Questions Your Doctor May Ask - and Why!
During a consultation, your doctor will use various techniques in his assesment of the symptom: Nipple discharge.
These may include a physical examination or other medical tests.
Your doctor may ask several questions when assessing
your condition. It is important to remember that your consultation is a two-way process and any extra information
you can share with your doctor may help them with their diagnosis.
Some of the questions your doctor may ask are listed below:
- When did you first notice the nipple discharge?
Why: to establish if acute or chronic.
- What type of discharge is it?
Why: e.g. bloody, watery, milky, green, yellow or pus-like.
- Bloody discharge may include intraduct papilloma (most common), intraduct carcinoma or mammary dysplasia. Green-grey discharge may include mammary dysplasia or mammary duct ectasia. Yellow discharge may include mammary dysplasia or breast abscess (pus). Milky white discharge may be due to lactation, lactation cysts, elevated prolactin hormone or drugs
- Is it from one or both nipples?
Why: if unilateral and watery or bloody discharge consider breast cancer, intraduct papilloma, Paget's disease, papillary cystadenoma or epithelioma of the nipple. If bilateral and milky should consider the various conditions that cause hyperprolactinemia (elevated prolactin hormone in the blood) or pregnancy. A bilateral bloody discharge suggests mammary dysplasia (chronic cystic mastitis).
- Is the nipple discharge spontaneous or does it have to be expressed?
- If discharge has to be expressed to be produced, does it occur by pressure at a single site or by general pressure on the breast?
- Is the nipple discharge related to the menstrual period?
Why: suggests benign mammary dysplasia (before the menstrual period) or due to oral contraceptive pill (more evident just before the menstrual period).
- Are you breast feeding?
Why: an obvious reason for bilateral milky nipple discharge.
- Is there a recent history of breast stimulation?
Why: e.g. sexual stimulation, mammograms, poorly fitting bra and tight clothes - may cause a small nipple discharge.
- Are you premenopausal or postmenopausal?
Why: this will help determine the cause of nipple discharge. e.g. in premenopausal women, spontaneous multiple duct green or brownish discharge, unilateral or bilateral, most marked before menstruation, is often mammary dysplasia.
- Risk factors for breast cancer?
Why: e.g. age over 40 years, Caucasian race, pre-existing benign breast lumps, personal history of breast cancer, family history of breast cancer in a first degree relative, late menopause (after age 53), obesity, childless until after 30 years of age, early age of first menstrual period.
- Past history of breast cancer?
Why: increases the risk of breast cancer in the other breast and also of recurrent breast cancer in the same breast.10 % of people with a past history of breast cancer will develop breast cancer in the other breast.
- Past medical history?
Why: e.g. causes of elevated prolactin hormone levels include pituitary tumor, sarcoidosis, hypothyroidism, renal failure and liver failure.
- Medications?
Why: e.g. some medications cause an elevated prolactin hormone level and milky nipple discharge such as oral contraceptives, phenothiazines, hormone replacement therapy, certain blood pressure medications, certain antidepressants, certain sedatives and Methyldopa.
- Family history of breast cancer in first degree relative?
Why: increases the risk of breast cancer threefold.
Questions your doctor may ask about related symptoms:
Sometimes, other symptoms may be present and may help your doctor analyse
your condition. These may include:
- Breast lump?
Why: a focal mass in the breast with a bloody discharge makes a breast cancer almost certain. If there is a focal mass, fever and a non-bloody discharge should consider a breast abscess. Mammary dysplasia can cause breast nodularity and sometimes a discrete lump but this varies with the menstrual period and usually causes multiple or bilateral masses.
- Breast pain?
Why: a bloody discharge associated with breast pain suggests breast cancer if unilateral; mammary dysplasia if bilateral (causes discomfort particularly before the menstrual period and settles after the period).
- Breast swelling before the menstrual period?
Why: suggests Mammary dysplasia.
- Fever?
Why: fever or chills along with a pus-like discharge from the breast is most likely acute mastitis or a breast abscess.
- Symptoms of breast cancer?
Why: e.g. breast lump, usually painless ( only 5% associated with pain), lump is hard and irregular. May have nipple discharge or nipple retraction. May have symptoms of metastases such as back pain, shortness of breath, weight loss or headache.
- Symptoms suggestive of metastatic disease?
Why: e.g. back pain, shortness of breath, weight loss, and headache - may suggest breast cancer metastases.
- Itching or burning of the nipple, with superficial erosion or ulceration?
Why: suggests Paget's disease of the breast.
- Symptoms of benign mammary dysplasia?
Why: e.g. most common in women between 30 and 50 years of age. Unilateral or bilateral breast pain, tenderness, lumpiness and swelling, especially prior to the menstrual period. Symptoms usually settle after the menstrual period. May have a nipple discharge which can be various colors, mainly green-grey.
- Symptoms of mammary duct ectasia?
Why: e.g. an entire breast quadrant may be hard and tender. A firm, tender, poorly defined lump may be felt near the margin of the areola (red part of breast surrounding the nipple). There may be a toothpaste -like nipple discharge.
- Symptoms of prolactinoma (pituitary gland tumor producing too much prolactin hormone)?
Why: e.g. headache, visual field loss, menstrual disturbance, reduced fertility, bilateral milky nipple discharge.
- Symptoms of pregnancy?
Why: e.g. missed menstrual periods, breast enlargement, breast tenderness, urinary frequency. Pregnant women may experience a milky discharge from the nipples due to an elevated level of prolactin.
» Next page: Types of Nipple discharge
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