Diagnostic evaluation

1. Bloody discharge. A mammogram of the involved breast should be obtained if the patient is over 35 years old and has not had a mammogram within the preceding 6 months. Biopsy of any suspicious lesions should be completed.

2. Watery, unilateral discharge should be referred to a surgeon for evaluation and possible biopsy.

3. Non-bloody discharge should be tested for the presence of blood with standard Hemoccult cards. Nipple discharge secondary to carcinoma usually contains hemoglobin.

4. Milky bilateral discharge should be evaluated with assays of prolactin and thyroid stimulating hormone to exclude an endocrinologic cause.

a. A mammogram should also be performed if the patient is due for routine mammographic screening.

b. If results of the mammogram and the endocrinologic screening studies are normal, the patient should return for a follow-up visit in 6 months to ensure that there has been no specific change in the character of the discharge, such as development of bleeding.

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