 13th!! 😩

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Oct 3, 2017 05:39PM - edited Oct 3, 2017 05:42PM by MTwoman

which antidepressant? there are reports of antidepressants causing hyperprolactinemia (which is elevated prolactin levels - which can cause nipple discharge). This should be reported to your prescribing physician.

edited to include this citation: https://www.ncbi.nlm.nih.gov/pubmed/20527996

Dx 12/10/2002, DCIS, Right, 1cm, Stage 0, Grade 2, 0/3 nodes, ER-/PR-, HER2- Surgery 12/20/2002 Lumpectomy: Right; Lymph node removal: Sentinel Surgery 12/23/2003 Reconstruction (right): Nipple reconstruction Surgery Reconstruction (right): Saline implant Surgery Reconstruction (right): Tissue expander placement Surgery Mastectomy: Right
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Oct 8, 2017 11:29PM Calandergirl wrote:

I just turned 35, never had a full term pregnancy but have the clear leakage from the right side and the yuck from the left. It was only one spot until around 4 days ago, now it's 3. Saw the doctor on Friday; my mammogram and u/s are tomorrow morning. I also have cystic tissue in the right side which led to biopsy and a few conversations a couple years ago.

Nay :)
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Oct 9, 2017 07:44PM Calandergirl wrote:

Had the imaging and they found nothing!

Nay :)
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Oct 10, 2017 10:39AM MTwoman wrote:

what was your BIRADS score/recommendations? and how are they explaining the discharge?

Dx 12/10/2002, DCIS, Right, 1cm, Stage 0, Grade 2, 0/3 nodes, ER-/PR-, HER2- Surgery 12/20/2002 Lumpectomy: Right; Lymph node removal: Sentinel Surgery 12/23/2003 Reconstruction (right): Nipple reconstruction Surgery Reconstruction (right): Saline implant Surgery Reconstruction (right): Tissue expander placement Surgery Mastectomy: Right
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Oct 13, 2017 02:47PM Lala-44 wrote:

my breast surgeon decided to put the discharge on slides and send them off to pathology. He said it looks for abnormal cells. What can they diagnose from breast discharge ? What kind of cancer can be detected this way? I’m confused :

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Oct 13, 2017 03:50PM djmammo wrote:

Lala-44

If something is growing in the duct it can shed cells that wind up in the discharge.

See THIS article.


Board Certified Diagnostic Radiologist specializing in Breast Imaging helping members understand their health care provider's reports and recommendations.
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Oct 14, 2017 12:31PM Lala-44 wrote:

thanks DJ. Always so very helpful.

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Nov 3, 2017 04:34PM WorriedMe77 wrote:

I have blueish/green discharge from both nipples but only when squeezed. I recently was given a Bi rad score of 5 because of a mass found on ultrasound and diagnostic mam

Dx 11/2017, DCIS/IDC, Left, <1cm, Stage IIB, Grade 2, 1/4 nodes, ER+/PR+, HER2+ Dx 11/14/2017, Left, <1cm, Grade 2 Surgery 12/4/2017 Lumpectomy: Left Targeted Therapy 2/8/2018 Perjeta (pertuzumab) Chemotherapy 2/9/2018 Carboplatin (Paraplatin), Taxotere (docetaxel) Radiation Therapy Whole-breast: Breast
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Nov 3, 2017 05:23PM MTwoman wrote:

WorriedMe, I just answered you on another thread here: https://community.breastcancer.org/forum/62/topics/774050?page=7&post_creation=true#post_5081788

so very sorry

Dx 12/10/2002, DCIS, Right, 1cm, Stage 0, Grade 2, 0/3 nodes, ER-/PR-, HER2- Surgery 12/20/2002 Lumpectomy: Right; Lymph node removal: Sentinel Surgery 12/23/2003 Reconstruction (right): Nipple reconstruction Surgery Reconstruction (right): Saline implant Surgery Reconstruction (right): Tissue expander placement Surgery Mastectomy: Right
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Nov 4, 2017 12:11AM empress2890 wrote:

HI EVERYONE, MY NAME IS TANEISHA, I AM 27YRS OF AGE. I HAVE A DAUGHTER SHE IS 7YRS OF AGE. A SHORT HISTORY BEFORE I BEGIN, MY MATRIARCH SIDE OF FAMILY (MOTHER- BREAST OVARIAN CANCER @48, DID MASCECTOMY AND REMOVAL OF OVARIES & RELATED REPRODUCTIVE ORGANS). GRANDMOTHER @50YRS ENDOMETRIAL CA2 & PRECANCEROUS BREAST CANCER. AUNT VERNA DIED @32 FROM ENDOMETRIAL CANCER STAGE 4. AUNTY ANGELLA DIED FROM BREAST OVARIAN CANCER @44 STAGE 4 TERMINAL AFTER TREATMENT FAILED.

