Not all nipple discharges are concerning but women are not aware which ones are and which are not. So it is important to understand for women that it is not right to elicit nipple discharge but if there is spontaneous bloody or watery nipple discharge then they have to show up to the doctor. Typically these discharges are unilateral, from a single duct in one breast. So if that kind of discharge is seen then it is pertinent that she goes to the doctor. If there is bilateral milky nipple discharge or discharge on expressing then typically it is not a sign for concern. So this is one factor that the patient needs to understand.
The second factor which is how we work up these cases is what we talked about in the talk at the conference – if the routine procedures like mammogram or breast ultrasound are negative then what is to be done next? How do we problem solve in cases where there is nipple discharge? There is a big role for contrast enhanced breast MRI in these cases and that’s exactly what we spoke about in these talks. Typically by doing procedures such as this we are able to identify cancers and of all the suspicious nipple discharges that exist, about 5-21% of these cases will have cancerous or precancerous lesions. It is for evaluation of these lesions and so that we can detect these lesions while they are early cancers that we do all these procedures.
Do you think there is sufficient information out there for people to read and see?
I would say there is a little mixed information out there. There is still a fair bit of confusion about what is to be done and what is not to be done. Traditionally only nipple cytology used to be done for evaluation of nipple discharges but if the cytology is negative then that does not definitely exclude cancer but there are certain centres or certain smaller regions where high end procedures may not be done, like contrast enhanced MRI. So facilities have to be made so that those patients can be referred to university hospitals or proper centres where all these tests can be done.
Do you have anything to add?
I would say let’s work on this together, let’s collaborate with our colleagues from all across the world, the United States, Canada. We can use our experiences in countries like Egypt and India, collaborate and save more lives. At the end of the day we are all physicians, we’re not here just to treat disease but to give health to our patients. We are talking about breast health and about overall health so let’s do a partnership in that.
