By Marshalee George, Kimlin Tam Ashing

You should watch for changes in your nipples. Remember that knowing your breast through regular self-examinations is the key to identifying changes that may be a sign of breast cancer.

Nipple inversion

Sometimes women may naturally have inverted nipples — in which the nipple does not protrude. That is their normal. But for some women, one of the nipples may become inverted or retracted when their normal is having “outies.” If this happens, it is important to see your doctor, as it may be a sign of breast cancer.

But before you run off to the doctor, make sure your nipple wasn’t temporarily inverted because of chest compression from a sports bra. If that was the cause, the nipple will pucker out eventually and was not related to breast cancer.

Milky nipple discharge

And when we hear the words nipple discharge, we usually think of pregnancy and breastfeeding. But it’s normal for a milky discharge to continue for up to two years after stopping breastfeeding. There are other times that nipple discharge may occur outside of breastfeeding and pregnancy.

Nipple discharge can occur during or after sexual stimulation that includes foreplay or sucking on the breasts. It also can be caused by medication use. Breast milk is enabled by a hormone called prolactin, produced by the pituitary gland in the brain. Prolactin is regulated by dopamine, and when certain medications interfere with the level of dopamine in the brain, that can lead to elevated prolactin levels. Such medications include the following:

  • Phenothiazines
  • Selective serotonin reuptake inhibitors (SSRI), more commonly known as antidepressants
  • Metoclopramide
  • Risperidone
  • Estrogens
  • Verapamil

An underactive thyroid can cause also prolactin level to increase and cause nipple discharge. Kidney disease and stress can also elevate your prolactin levels. At the extreme is a noncancerous adenoma (tumor) called prolactinoma in the pituitary gland that increases the production of prolactin. Milky discharge is not commonly seen in breast cancer, but if you do start having discharge you should see your doctor to determine the cause.

Bloody nipple discharge

Very often women think that nipple discharge means they have cancer, but most nipple discharge is from noncancerous causes.

Bloody nipple discharge is often caused by a small noncancerous (benign) tumor called intraductal papilloma (IP) that is formed in the milk duct of the breast. IP is made up of fibrous tissue, glands, and blood vessels and is common in women between the ages of 35 and 55. IP can occur in one breast or both breasts at the same time and does not mean you have breast cancer. However, sometimes IP can contain abnormal or atypical cells, and these cells may increase your risk of breast cancer.

IP is usually painless, but because of the risk that it contains abnormal or cancer cells, the treatment recommendation is to have it surgically removed. Once the tumor is removed, it can be examined in more detail and determined if there are any areas of cancer within it. Most often there is no cancer associated with IP, but it is important to make sure. If you are diagnosed with IP, talk to your doctor to discuss the treatment best for you.

If you’ve had nipple discharge and wondered why the doctor kept asking you about the medications you were taking and ordered several blood tests, now you know that it was to determine whether your

  • Prolactin level was normal.
  • Thyroid function was normal.
  • Kidneys were functioning well.
  • Medications could be causing increased prolactin.

In addition, your doctor may order a mammogram, breast ultrasound, and/or breast biopsy (see Chapter 4 for more on these) to help confirm the diagnosis of IP.

Nipple discharge is more suspicious for breast cancer when it only involves one nipple and when it occurs along with skin changes. You must seek medical care if you develop nipple discharge along with skin changes.