Dear Readers,

Amoy is a 32-year-old lady who writes Lifeline from her home in Mandeville. She is the mother of two young children and is worried that since the birth of her last child, both breast nipples have continued to secrete milk-like fluid, although she stopped breastfeeding over three years ago. Her family doctor has reassured her that her breasts are normal and that she should not worry about the nipple secretions. Amoy asks Lifeline for an opinion on the matter.

Nipple discharge is the third most common breast disorder for which women seek medical help after breast lumps and breast pain. The female breast secretes some small amount of fluid most of a female adult's life, but in non-lactating women (women not breast feeding), small plugs of tissue block the nipple ducts and prevent the nipples from leaking fluids. Most nipple discharges are not cancerous!

Nipple discharge should be looked upon with concern when:

It is bloody or has a pink tinge or a brown colour.

The discharge is sticky (even if clear and definitely if discoloured).

The nipple leaks fluids even without squeezing.

The nipple discharge occurs from one nipple only.

Nipple discharge occurs for the first time in a female over 40 years old.

The nipple discharge is associated with a swelling or lump in the breast.

The nipple discharge occurs in a man.

A nipple discharge refers to any fluid that comes out of the nipple area of the breast. While most nipple discharges occurring in ladies who are neither pregnant nor breastfeeding are normal, this is not acceptable in a man. A NIPPLE DISCHARGE IN A MAN UNDER ANY CIRCUMSTANCES COULD BE PROBLEMATIC AND SHOULD BE EVALUATED BY A PHYSICIAN.

A nipple discharge is most likely to be normal if

It comes out of both nipples

It occurs only if you squeeze the nipples.

The colour of the discharge does not necessarily tell if it is normal or not, for a normal discharge can be clear, milky looking, pale yellow, or pale green, or even occasionally, brown. However, a bloody nipple discharge is never normal. Squeezing the nipple to view the discharge only makes the discharge more copious as the nipple ducts are being traumatised by the squeezing and will now also leak inflammatory fluids.

Leaving the nipples alone might result in the discharge going away. Several women who have been pregnant at least once continue to see nipple discharge afterwards.

Nipple discharges are usually non-cancerous. Cancer (usually intra-ductal carcinoma or invasive carcinoma and rarely Paget's disease of the breast) accounts for less than 10 per cent of all nipple discharge seen. The remainder (90 per cent) results from benign ductal disorders, e.g. intra-ductal papilloma, Mammary duct ectasia (inflammation and clogging of the ducts), and fibrocystic changes, endocrine (hormonal) imbalances, breast abscesses or other breast

infections.

Normal causes of nipple discharge include:

Pregnancy

Stopping breastfeeding

Stimulating or squeezing the nipples.

Chaffing of the nipples by, e.g. a woman's bra.

Some other causes of nipple discharge include:

Injury to the breast.

Hypothyroidism (underactive thyroid gland).

Overproduction of Prolactin hormone by the pituitary gland.

Some often-used medications (e.g. oral contraceptive pills, cimetidine, alpha methyl dopa, reserpine, metoclopramide, phenothiazines, tricyclic anti-depressants).

Use of certain herbs such as fennel and anise.

Marijuana.

Nipple discharges sometimes seen in babies due to maternal hormones present in baby from before birth (usually resolves in two weeks).

Nipple discharge can also be associated with menstrual hormonal changes.

Usually, with an abnormal nipple discharge, a physician will examine the breasts and may also investigate with breast ultrasound or breast mammogram and blood tests for hormonal evaluation before reassuring the woman that her nipple discharge is innocuous. Occasionally, breast tissue biopsy is necessary.

Once the cause of the nipple discharge is determined, it can be treated, or left alone, if this is considered appropriate. It is possible that

Medication causing nipple discharge may need to be discontinued.

Breast ducts or lumps may need to be removed.

Medications may need to be taken to correct underlying health conditions.

Usually, if all tests are normal, then no treatment is necessary. A check-up mammogram and breast examination are usually scheduled for within one year.

Any man with a nipple discharge should schedule a check-up appointment with a physician immediately.

Write to:

LIFELINE,

PO BOX 1731,

KGN 8

AJM