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Nipple Changes In Breast Cancer

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Iqra Mazhar

Overview

Nipple changes in <a href="https://merisehat.pk/disease/breast-cancer">breast cancer</a> refer to any alterations in the appearance, shape, or texture of the nipple that may be indicative of breast cancer. 
Nipple changes are an uncommon but important symptom of breast cancer and may include nipple inversion, changes in nipple color, and abnormal nipple discharge. 
&nbsp;

The incidence and prevalence of nipple changes in breast cancer are not well-documented in the literature. However, nipple changes are recognized as an important symptom of breast cancer, and their occurrence may vary depending on the stage and type of breast cancer.

Approximately 7%-15% of people with abnormal nipple discharge have a malignancy<a href="#accordion">[1]</a>. Most of these cancer-related nipple discharges are due to papillary carcinoma or ductal carcinoma in situ<a href="#accordion">[1]</a>. Nipple changes are more common in advanced stages of breast cancer, such as inflammatory breast cancer. The mechanism of action of nipple changes in breast cancer is not fully understood. Nipple changes such as inversion and discharge may be caused by the infiltration of cancer cells into the milk ducts or the breast tissue surrounding the ducts. Moreover, changes in nipple color may be due to the inflammation associated with inflammatory breast cancer.

Male breast cancer can also present with nipple change. Nipple changes such as inversion or retraction are often the first sign of breast cancer in men. Male breast cancer is rare, accounting for less than 1% of all breast cancers<a href="#accordion">[2]</a>. Despite it being uncommon, it is still important for men to be aware of the signs and symptoms and to seek medical attention if they notice any changes in their breast tissue or nipple. 
&nbsp;

Several types of nipple changes may be associated with breast cancer. These changes may include changes in nipple color, shape, texture, and discharge. Here are some of the types of nipple changes that have been reported in association with breast cancer: 
&nbsp;

<ol>
	<li>Nipple Inversion: This occurs when the nipple becomes retracted or pulled inward. Nipple inversion may be a sign of breast cancer, particularly if it occurs suddenly or in one breast only.</li>
	<li>Nipple Discharge: This occurs when fluid is secreted from the nipple. Abnormal nipple discharge may be a sign of breast cancer, particularly if it is bloody or comes from only one breast. However, nipple discharge can also be caused by non-cancerous conditions, such as an infection or medication.</li>
	<li>Changes In Nipple Color: Breast cancer may cause changes in nipple color, such as redness, darkening, or a rash-like appearance. Changes in nipple color may be associated with inflammatory breast cancer.</li>
	<li>Changes In Nipple Texture: Breast cancer may cause changes in nipple texture, such as thickening, scaling, or crusting. Changes in nipple texture may be a sign of underlying breast cancer.</li>
	<li><a href="https://merisehat.pk/disease/pagets-disease-of-the-breast">Paget&#39;s Disease Of The Nipple</a>: This is a rare form of breast cancer that affects the nipple and areola. Paget&#39;s disease of the nipple may present with symptoms such as itching, burning, and scaling of the nipple, as well as nipple discharge. 
	&nbsp;</li>
</ol>

Note: If you notice any changes in your nipple it&#39;s important to speak with a healthcare provider to determine the cause. 
&nbsp;

Signs and Symptoms

Nipple changes can be a sign of breast cancer, and it is important to recognize the signs and symptoms to seek medical attention promptly. Some of the signs and symptoms of nipple changes in breast cancer include: 
&nbsp;

<ol>
	<li>Changes In Nipple Position: The nipple may become inverted, meaning it turns inward instead of pointing outward.</li>
	<li>Changes In Nipple Texture: The nipple may become scaly, flaky, or crusty.</li>
	<li>Changes IN NIPPLE COLOR: The nipple may become red, pink, or darkened.</li>
	<li>Changes In Nipple Shape: The nipple may become irregularly shaped, with swelling or puckering.</li>
	<li>Abnormal Nipple Discharge: The nipple may produce a discharge that is clear, bloody, or contains pus.</li>
</ol>

