Rationale

Breast secretions (i.e., nipple discharge) in women of reproductive age are common and usually of benign origin. However, spontaneous and persistent breast discharge may indicate underlying disease and requires investigation.

Causal Conditions

(list not exhaustive)

1. Galactorrhea

   1. Idiopathic

   2. Hyperprolactinemia

      • Physiologic

      • Drugs, including herbal remedies

      • Pituitary tumours

      • Endocrine abnormalities

2. Breast neoplasm

Key Objectives

Given a patient with breast discharge, the candidate will diagnose the cause, severity, and complications and will initiate an appropriate management plan, with emphasis on differentiating between galactorrhea and other causes of breast discharge.

Enabling Objectives

Given a patient with breast discharge, the candidate will

1. list and interpret critical clinical findings, including

   1. skin lesions on the breasts;

   2. characteristics of discharge; and

   3. breast mass;

2. list and interpret critical investigations, including

   1. diagnostic cytology;

   2. diagnostic imaging; and

   3. laboratory tests; and

3. construct an effective initial management plan and determine appropriate follow-up, including

   1. counselling/educating the patient (e.g., possible fear of cancer); and

   2. determining whether the patient requires specialized care.