1. Nipple discharge may be a sign of cancer, and it must be thoroughly evaluated. Eight percent of biopsies performed for nipple discharge demonstrate cancer.
2. Determine the duration, bilaterality or unilaterality of the discharge, and the presence of blood. A history of oral contraceptives, hormone preparations, phenothiazines, nipple or breast stimulation, or lactation should be determined. Discharges that flow spontaneously are more likely to be pathologic than discharges that must be manually expressed.
3. Unilateral, pink colored, bloody or non-milky discharge, or discharges associated with a mass are the discharges of most concern.
4. Bilateral, milky discharge suggest an endocrine problem. Nipple discharge secondary to malignancy is more likely to occur in older patients.
5. Risk factors. A risk assessment should identify risk factors, including age over 50 years, past personal history of breast cancer, history of hyperplasia on previous breast biopsies, and family history of breast cancer in a first-degree relative (mother, sister, daughter).
B. Physical examination should include inspection of the breast for ulceration or contour changes and inspection of the nipple. Palpation should be performed with the patient in both the upright and the supine positions to determine the presence of a mass.
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