&nbsp;

Nipple discharge can be of various types. These include:

<ul>
	<li>Bloody Or Clear Discharge: This type of discharge can be a sign of breast cancer, especially if it occurs spontaneously or only from one breast.</li>
	<li>Milky Discharge: Milky discharge from the nipples is not usually a sign of breast cancer, but it can be in rare cases. If the discharge is only from one breast or is accompanied by other symptoms, such as a lump, it should be evaluated by a healthcare provider.</li>
	<li>Green Or Brown Discharge: This type of discharge can be caused by a non-cancerous growth in the breast, but it can also be a sign of breast cancer in rare cases.</li>
</ul>

&nbsp;

It is crucial to note that not all nipple changes are necessarily indicative of breast cancer. However, any changes in the nipple should be promptly evaluated by a medical professional to determine the underlying cause. 
&nbsp;

Causes

The exact causes of nipple changes in breast cancer are not fully understood. However, nipple changes may occur due to the underlying changes in the breast tissue that are associated with breast cancer. Here are some of the possible causes of nipple changes in breast cancer: 
&nbsp;

<ol>
	<li>Tumor Growth: Breast tumors may cause changes in the surrounding breast tissue, including the nipple. As the tumor grows, it may push against the ducts that lead to the nipple, causing changes in nipple shape or position.</li>
	<li>Inflammatory Breast Cancer: Inflammatory breast cancer is a rare and aggressive form of breast cancer that may cause changes in nipple color, texture, or shape. This is due to the inflammation and swelling that occurs in the breast tissue.</li>
	<li>Ductal Carcinoma In Situ (DCIS): DCIS is a non-invasive form of breast cancer that may cause changes in nipple discharge or texture. This is because the abnormal cells may block the ducts that lead to the nipple.</li>
	<li>Paget&#39;s Disease Of The Nipple: Paget&#39;s disease is a rare form of breast cancer that affects the nipple and areola. It may cause changes in nipple texture, such as scaling or crusting, as well as nipple discharge.</li>
	<li>Other Factors: In addition to breast cancer, nipple changes may also be caused by other factors such as trauma, infection, or hormonal changes. 
	&nbsp;</li>
</ol>

Screening tests for breast cancer are designed to detect breast cancer early before it has a chance to spread to other parts of the body. While there are no specific screening tests for nipple changes in breast cancer, a breast self-exam can help assess for any abnormalities. Furthermore, it helps men and women become more aware of their breast anatomy and helps them stay on the lookout for any changes.

Doctors also conduct a clinical breast examination. This is a physical exam of the breast tissue performed by a medical professional. During the exam, the doctor will look for nipple changes, lumps, or other abnormalities in the breast tissue.

It is important to note that no screening test is 100% accurate, and some cancers may go undetected by screening tests. Therefore, it is important to seek medical attention promptly if any changes in the nipple or breast tissue are detected. 
&nbsp;

Diagnosis

If nipple changes are detected during a breast self-exam or clinical breast examination, further diagnostic tests may be recommended to determine if breast cancer is present. Here are some of the diagnostic tests used to confirm nipple changes in breast cancer: 
&nbsp;

<ol>
	<li>&nbsp;Mammography: Mammography is an X-ray imaging test used to detect abnormalities in breast tissue, including nipple changes. The test is typically performed on women over the age of 50. However, women at high risk for breast cancer may be screened earlier.</li>
	<li>&nbsp;Breast Magnetic Resonance Imaging (MRI): Breast MRI is a non-invasive imaging test that uses a magnetic field and radio waves to produce detailed images of breast tissue. It may be used in conjunction with mammography to detect nipple changes in women at high risk for breast cancer.</li>
	<li>&nbsp;Biopsy: A biopsy is the most accurate way to determine if nipple changes are due to breast cancer. During a biopsy, a small sample of breast tissue is removed and examined under a microscope to look for cancer cells.</li>
	<li>&nbsp;Ultrasound: Breast ultrasound uses sound waves to produce images of breast tissue. It can be used to further evaluate nipple changes that were detected on a mammogram or clinical exam.</li>
	<li>&nbsp;MRI-guided Biopsy: If a breast MRI identifies an abnormality in the breast tissue, an MRI-guided biopsy may be performed. During this procedure, a small sample of breast tissue is removed while the patient is inside the MRI machine.</li>
	<li>&nbsp;Ductography: Ductography is a specialized imaging test that uses contrast dye to examine the milk ducts in the breast tissue. It may be used to evaluate nipple changes that are associated with abnormal nipple discharge. 
	&nbsp;</li>
</ol>

