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Breast 2
Breast 2
24. Which of the following conclusion(s) can be drawn from the results
of the NSABP prospective randomized trials completed in the 1970s and
1980s?
At one time or another, many women notice a nipple discharge. The most
common physiologic basis for nipple discharge is lactation. Milk may
continue to be secreted intermittently for as long as two years after breast
feeding has stopped, particularly with breast stimulation. A milky whitish
discharge, usually bilateral, that is not related to lactation or breast
stimulation is termed galactorrhea. The presence of bilateral
galactorrhea should prompt an evaluation for underlying endocrinopathy
causing increased prolactin secretion by the pituitary. Classically, this is
associated with amenorrhea, but galactorrhea may be the only sign of
hypoprolactinemia. Nipple discharges associated with fibrocystic disease
are generally, green, yellow, or brown, Intraductal papillomas and cancer
lead to a bloody or blood-tinged serous discharge. The brownish
discharge of fibrocystic disease can easily be confused with old blood. A
guaiac test or simply dabbing the discharge with a gauze pad and
examining the stain can usually differentiate the two. A bloody or blood-
tinged discharge must be promptly evaluated to exclude carcinoma. If the
discharge is expressible at the time the patient is seen, a contrast
ductogram may be obtained.