The Significance of Nipple Discharge of the Male Breast

Abstract

Although male breast cancer typically presents as a palpable mass, failure to recognize the significance of other symptoms may lead to a delay in diagnosis. Here we present our experience with male patients presenting with a chief complaint of nipple discharge (ND). Using the ICD-9 code for "breast symptoms," we identified 2,319 patients without a current cancer diagnosis who presented to Memorial Sloan-Kettering Cancer Center for evaluation; 24 (1%) patients were male (1995-2005). Data were collected by retrospective review. Among 24 male patients presenting for evaluation, 14 (58%) presented with a chief complaint of ND, while the remaining 10 (42%) presented for evaluation of a palpable mass in the absence of ND. Among 14 patients presenting with ND, subsequent clinical breast examination identified a breast mass +/- nipple changes in 7 of 14 patients. In total, 8 of 14 (57%) patients had an underlying malignancy; two of seven patients with ND alone had DCIS (median interval from onset of ND to presentation 3 weeks, range 2-4 weeks), and six of seven patients with ND and a palpable mass had invasive disease (median interval between onset of ND and presentation 16 weeks, range 2-52). The remaining 10/24 patients presented with a painless palpable mass of whom 8 (80%) were found to have underlying invasive disease (median interval between onset of mass, and presentation was 4 weeks, range 2-20 weeks). All patients with invasive disease were node-positive. At 23.7 months median follow-up (range, 7.7-88.3 months), 14 of 16 cancer patients remain free of disease and two have died as a direct result of metastatic disease. The incidence of cancer among males presenting with ND was 57%. In the absence of additional clinical findings, ND may be a herald for early, non-invasive disease. Increased awareness of subtle features of malignancy may represent a window of opportunity for early diagnosis and improved outcomes for male breast cancer patients.

Male Breast Cancer Presenting as Nipple Discharge

“…Morrogh and King from the Memorial Sloane Kettering Centre, New York, presents the only significant series of MBC patients presenting with ND [13]. They found that among 430 patients who presented to their institution with ND over a 10-year period only 3% were male.…”

“…The median time interval between onset of symptoms and diagnosis was 16 weeks for patients presenting with ND and 3 weeks for those presenting with a palpable mass, raising the possibility that had this group recognised the significance of the ND they may have presented at an earlier stage [13]. …”

Manifestations cutanées du cancer du sein chez l’homme

“…Les modifications cutanées du mamelon sont à type de : rétraction décrite dans 9 à 19 % des cas [3,5], ulcération (0 à 13 %) et écoulement (6 à 15 %) [3,5]. L'incidence du cancer du sein chez des hommes consultants pour un écoule-ment mamelonnaire est de 57 % [14]. L'écoulement mamelonnaire isolé sans masse palpable pourrait constituer un signe précoce du cancer du sein au stade non invasif [14] ; il doit orienter le praticien à pratiquer systématiquement une étude cytologique de l'écoulement et une exploration radiologique du sein.…”

“…L'incidence du cancer du sein chez des hommes consultants pour un écoule-ment mamelonnaire est de 57 % [14]. L'écoulement mamelonnaire isolé sans masse palpable pourrait constituer un signe précoce du cancer du sein au stade non invasif [14] ; il doit orienter le praticien à pratiquer systématiquement une étude cytologique de l'écoulement et une exploration radiologique du sein. Les modifications de l'aspect du mamelon (rétraction, ulcération, eczématisation) doivent faire éliminer une origine néoplasique en l'occurrence le cancer du sein.…”

Managing Male Mammary Maladies

“…Morrogh and King reported 24 males with breast problems seen at Sloan-Kettering Memorial between 1995 and 2005 (31). Of these, 14 (58%) complained of nipple discharge whereas the other 10 (42%) had palpable lumps with no discharge.…”