It is important to note that the diagnostic tests used to confirm nipple changes in breast cancer are invasive and carry a small risk of complications. However, these tests are necessary to accurately diagnose breast cancer and develop an appropriate treatment plan. 
&nbsp;

Treatment

The treatment for nipple changes in breast cancer depends on various factors such as the stage of cancer, location, size, and other medical conditions. Here are some of the common treatments used to manage nipple changes in breast cancer: 
&nbsp;

<ol>
	<li>Surgery: Surgery is usually the first line of treatment for nipple changes in breast cancer. The type of surgery may vary depending on the size and location of cancer. Mastectomy, lumpectomy, and breast-conserving surgery are some of the common surgical procedures used to treat nipple changes in breast cancer.</li>
	<li>Radiation Therapy: Radiation therapy uses high-energy X-rays to kill cancer cells. It may be used after surgery to destroy any remaining cancer cells in the breast tissue.</li>
	<li>Chemotherapy: Chemotherapy uses drugs to kill cancer cells. It may be used before or after surgery to shrink the tumor or destroy any remaining cancer cells in the body.</li>
	<li>Hormone Therapy: Hormone therapy is used to block the effects of estrogen and progesterone, which can promote the growth of some breast cancers. It may be used in combination with other treatments to manage nipple changes in breast cancer.</li>
	<li>Targeted Therapy: Targeted therapy uses drugs to target specific molecules that promote the growth of cancer cells. It may be used in combination with other treatments to manage nipple changes in breast cancer. 
	&nbsp;</li>
</ol>

The choice of treatment depends on various factors, and it is important to discuss all available treatment options with a healthcare provider to determine the best course of action. 
&nbsp;

Nipple changes in breast cancer can lead to various complications, some of which are related to the treatment of breast cancer, and others are related to the progression of the disease. Here are some of the complications associated with nipple changes in breast cancer: 
&nbsp;

<ol>
	<li>Lymphedema: Lymphedema is a condition where lymphatic fluid accumulates in the tissues, causing swelling and discomfort. It is a common complication after breast cancer treatment, especially after lymph node removal.</li>
	<li>Infection: Breast cancer treatment may increase the risk of infection in the affected breast tissue, including the nipple. Infections can cause pain, swelling, redness, and discharge.</li>
	<li>Pain: Nipple changes in breast cancer can cause pain and discomfort, which may be related to the cancer or the treatment.</li>
	<li>Scarring: Breast cancer surgery can lead to scarring in the affected breast tissue, which may affect the appearance of the breast.</li>
	<li>Recurrence: Nipple changes in breast cancer may indicate the presence of cancer cells in the breast tissue. In some cases, cancer may recur even after treatment. 
	&nbsp;</li>
</ol>

It is important to discuss the potential complications associated with nipple changes in breast cancer with a healthcare provider. Regular follow-up appointments and self-examination can help detect any complications early and prevent further complications. 
&nbsp;

Factors that increase the risk of breast cancer also raise the chances of nipple changes: 
&nbsp;

