Nipple discharge

Nipple discharge is fluid from the nipple, with or without squeezing the breast. The discharge can be milky, clear, green, purulent, bloody, or faintly yellow. The consistency can be thick, thin, sticky, or watery. ==Causes==

Nipple discharge can arise from any one or more of the 15 to 20 milk ducts that each breast contains, and its causes can be divided into normal (physiological) and abnormal (pathological). Up to half of women with intraductal papillomas may present with bloody nipple discharge, but it can also be straw-coloured. Ductal carcinoma in situ (DCIS) usually presents with abnormal findings on mammography, but can less frequently present with a lump or nipple discharge in women, whereas in men with DCIS, nipple discharge is the common presentation. Infection in a breast, either mastitis or breast abscess may cause a discharge. • Medication for hypertension: Methyldopa, reserpine, verapamil • Gastrointestinal agents: Cimetidine, metoclopramide • Hormones: Estrogen, birth control pill • Opiates: Codeine, heroin, methadone, morphine • Psychotropic drugs: Antipsychotics, monoamine oxidase inhibitors, neuroleptics, selective serotonin reuptake inhibitors, tricyclic antidepressants Some herbs including anise and fennel have also been implicated as causing leaking of fluid from nipples. ==Diagnosis==

The evaluation of milky nipple discharge in a non-pregnant, not breast feeding women is different to the assessment of other abnormal nipple discharge. The absence of cancerous cells in samples of nipple discharge does not exclude cancer, hence cytology of the nipple discharge is not usually performed. ==Treatment==

Initially, an evaluation for cancer is indicated. Treatment will depend on the cause found, and may involve changing medication, having a lump removed, applying a cream to treat a skin condition or being given medication to treat the condition causing the discharge. Duct ectasia may be treated with surgical removal of the ducts involved. ==Epidemiology==

Nipple discharge is the third most common breast complaint by women, after breast pain and a breast lump. 10% of women can notice a nipple discharge when squeezing their breast and more than 50% of women can experience this using a breast pump. Most abnormal nipple discharge is not associated with breast cancer, but 1-5% of breast cancers present with nipple discharge. ==References==