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Unveiling Nipple Discharge As A Potential Indicator Of Breast Cancer

Breast cancer stands as the predominant cancer affecting women in India. This condition entails the formation of abnormal malignant tumours within the breast region. These tumours initially divide in a controlled manner, but as they progress, they exhibit unregulated growth and, in more advanced stages, have the potential to spread to other parts of the body. The early symptoms of breast cancer are of paramount importance. Lumps and bumps in the breast, near the collar bones or under the armpits are crucial indicators of a tumour in the breast. Another noteworthy symptom is a nipple discharge. This article aims to delve into these early signs, providing a comprehensive understanding of their significance.

What is nipple discharge?  

A nipple discharge is described as a condition where any fluid or liquid comes out of the breast nipple. A nipple discharge either seeps out on it’s own or it squeezes out. The primary function of the female breast is the production and secretion of milk after giving birth to a baby. The milk is produced in the lobules and passed into the nipples through a structure called the ducts. Milk is produced after childbirth to feed the baby.
A nipple discharge can happen when a woman is not pregnant and is usually normal. However, it also indicates an infection or other serious health issues like cancer.

How is nipple discharge associated with cancer?  

A nipple discharge is one of the early symptoms of breast cancer. According to a research paper published in PubMed Central, the incidence of breast cancer in pathological nipple discharge is 7 to 15%. A nipple discharge, along with the presence of lumps, is a matter of concern; however, a biopsy can determine whether the abnormal growth is benign or malignant in nature. Nipple discharge results from cancer if the tumour is in or near the ducts. Benign or non-cancerous conditions such as mastitis, fibrocystic changes, intraductal papillomas, duct ectasia, and papillomatosis are also associated with breast cancer.

What are the types of nipple discharge?

The types of nipple discharge are classified based on the colour of the fluid and are as follows; 

  • White, yellowish or cloudy discharge: It results from the infection of breasts or nipples. 
  • Green discharge: It results from fibrocystic changes in the breast. Cysts feel like a lump, but they are not cancerous. 
  • Brown, milky or cheese-like discharge results from the blocked milk duct, also known as mammary duct ectasia.
  • Clear: A clear nipple discharge indicates possible breast cancer, especially if it comes from only one nipple. 
  • Bloody: Bloody discharge also suggests possible breast cancer or papilloma (benign tumour). 

Nipple discharge that happens spontaneously, without squeezing, is the primary cause of cancer because the ones that happen without squeezing need not be dangerous. Similarly, if the discharge comes from a single spot instead of multiple spots, then it is a possible health issue, and she should consult a doctor.

What are the causes of nipple discharge other than breast cancer?

Nipple discharge is not necessarily a surety of breast cancer. It indicates a possible breast health problem, including an infection. The causes of nipple discharge, other than breast cancer, are as follows; 

  • Abscess: It refers to the accumulation of pus in the breast region resulting from complications caused by a bacterial infection called mastitis. Abscess is treated through antibiotics or by draining it with a needle or a small cut. 
  • Birth control pills: Women who take birth control pills or hypertension medicines experience elevated prolactin levels, resulting in a nipple discharge. 
  • Breast infection: Bacterial infections like mastitis cause nipple discharge. 
  • Drug abuse: Excess prolactin levels resulting from intake of drugs like sedatives or marijuana lead to nipple discharge. 
  • Hypothyroidism: Health conditions such as hypothyroidism can lead to nipple discharge because of the increase in prolactin levels. 
  • Endocrine disorders or hormone changes: Hormonal changes resulting from an endocrine disorder lead to nipple discharge. 
  • Excess stimulation: Excess nipple stimulation during sexual activities leads to galactorrhea or milky nipple discharge. 
  • Injury or trauma: The breast can get injured during a car accident, surgery, while playing sports, or due to tight clothing. If the injury is close to the breast ducts, it can result in a nipple discharge. 
  • Mammary duct ectasia: Nipple discharge results from a blocked milk duct, called mammary duct ectasia.

How do we diagnose discharge-related health concerns?

Women can feel their breasts to check for possible lumps. If there are lumps, the symptom shouldn’t be disregarded. Breast-related health issues that result in nipple discharge can be diagnosed through the following methods; 

  • Imaging tests such as mammograms (breast X-ray), ultrasound, and magnetic resonance imaging (MRI) help diagnose tumours, cysts or other accumulations of abnormal cells or fluids. 
  • A biopsy helps determine whether the abnormal lump or tumour is benign or malignant. 
  • A blood test is conducted to check for the levels of prolactin, estrogen-progesterone, and thyroid-stimulating hormone. 

Ductogram is conducted if the discharge is coming from a single. A contrasting dye is injected into the breasts with the help of anaesthesia, which makes the abnormalities in the duct visible in a mammogram.

How is a nipple discharge treated?

If the nipple discharge is due to breast cancer or a benign tumour, then the treatment involves the tumour’s destruction or surgical removal. If the breast cancer has spread beyond it’s point of origin, then the treatment involves partial removal (lumpectomy) or complete removal (mastectomy) of the breast. If the cancer is ER-PR positive (estrogen-progesterone), then medical experts might suggest the removal of both breasts. If the nipple is not related to cancer or a benign tumour, then treatment involves; 

  • Medication to treat infections
  • Hormone treatment 
  • Surgical removal of a milk duct to treat injuries or damages

Can nipple discharge happen in male breasts?

Male breasts also have ducts that lead to the nipples. Changing hormonal levels during the puberty period can lead to nipple discharge in men. Male breasts can also experience nipple discharge due to a variety of reasons, such as breast infection, gynaecomastia (large and swollen male breasts), duct ectasia, benign tumour and breast cancer. Men experience milky discharge from their breasts due to a pituitary tumour called a prolactinoma. It increases prolactin levels in men, reducing testosterone (male hormone) levels in men.

In conclusion,

Women and men who experience nipple discharge should consult a doctor immediately, especially if the colour of the discharge is clear or bloody. Nipple discharge is an early symptom of breast cancer, according to a research paper published in PubMed Central. Oftentimes, a lack of awareness prompts people to ignore this symptom until they experience severe symptoms of breast cancer like pain, weight loss, etc. Early detection and treatment ensure a 92-100% chance of survival.

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