<ol>
	<li>Age: Breast cancer is more common in women who are older than 50 years of age.</li>
	<li>Family History: Women with a family history of breast cancer, especially in a first-degree relative (mother, sister, daughter), have an increased risk of developing breast cancer.</li>
	<li>Genetic Mutations: Inherited mutations in the BRCA1 or BRCA2 genes increase the risk of developing breast cancer.</li>
	<li>Hormonal Factors: Exposure to estrogen and progesterone over a long period, such as the early onset of menstruation or late menopause, can increase the risk of breast cancer.</li>
	<li>Personal History: Women who have had breast cancer in one breast have an increased risk of developing breast cancer in the other breast.</li>
	<li>Alcohol Consumption: Drinking alcohol can increase the risk of developing breast cancer.</li>
	<li>Obesity: Being overweight or obese can increase the risk of developing breast cancer.</li>
	<li>Radiation Exposure: Radiation exposure, especially during childhood or early adulthood, can increase the risk of developing breast cancer. 
	&nbsp;</li>
</ol>

It is important to note that having one or more of these risk factors does not mean that a person will develop breast cancer. Regular screening and self-examination can help detect breast cancer early and improve the chances of successful treatment. 
&nbsp;

There are several preventive factors associated with reducing the risk of nipple changes in breast cancer. This includes: 
&nbsp;

<ol>
	<li>Regular Breast Self-Exams: Women and men should perform regular breast self-exams to check for any lumps, changes in the nipple, or other abnormalities.</li>
	<li>Clinical Breast Exams: Women should have a clinical breast exam performed by a healthcare provider at least once every three years starting at age 20, and annually starting at age 40.</li>
	<li>Mammograms: Women should have regular mammograms to screen for breast cancer, as recommended by their healthcare provider. Mammograms can detect breast cancer before symptoms appear.</li>
	<li>Lifestyle Changes: Women and men can reduce their risk of breast cancer by maintaining a healthy weight, exercising regularly, quitting alcohol, and avoiding tobacco products.</li>
	<li>Genetic Testing: Women with a family history of breast cancer may benefit from genetic testing to determine if they have inherited mutations that increase their risk of developing breast cancer.</li>
	<li>Hormone Therapy: Women who have an increased risk of breast cancer may benefit from hormone therapy to reduce their risk.</li>
	<li>Breastfeeding: Women who breastfeed their babies for a longer period may have a reduced risk of breast cancer. 
	&nbsp;</li>
</ol>

It is important to discuss breast cancer prevention strategies with a healthcare provider to determine the best course of action based on individual risk factors. 
&nbsp;

