Not All Nipple Discharge Is a Sign of Cancer

Nipple discharge is one of the most common reasons for visits to breast disease clinics. Although this condition is often associated with breast cancer, not every discharge from the breast is a sign of cancer, emphasizes Specialist Dr. Aresh Soudmand, Diagnostic Radiology Specialist at Batıgöz Health Group Balçova Surgical Medicine Center. He notes that the discharge must be evaluated according to its characteristics and in some cases carries important clues for early diagnosis.

Discharge Characteristics Guide the Diagnostic ProcessIn evaluating nipple discharge, not only the presence of discharge matters; its color, consistency, whether it comes from one or both breasts, whether it originates from a single or multiple milk ducts, and whether it occurs spontaneously are of great importance.

Reminding that milk production seen during pregnancy and lactation is physiological, Specialist Dr. Soudmand notes that milk-like discharges may be considered normal for some time after breastfeeding ends, but discharge occurring outside the breastfeeding period must always be evaluated by a physician.

Not All Nipple Discharge Indicates Cancer
Discharge from both breasts, originating from multiple milk ducts, and white, milk-colored, yellow or greenish discharge most often develops due to hormonal reasons.

Specialist Dr. Soudmand points out that elevated prolactin hormone, thyroid diseases, certain blood pressure medications, antidepressants, birth control pills and various hormonal treatments can cause such discharge. He also emphasizes that frequent manual expression of the nipple for checking can perpetuate the discharge. For this reason, unnecessary squeezing of the nipple is not recommended.

Unilateral and Bloody Discharge Warrant Attention
Clear, pink or bloody discharge from a single breast, occurring spontaneously and originating from only one milk duct requires more detailed examination.

Specialist Dr. Soudmand notes that these findings do not always indicate breast cancer, but alerts to the possibility that nipple discharge may be an initial sign of conditions such as intraductal papilloma, ductal ectasia, atypical cellular changes, ductal carcinoma in situ (DCIS) or invasive breast cancer.

Benign Lesions Are the Most Common Cause of Bloody Discharge
Although bloody nipple discharge is one of the findings that causes the most concern in women, it is noted that the most common cause is benign intraductal papillomas developing within milk ducts.

Specialist Dr. Soudmand states that papillomas can cause bleeding of small blood vessels within the milk duct. Nevertheless, bloody discharge must always be investigated with radiological imaging methods, as some early-stage breast cancers may present with only this symptom.

What Does Green or Dark-Colored Discharge Mean?
Green or dark-colored nipple discharge is most often associated with ductal ectasia, defined as widening of the milk ducts.

This condition, seen more frequently in women approaching menopause, can develop secretion accumulation and inflammatory changes in the milk ducts. Although usually benign, clinical evaluation and radiological examination are recommended.

Breast Infections Can Also Cause Discharge
Infections are highlighted as another cause of nipple discharge.

In mastitis and breast abscesses, particularly seen during breastfeeding, yellow, foul-smelling and inflammatory discharge can develop. This presentation is often accompanied by breast redness, pain, tenderness and fever. Early diagnosis and appropriate treatment can yield successful outcomes.

Imaging Methods Play a Decisive Role in Diagnosis
The imaging method used in evaluating nipple discharge is determined according to the patient's age and clinical findings.

In women aged 40 and over, mammography is one of the preferred initial methods, allowing evaluation of microcalcifications, masses and structural changes in milk ducts. It plays an important role particularly in detecting early-stage breast cancers.

In younger women and patients with dense breast tissue, ultrasound comes to the forefront. Through ultrasound, duct dilatation, papillomas, cysts and abscesses can be evaluated in detail. Doppler ultrasound can be added to the examination when necessary.

Breast MRI and Biopsy Can Be Performed When Indicated
In cases where nipple discharge persists despite normal mammography and ultrasound results, particularly in unilateral and bloody discharge, breast MRI examination may be planned.

Contrast-enhanced breast MRI offers high sensitivity in evaluating small lesions within milk ducts, and biopsy can be performed under ultrasound or stereotactic mammography guidance when suspicious areas are detected.

Specialist Dr. Soudmand also emphasizes that the widely held belief "If biopsy is performed, cancer spreads" has no scientific basis.

When Should You Consult a Physician?
In the following situations, it is recommended to consult a general surgeon or a radiology specialist experienced in breast imaging without delay:

Discharge coming from only one breast,
Occurring spontaneously,
Being bloody or clear in color,
Coming from a single milk duct,
Presence of a palpable mass in the breast,
Nipple retraction,
Breast skin thickening or orange-peel appearance,
Feeling of swelling in the armpit.

Although milk-colored or greenish discharge from both breasts only upon expression is most often due to benign causes, specialist evaluation should not be neglected.

Early Evaluation Facilitates the Diagnostic Process
In his assessment of the matter, Specialist Dr. Aresh Soudmand, Diagnostic Radiology Specialist at Batıgöz Health Group Balçova Surgical Medicine Center, states that nipple discharge alone does not establish a breast cancer diagnosis but is a finding that must be taken seriously:

"To correctly identify the cause of nipple discharge, planning appropriate radiological imaging methods together with clinical examination is of great importance. Through evaluations performed in the early period, benign diseases can be managed without causing unnecessary concern, and when necessary, the diagnostic process can be planned without delay. Informed monitoring and timely specialist evaluation hold an important place in breast health."

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