FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

READER'S BREAST DISCHARGE NEEDS FURTHER MEDICAL EVALUATION

Question: I've had water coming from my right nipple, and I'm not pregnant (I'm 57 years old), and I'm not taking any hormones. My surgeon examined me and had a mammogram done. That test showed fibrocystic changes. What are "fibrocystic changes" and why does it cause water to come from my breast?

Answer: Fibrocystic changes of the breast which produce "lumps" of fibrous connective tissue are very common and affect about one-third of women in this country. The normal breast glands are somewhat "lumpy" to the touch, but fibrocystic lumps are larger and they are often tender. By themselves, fibrocystic changes cause no serious problems. And, fortunately, this condition does not increase the risk of breast cancer.

Fibrocystic changes do make it a bit more difficult for a woman to confidently interpret findings from her breast self-examination. Fibrocystic changes feel much like normal breast tissue, except that they are a bit larger and "lumpier." Cancer lumps, the terrible disease that strikes one out of every eight women, is the most important reason for performing breast self-examination. I think it may help to review the signs that distinguish the feel of normal breast tissue with or without fibrocystic changes from cancer. They are as follows:

CANCER TISSUE NORMAL BREAST

lump is hard lump is soft and compressible

lump is rough and irregularlump is smooth and regular

lump can't be moved very muchlump is easily pushed about

no other lump feels like thismany lumps feel about the same

it's new; never felt it beforethese lumps are always here

It's important for every woman to practice breast self-examination each month. In the reproductive years, it is usually best done after the menstrual period because the normal breast glands are less swollen and a new lump would seem more obvious. For older women, I recommend doing it each month when the phone bill arrives. (The phone company never forgets to send its bill!)

Another important method for detecting breast abnormalities is mammography a special type of X-ray of the breast that is good at finding cancer while it is still small. Unfortunately, it isn't very good at finding cancer in reproductive-age women because their breasts are filled with dense-appearing milk glands. The number of glands decrease with increasing age so that by age 50 a yearly mammogram is advisable for all women. The benefit in younger women is a topic of much debate in the medical, insurance, legal and political arenas.

However, since you are 57 and were having breast problems, the mammogram you had was most appropriate. The fibrocystic changes that were identified are quite common, and not serious. They are also not the cause of your breast discharge.

The presence of a discharge from the breast is normal late in pregnancy and during lactation. Since you are 57, I don't think that is the cause in your case. Breast tumors, such as cancer, can produce a discharge that is usually blood-tinged rather than clear or milk colored. Mammography is particularly good at identifying these types of growths, so I think it is unlikely that this is your problem.

Many abnormalities of the hormone-producing system can cause breast discharge. Low thyroid function is certainly a consideration as is abnormal function of the pituitary gland. Hodgkin's disease, lung cancer and other illness can produce hormones that don't respond to the normal control mechanisms, and occasionally this can result in a breast discharge. It is also possible that your breast discharge is the result of medication you take for other conditions. Atenolol, a medication used for blood pressure and heart disease, along with a number of medications used to treat anxiety and other emotional disorders can cause breast discharge.

I suggest that you return to your doctor for a more comprehensive evaluation of your breast discharge. The fibrocystic changes you have are not the cause.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.