MY LAST AUNTY P, BREAST OVARIAN, AND ENDOMETRIAL CANCER STAGE 3, BUT DIED FROM BLOCKED ARTERIES IN THE HEART@55 IN JULY 2017.

I have endometrial hyperplasia, if had advance i cannot say. I have done numerous hormone treatments to sort it out. Cin 2, confirmed from colopscopy. Followed by COLD KNIFE COAGULATION. (IT WAS BURNED). I HAD CONFIRMED A LUMP IN LEFT BREAST IN 2015 @5MM. SURGEON TOLD ME IT WOULD HAVE DISAPPEARED. EVENTUALLY IT DID, BUT NOT BEFORE COMING BACK AND EXPANDED MORE. CONSTANT BREAST PAIN, IMPALPABLE LUMP IN LEFT BREAST AT TIMES. CURRENTLY HAVING NIPPLE DISCHARGE OF SLIGHT BLOODY PUS, OR WATERY @ TIMES. RIGHT BREAST DISCHARGE SEEMS WORSE THAN LEFT.

I AM SCHEDULED FOR A TOTAL ABDOMINAL AND BILATERAL OOPHERECTOMY ON DECEMBER 1, 2017, HOWEVER, MY GYNAE TEAM WAS TRYING TO GET A JOINT SURGERY (ADVANTAGE OF DOING THE 2 SURGERY ONCE) WITH GEN SURGEONS WHO PERFORMS DOUBLE MASECTOMY, CONSIDERING THE ISSUES IM HAVING AND THE FACT THAT I MAY HAVE GENE MUTATION. BUT GEN SURGEONS WILL NOT MOVE FORWARD WITHOUT CONFIRMATION OF GENE MUTATION (RE BRACA 1&2TESTING. THIS WAS DONE TODAY AND WAITING RESULTS. 4 WEEKS TIME BEFORE CONFIRMATION).

I DID MY BREAST MRI. RESULT IS AS FOLLOWS:

BREASTS ARE SYMMETRICAL & DEMONSTRATE PREDOMINANTLY FATTY TISSUE WITH SCATTERED FIBROGLANDULAR ELEMENTS

0.04CM RIGHT 1:00 CYST 4CM POSTERIOR TO THE NIPPLE. POST IV CONTRST, THERE IS MILD NODULAR BACKGROUND PARENCHYMAL ENHANCEMENT BILATERALLY. BENIGN CHARACTERISTICS. NO ENHANCING BREAST LESION SEEN.

IMPRESSION:

SUBCENTIMETER RIGHT 1:00 CYST.

NO EVIDENCE OF MALIGNANCY. BIRAIDS 2.

I WOULD LIKE TO UNDERSTAND, WHAT THIS MEANS. PLEASE AND THANK YOU AS I'M EMOTIONALLY DRAINED FROM BEING IN THE HOSPITAL CONSTANTLY RE HEMORAGHING FROM ABNORNAL URETRINE BLEEDING. I AM WORRIED ABOUT MY BEASTS AS WELL. 😔

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Nov 6, 2017 10:45AM MTwoman wrote:

empress, what your imaging report says is that 1) your breast tissue is primarily fatty tissue (i.e. easier to see through than dense tissue and dense breast tissue conveys an increased risk for bc, so good you don't have that) 2) symmetrical is good 3) the cyst at 1:00 is no problem, simple cysts aren't removed and aren't even considered an increased risk for bc (if painful, they can be aspirated, which means have their fluid taken out with a needle) 4) "no evidence of malignancy" means they found NO signs of breast cancer 5) BIRADS 2 is the score when they find NO evidence of breast cancer. So you got a great report, congrats! Once you get your genetic testing back, you can discuss any findings with a genetic counselor and then make some decisions about your specific risk profile and the risks versus benefits of prophylactic surgery. Good luck!

Dx 12/10/2002, DCIS, Right, 1cm, Stage 0, Grade 2, 0/3 nodes, ER-/PR-, HER2- Surgery 12/20/2002 Lumpectomy: Right; Lymph node removal: Sentinel Surgery 12/23/2003 Reconstruction (right): Nipple reconstruction Surgery Reconstruction (right): Saline implant Surgery Reconstruction (right): Tissue expander placement Surgery Mastectomy: Right
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Dec 11, 2017 12:20PM NSwrites wrote:

Hi DJMammo - sorry to call on you by name, but I figured you were the best person to ask.

