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Query: UMLS:C0849787 (nipple discharge)
 518 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A review of the histories of 1059 patients with breast problems seen consecutively in office consultation revealed an incidence of breast cancer of 13%. Patients over 50 years of age or whose mother or sister had had breast cancer had a substantially greater likelihood of having breast cancer. The finding of the problem on routine examination, a family history of breast cancer in a relative other than the mother or a sister, or prominent breast pain or nipple discharge made the diagnosis of cancer less likely. Menstrual status, a history of previous benign disease, nulliparity, current hormone therapy and duration of symptoms did not help identify the patient likely to have breast cancer. Much time could be saved for both doctor and patient in taking the history from patients with breast disorders. Only the patient's age and the history of the mother and sisters with regard to breast cancer will help identify the "high-risk" patient. Other historical findings are either valueless or should be used to reassure these usually anxious women.
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PMID:Value of the history in the office diagnosis of breast cancer. 86 61

Nipple discharge, especially the blood-stained type, is regarded as an important symptom in breast disease. In many reports the high incidence of malignancy is stressed and an active surgical approach has often been recommended. In this series of 80 women with nipple discharge the type of secretion and the result of exfoliative cytology were evaluated. Three women had cancer but the nipple discharge was important for the diagnosis in only one case. Six women had papilloma and in all the nipple discharge was essential for the diagnosis. Fibroadenosis and duct ectasia were the most common diagnoses. The blood-stained secretion was due to fibroadenosis in about half of the cases. No cancer was found in 46 women with a serous secretion. When a tumour is present nipple discharge is of little importance for the diagnosis and treatment. In the absence of a tumour and when exfoliative cytology gives no suspicion of cancer and no atypical cells or papillomatous clusters are present, an expectant attitude towards surgery seems satisfactory. With such an approach many surgical biopsies prove unnecessary, but a prerequisite is an organized follow-up.
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PMID:On the significance of nipple discharge in the diagnosis of breast disease. 103 57

As a result of health education programs that have stressed self-examination and the importance of early diagnosis and treatment, less than 5 percent of breast lesions seen in clinical practice today are malignant. Nevertheless, breast cancer is the leading cause of deaths due to cancer in women and the second most common breast lesion. Chronic cystic mastitis, the most common breast lesion seen in women, can often be treated conservatively by aspirating the cystic fluid. Close follow-up is necessary so that if carcinoma develops, it can be treated early. Carcinoma is unpredictable but not hopeless. Although controversy exists regarding treatment, radical mastectomy is still the preferred treatment in most cases. Other breast diseases include adenofibroma, a common lesion requiring excisional biopsy for positive diagnosis; nipple discharge, which should be carefully examined cytologically; and relatively rare breast lesions, including intraductal papilloma, adenosis, traumatic fat necrosis, and cystosarcoma phylloides.
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PMID:Diseases of the breast. 116 67

In the majority of the cases of nipple discharge the cause is a benign lesion: nearly 50% are papillomas. Biopsy is always indicated in nipple discharge without palpable tumor. A long follow-up of the patients is necessary.
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PMID:[Nipple discharges without palpable tumor]. 119 40

Estrogen and progesterone, although of a synthetic type in contraceptive pills, play a major role in the development, growth and function of the breasts. There is no statistically valid evidence to indicate that the widespread use of estrogens for contraceptive purposes and for the menopausal syndrome has increased the incidence of benign, premalignant or malignant breast lesions. However, if a cancer is present in a woman's breast, estrogen can increase its rate of growth. Furthermore, while the effect of exogenous estrogen administration to the population as a whole may be null, there may be a subgroup in which their use may have different effects, with a possible increase in breast cancer incidence in nulliparous or late parous women and a decrease in those with early parity. Patients with a dominant lump, suspicious diagnostic aid changes, serous, serosanguineous, bloody or watery nipple discharge or other adverse breast changes should not receive exogenous estrogens unless the lesion is found to be completely benign on biopsy. Even then, patients with gross cystic disease will continue to have these changes as long as estrogens are administered, and so they should avoid the use of estrogens. Patients in the high rist group for developing breast cancer should be cautioned about the potential dangers of the use of estrogens, whether in birth control pills or in other preparations for the menopause, and if they use them, these patients should be followed carefully by breast self-examinations, periodic examinations by physicians and diagnostic aids. Finally, serious consideration should be given to the inclusion of estriol in all estrogen preparations for its impeding or blocking effect against the potential carcinogenic properties of estradiol and estrone and to the addition of progesterone for its estrogen-antagonistic effect.
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PMID:The pill and the breast. 125 43

