Nipple discharge? Clinical history is essential to diagnosis: look to color for clues.(Gynecology)

SAN DIEGO -- Clinical history is the most important factor in determining if nipple discharge is significant, Dr. Julia A. Files said at the annual meeting of the American College of Physicians.

"Nipple discharge is an alarming symptom to both patients and physicians," said Dr. Files, an internist with the Mayo Clinic, Scottsdale, Ariz.

"The most important thing you need to figure out is if this is a suspicious or a benign discharge. Is this discharge breast cancer? That's what we really want to know," she said.

Benign discharges are usually bilateral and occur with breast manipulation or stimulation. They can occur during breast self-exams or when a woman is running without adequate breast support. Benign discharges are described as milky, sticky, or multicolored.

Suspicious discharges are generally unilateral, spontaneous, persistent, and not associated with lactation. "The woman will come in and say, "I took my bra off and there was a discharge, or sticky stuff on my bra,' "Dr. Files said. "It's a persistent finding."

An increased association with carcinoma has been seen when the discharge is clear, serous, serosanguineous, or bloody.

As part of a routine work-up, Dr. Files recommends diagnostic breast imaging using mammography and ultrasound with special attention to the retroareolar area. No definite benefits have been identified for the routine use of nipple discharge cytology ...