I have both spontaneous and expressable dark nipple discharge (brownish black) from one duct of one breast only. The other ducts release milky fluid.

I had a mammogram and ultrasound that showed nothing out of the ordinary (I have fibrocystic breasts), with a BIRAD score of 2.

I still have the discharge and the nurse at my clinic seemed reluctant to order additional tests. I have asked her to talk with the doctor about ordering additional tests, as the symptom has persisted.

My question is: is there a specific test I should insist on to diagnose this? Everything I have read indicates that because this is one breast, one duct, and dark abnormally colored discharge that comes out spontaneously, this is not something to brush off, but I can't seem to find indications of what "something" might actually be happening, so I'm struggling to advocate for testing. Can you advise me in any way about the possible tests/questions I should raise with my doctor?

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Dec 11, 2017 12:30PM Mins_Mum wrote:

Hi NS, I have had a very similar set of symptoms and am 7 months in, with no real explanation but also no diagnosis. I have seen 3 different breast surgeons in this time, and have had several imaging exams with a BIRADS score of 2 and it really does appear that there is nothing malignant going on. I just had my 6 month follow up, with a similar outcome.

Let’s see what DJmammo says, but from my experience I’d say the ultrasound has given the clearest picture to the doctors of everything I’ve had done.

I had a hard time finding any info on what this could be, so I wanted to let you know that so far this has turned out to be a lot of worrying but nothing of significance. I hope the same for you

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Dec 12, 2017 06:55AM djmammo wrote:

NSwrites

As a rule I don't worry about nipple discharge unless it is frankly bloody or clear. Black, green, blue discharge is usually related to fibrocystic changes. When dark it can mask the presence of blood.

The discharge can be tested for the presence of blood fairly easily. The most common cause for bloody discharge is an intraductal papilloma. These can be extremely small, and if there is debris in the duct it may not be seen on US without using Doppler to detect the blood flow within it.

The most specific exam for an intraductal mass is a ductogram.

Board Certified Diagnostic Radiologist specializing in Breast Imaging helping members understand their health care provider's reports and recommendations.
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Dec 12, 2017 08:35AM NSwrites wrote:

thanks, djmammo. If mine is due to fibrocystic changes, do you know if it will resolve on it's own? I have noticed the discharge for over three weeks now.

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Dec 12, 2017 08:57AM djmammo wrote:

NSwrites

It varies from patient to patient. If its benign and persists, the duct causing the discharge can be removed.

Board Certified Diagnostic Radiologist specializing in Breast Imaging helping members understand their health care provider's reports and recommendations.
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Dec 21, 2017 09:48PM Lk1080 wrote:

I have had occasional discharge from both breasts. i notice because I see a crust in the nipple. I had prolactin test and that is normal. Just had a 3d mammogram. The radiologist looked at my mammogram while I was waiting and said it looked great. i think that I have had the occasional discharge for at least 2 years, do you think I need more testing to make sure everything is ok?

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Jan 21, 2018 11:03AM - edited Jan 21, 2018 11:04AM by Leigh81

Hi. I've had nipple discharge off and on for the last 18 years. I am 36. It is not spontaneous. And is ranges from cloudy to yellowish, green in colour. It looks like it comes from 2 ducts. I've not really ever spoken to my dr about it. 2 years ago I had an ultrasound on my breast, nodes under my arm and a suspected on above the collarbone. Everything came back normal. I also struggle with sever health anxiety. I am to go back next week for a follow up to check the size of the nodes. They are not swollen anymore but she wants to follow up anyway. I'm terrified. Anyway I can eaise my mind.

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Jan 21, 2018 12:39PM djmammo wrote:

Lk1080 and Leigh81

We primarily worry about discharge that is visibly bloody or clear, persistent, from just one duct opening, and spontaneous. All the other colors are usually from fibrocystic changes. Prolactin levels are checked when the discharge looks like milk (lactation) otherwise there is no point in checking that.

The worrisome types are usually caused by a small growth in the duct (papilloma) that is almost never seen on mammogram unless it is calcified or significantly obstructing a duct at which time you may only see a dilated duct. The first exam would be ultrasound followed by a ductogram if the US is negative. MRI can show such a growth but the ductogram is much more specific if one is present. They are always removed as some can evolve into a cancer over time.

Board Certified Diagnostic Radiologist specializing in Breast Imaging helping members understand their health care provider's reports and recommendations.

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