We have previously reported carcinoembryonic antigen (CEA) measurement in nipple discharge to be a useful adjunct in the diagnosis of non-palpable breast cancer. We have now developed a "microdot-immunobinding assay" using a specially constructed device to screen efficiently large numbers of patients with nipple discharge for non-palpable breast cancer. The method is as follows: a sample of nipple discharge is placed on a solid phase monoclonal anti-CEA antibody and, if CEA is present in the discharge, it will be detected by a second monoclonal anti-CEA antibody conjugated with alkaline phosphatase. The use of bromochloroindolyl phosphate as a chromogen results in a stable color reaction that can be semiquantitatively analyzed with the naked eye. CEA levels determined by this microdot assay correlated well with those determined using the earlier Elmotec assay. To determine the accuracy of the method, a collaborative study involving 11 institutes in Japan was organized. The CEA levels in nipple discharges from 77 patients undergoing surgery, 44 of whom were diagnosed as having breast cancer, were assayed. The results were that 17 of the 23 patients with palpable breast cancer, and 16 of the 21 patients with non-palpable breast cancer exhibited CEA values > 400 ng/ml, a cut-off value determined in a previous study. The overall accuracy (78%) of this test for diagnosing non-palpable breast cancer was higher than that obtained from ductography or cytology. The system may thus be of use in the screening of early breast cancer.
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PMID:Evaluation of an improved dot-immunobinding assay for carcinoembryonic antigen determination in nipple discharge in early breast cancer: results of a multicenter study. 129 55

Breast carcinoma-in-situ constitutes 4.1% of 707 breast cancers diagnosed between 1988 and 1990. Among these 30 patients, intraductal carcinoma-in-situ (DCIS) outnumbers lobular carcinoma-in-situ (LCIS) by 9-fold. They are mostly symptomatic - 87% present as breast lumps and/or nipple discharge, with 52% of lumps exceeding 2cm size. Three patients were detected by screening mammography and it is expected that more breast carcinoma-in-situ will be detected through mammographic screening. Two-thirds of the patients had mastectomy while the rest had lesser procedures. The different surgical procedures and adjuvant therapy instituted for the patients are reflections of the differing opinions regarding optimum therapy for carcinoma-in-situ and the differing rationale for DCIS and LCIS lesions.
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PMID:Breast carcinoma-in-situ: an emerging problem in Singapore. 132 32

Ductal carcinoma in situ of the breast is very rare in men, representing 0-7% of all male breast cancers. We analysed 15 cases from a retrospective multicentric series of 404 patients (3.7%). It occurs earlier than infiltrating carcinoma (mean age: 55 years), sometimes before 40 years of age. The main symptoms are bloody nipple discharge or retro areolar mass. Modified radical mastectomy constitutes the basic treatment. Lower axillary dissection can eventually be indicated in comedocarcinoma or in tumors larger than 25 mm. The main histologic subgroup is papillary carcinoma, pure or intracystic. As is the case in women, local recurrence, invasive or not, rarely occurs. Theoretically, the cure rate approaches 100%. However, as in all cases of breast cancer in men, an important number of deaths due to secondary cancer or intercurrent disease have been noted. Until now, no clear etiologic factors have been found.
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PMID:[Breast cancer in males: a study of 15 cases of pure ductal carcinoma in situ]. 133 68

The modalities and indications for surgery in the treatment of breast cancers have changed considerably over the last 30 years with a succession of exclusive surgery, exclusive radiotherapy, then limited surgery with adjuvant radiotherapy, adjuvant chemotherapy and finally neoadjuvant chemotherapy. With the contribution of all of these treatment modalities, the authors discuss the respective roles of radical surgery and conservative surgery as first-line surgery for invasive breast cancers. After recalling its objectives, first-line surgery is then described in terms of its diagnostic role in the presence of a suspicious node, an patch of mastopathy, nipple discharge or subclinical lesions. The various radical and conservative techniques of primary curative surgery are then described in the context of combined therapy (adjuvant radiotherapy and/or chemotherapy): no longer Halsted's radical mastectomy, by modified Patey's mastectomy with limited lymph node dissection and especially partial mastectomies (quadrantectomy, lumpectomy) with axillary lymph node dissection, alone or combined with radiotherapy. The implications on the cosmetic result and the various modalities of reconstructive surgery are also discussed.
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PMID:[Primary surgery in the treatment of invasive cancers of the breast]. 134 Jan 68

Statistics from the Connecticut Tumor Registry from 1979 to 1988 were examined, and individual medical records from 1979 to 1983 were also reviewed. Three hundred nineteen medical records were available for review, documenting 220 cases of ductal carcinoma in situ and 102 cases of lobular carcinoma in situ. In 1979, there were 33 new cases of ductal carcinoma in situ reported to the Connecticut Tumor Registry, representing 1.8% of all breast cancers. There has been a yearly increase in ductal carcinoma in situ, with 200 new cases, or 7.4% of all breast cancers, reported in 1988. Forty-eight (22%) of 217 patients with ductal carcinoma in situ had bilateral breast involvement with ductal carcinoma in situ or an invasive breast cancer. Ten (83%) of 12 mastectomy specimens from patients with ductal carcinoma in situ who presented with nipple discharge demonstrated residual tumor, suggesting a more diffuse involvement. Two of the three reported recurrences involved nipple discharge. Thirty-seven (16.8%) of the 220 patients with ductal carcinoma in situ and six (5.9%) of the 102 patients with lobular carcinoma in situ were diagnosed as having another unrelated cancer. Ongoing clinical trials will direct optimum therapy for patients increasingly diagnosed as having ductal carcinoma in situ.
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PMID:Ten-year follow-up of breast carcinoma in situ in Connecticut. 136 82


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