What Causes Nipple Discharge In Women – Is It Linked To Cancer?
Awareness about breast problems is really important especially when you are pregnant and waiting to catch a glimpse of your child. For women who are not yet involved in breastfeeding, seeing discharge from the nipples can also evoke a sense of fear.
Any fluid that leaks out of the nipples of the breast can be referred to as nipple discharge. The fluid could seep out on its own or you might have to squeeze the nipple to get the fluid out. If you notice nipple discharge, there isn’t any reason to panic, it is normal in the reproductive years of a woman. However, in some cases, it could be a severe case such as cancer, so it needs to be evaluated by a doctor to rule out any unwanted condition.
Men can also experience nipple discharge, but it’s rare. This can occur due to the deficiency in testosterone or breast cancer.
Types and Symptoms – What is normal and abnormal nipple discharge?
Nipple discharge can come in various colors. The color of the discharge can provide a hint about the type or cause. For easy understanding, below is the color and possible cause of the discharge. Check with your doctor if you are experiencing one of these signs.
Yellow or white discharge filled with pus – breast or nipple infection such as mastitis
Brownish or cheese-like discharge – blocked milk duct (mammary duct ectasia)
Green discharge – breast cysts
Clear discharge – breast cancer, especially when leaking from one breast
Bloody discharge – intraductal papilloma or breast cancer
Color often is not the only criteria in deciding the normality and abnormality of discharge. Bloody discharge is never normal and should be reported to doctor without delay. The discharge can occur from one or both the nipples. Other symptoms a woman can experience include:
- Tenderness and pain in breast
- Changes in nipple such as turning inward or color changes
- Swelling or lump around the nipples or in the breast
- Changes in breast size, one looking smaller or larger than the other
- Missed periods
- Nausea or vomiting
Causes of nipple discharge
Nipple discharge can occur in pregnant, breastfeeding and non-pregnant women. And at most of the times, its completely normal to experience discharge.
What causes nipple discharge in pregnancy?
In the initial stages of pregnancy, usually by the end of first trimester or the beginning of the second trimester, breast tissues start maturing and prepare you for breastfeeding. In this early phase, a small amount of clear discharge can be seen leaking out from the nipples. This leakage is the first thick creamy yellowish fluid the breasts make before producing milk. In the later stages, the discharge may turn into milky appearance.
Many women notice nipple discharge throughout the pregnancy, especially during breast massage or sexual arousal. Some other women might not experience any discharge.
Does nipple discharge occur after stopping breastfeeding?
Even you have stopped breastfeeding your child, the discharge may continue for up to 2-3 years. This is completely normal.
Can nipple discharge occur due to stimulation?
Fluid may come out when the nipples are squeezed or stimulated. It can also leak when nipples are repetitively rubbed or scratched by your bra especially during strenuous exercise such as jogging.
Other causes of nipple discharge
- Women who are not pregnant or breastfeeding may also experience discharge. Below are some of the reasons for nipple discharge in non-pregnant women.
- Breast infection or breast abscess
- Birth control pills
- Underactive thyroid gland (hypothyroidism)
- Certain psychotropic drugs
- Illegal drugs such as marijuana
- Drugs such as antidepressants and tranquilizers that trigger the levels of milk producing hormone prolactin
- Fibrocystic breast changes
- Hormonal changes during monthly periods or menopause
- Excess breast or nipple stimulation
- Blocked milk duct (mammary duct ectasia)
- Non-cancerous tumor of the pituitary gland (prolactinoma)
- Harmless wart-like growth in the milk ducts (Intraductal papilloma)
- Breast injury
- Breast cancer
Is nipple discharge a sign of breast cancer?
Nipple discharge is mostly either normal or a result of some benign medical disorder. However, sometimes the discharge, especially the bloodily fluid can indicate a possibility of some kind of breast cancer.
The chances can be high if the discharge is accompanied by a lump or thick mass within the breast. If this is the case, then there could be two possible forms of breast cancer.
- Intraductal Carcinoma – This type of cancer develops within the breast ducts located beneath the nipple. It occurs mostly in women in the age group of 35-55. If it’s a single tumor growth, it doesn’t cause much harm but if it forms clusters (multiple papilloma), then chances of cancer are slightly increased.
- Paget’s disease – This is a rare form of cancer in which a woman can experience nipple discharge. Paget’s disease typically develops in the ducts and later moves to the nipple causing crusty hard skin on the areola (circular are around nipple).
If a woman is really having a breast cancer, she will find the discharge coming out of only one breast with the presence of lump as well. Discharge occurs rarely due to cancer, however, 3-9 percent people with this symptom are diagnosed with cancer. So it’s better to rule out cancer by talking to your doctor.
Evaluation of Nipple discharge
Though nipple discharge mostly does not occur due to cancer, it could be a sign of some underlying condition that needs treatment. At your first appointment with the doctor, your breast will be physically examined. You can expect following questions:
- When did the discharge start?
- Does discharge occurs on its own or you are squeezing the nipple?
- Does it occur in one or both the nipples?
- What medicines are you currently taking?
- What other medical conditions you have?
- What other symptoms you are experiencing?
- Are you pregnant or a breastfeeding mother?
Based on your answers and physical examination, the doctor would like to do some clinical tests to check for lumps or cancer. The doctor can order:
- Mammogram– This imaging technique takes x-ray of the breasts and helps the doctor determine lump or cancer.
- Ductogram – Also known as galactogram, this is a specialized procedure that is available only in few places. This procedure involves injecting a contrast material and mammography to create pictures of the milk ducts inside the breasts.
- Ultrasound – The doctor might also use ultrasound imaging technique to create pictures of inside of the breasts.
- Biopsy – A small sample tissue of your breast will be taken and tested for the presence of cancer cells.
- Blood test – The doctor might also order blood tests to check the prolactin level in the breasts. He may also order the blood test to check underactive thyroid.
- CT scan or MRI – This imaging technique can be used for checking pituitary tumor.
Treating nipple discharge
- The treatment will depend on the cause of nipple discharge. You might not need any treatment. For those who need treatment, they can expect following recommendations:
- Change in medications that might be linked to nipple discharge
- Antifungal or antibacterial creams for skin changes around the nipples
- Medications for treating underlying condition
- Surgical procedure to remove breast ducts and lumps
Nipple discharge in most of the cases isn’t a harmful condition. But it is always a good idea to check with the doctor and rule out any serious condition which may or may not show its sign until it’s too late.