Key Points

<ul>
	<li>Nipple changes in breast cancer refer to any alterations in the appearance, shape, or texture of the nipple that may be indicative of breast cancer.</li>
	<li>Changes in nipple morphology may be caused by the abnormal growth of breast cancer cells, leading to changes in the shape and texture of the nipple.</li>
	<li>Nipple inversion occurs when the nipple becomes retracted or pulled inward.</li>
	<li>Nipple discharge occurs when fluid is secreted from the nipple.</li>
	<li>Breast cancer may cause changes in nipple color, such as redness, darkening, or a rash-like appearance.</li>
	<li>Breast cancer may cause changes in nipple texture, such as thickening, scaling, or crusting.</li>
	<li>Bloody or clear discharge can be a sign of breast cancer, especially if it occurs spontaneously or only from one breast.</li>
	<li>Green or brown discharge can be caused by a non-cancerous growth in the breast, but it can also be a sign of breast cancer in rare cases.</li>
	<li>Inflammatory breast cancer is a rare and aggressive form of breast cancer that may cause changes in nipple color, texture, or shape.</li>
	<li>DCIS is a non-invasive form of breast cancer that may cause changes in nipple discharge or texture.</li>
	<li>In addition to breast cancer, nipple changes may also be caused by other factors such as trauma, infection, or hormonal changes.</li>
	<li>Screening tests for nipple changes in breast cancer are designed to detect breast cancer early.</li>
	<li>Mammography is an X-ray imaging test used to detect abnormalities in breast tissue, including nipple changes.</li>
	<li>Breast MRI is a non-invasive imaging test that uses a magnetic field and radio waves to produce detailed images of breast tissue.</li>
	<li>A clinical breast exam is a physical exam of the breast tissue performed by a medical professional.</li>
	<li>Women can perform monthly breast self-exams to look for any changes in the nipple or breast tissue.</li>
	<li>If nipple changes are detected during a screening test, further diagnostic tests may be recommended to determine if breast cancer is present.</li>
	<li>A biopsy is the most accurate way to determine if nipple changes are due to breast cancer.</li>
	<li>Ductography is a specialized imaging test that uses contrast dye to examine the milk ducts in the breast tissue.</li>
	<li>Surgery is usually the first line of treatment for nipple changes in breast cancer.</li>
	<li>Radiation therapy uses high-energy X-rays to kill cancer cells.</li>
	<li>&nbsp;Chemotherapy uses drugs to kill cancer cells. It may be used before or after surgery to shrink the tumor or destroy any remaining cancer cells in the body.</li>
	<li>Hormone therapy is used to block the effects of estrogen and progesterone, which can promote the growth of some breast cancers.</li>
	<li>Targeted therapy uses drugs to target specific molecules that promote the growth of cancer cells.</li>
	<li>A common complication, lymphedema, is a condition where lymphatic fluid accumulates in the tissues, causing swelling and discomfort.</li>
	<li>Breast cancer treatment may increase the risk of infection in the affected breast tissue, including the nipple.</li>
	<li>Breast cancer is more common in women who are older than 50 years of age.</li>
	<li>Women with a family history of breast cancer, especially in a first-degree relative (mother, sister, daughter), have an increased risk of developing breast cancer.</li>
	<li>Inherited mutations in the BRCA1 or BRCA2 genes increase the risk of developing breast cancer.</li>
	<li>Drinking alcohol can increase the risk of developing breast cancer.</li>
	<li>Women should have a clinical breast exam performed by a healthcare provider at least once every three years starting at age 20 and annually starting at age 40.</li>
	<li>Women can reduce their risk of breast cancer by maintaining a healthy weight, exercising regularly, and quitting alcohol consumption and tobacco products. 
	&nbsp;</li>
</ul>

[1] Parthasarathy V, Rathnam U. Nipple discharge: an early warning sign of breast cancer. Int J Prev Med. 2012;3(11):810-814.

[10] National Cancer Institute. (2021). Breast cancer treatment (PDQ) - patient version.

[11] American Cancer Society. (2021). Breast cancer in men.

[2] Khattab A, Kashyap S, Monga DK. Male Breast Cancer. [Updated 2022 Sep 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.

[3] Cserni, G., Amendoeira, I., Apostolikas, N., Bellocq, J. P., Bianchi, S., Bussolati, G., ... & Wells, C. A. (2003). Pathological work-up of sentinel lymph nodes in breast cancer. Review of current data to be considered for the formulation of guidelines. European journal of cancer, 39(12), 1654-1667. doi: 10.1016/S0959-8049(03)00463-6.

[4] Yang, X. R., Chang-Claude, J., Goode, E. L., Couch, F. J., Nevanlinna, H., Milne, R. L., ... & Anton-Culver, H. (2011). Associations of breast cancer risk factors with tumor subtypes: a pooled analysis from the Breast Cancer Association Consortium studies. Journal of the National Cancer Institute, 103(3), 250-263. doi: 10.1093/jnci/djq526.

[5] Dawood, S., Merajver, S. D., Viens, P., Vermeulen, P. B., Swain, S. M., Buchholz, T. A., ... & Winer, E. P. (2011). International expert panel on inflammatory breast cancer: consensus statement for standardized diagnosis and treatment. Annals of oncology, 22(3), 515-523. doi: 10.1093/annonc/mdq345.

[6] Sughra, R., & Basu, P. (2014). Nipple changes in breast cancer: A retrospective review. Journal of Clinical Oncology, 32(15_suppl), e12024-e12024. doi: 10.1200/jco.2014.32.15_suppl.e12024.

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