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Benign breast conditions are heterogenous, with varying clinical presentations. These conditions commonly include nipple discharge, breast pain, palpable masses, common breast lesions, and high-risk breast lesions. Signs and symptoms of these conditions range from pain and abnormal physical examination findings to asymptomatic abnormalities detected on breast imaging. A combination of clinical examination, patient history, and diagnostic studies should be used to make a diagnosis. The primary challenges in addressing new breast symptoms are determination of a clear diagnosis and creation of a management plan, as well as evaluation of future risk of malignancy related to benign diagnoses. Risk assessment can prove difficult in patients of certain racial groups, given the differences in risk attributed to specific benign conditions. This also can prove challenging given the lack of racial diversity in early trials assessing risk in benign breast disease. Many benign breast conditions are diagnosed and managed in the family medicine setting, but some patients may require consultation with a breast subspecialist.

Case 2. Patricia is a 45-year-old premenopausal woman, who comes to your office with a 3-month history of left nipple discharge. She reports that she has noted rust-colored discharge from the left breast that is expressed only with manipulation. She has undergone annual mammograms for the past 5 years, the results of which have been normal. You refer her for mammography, which shows a small (3-mm) retroareolar mass. Targeted biopsy results reveal an intraductal papilloma without associated atypia. Patricia is concerned about the risk of breast cancer and asks about management and surveillance options.

Nipple Discharge

Nipple discharge is one of the most common breast complaints, and accounts for up to 7% of breast symptoms.43 Benign causes, which account for 90% of nipple discharge, include intraductal papillomas, duct ectasia, and fibrocystic disease.

The etiology of nipple discharge is classified as physiologic or pathologic.43,44 Physiologic discharge typically is bilateral, nonspontaneous, and white or green in color.43 It often is attributable to endocrine abnormalities or certain drugs, such as tranquilizers, oral contraceptives, or certain antihypertensives. Rarely, it can be related to a pituitary adenoma.

Pathologic discharge tends to be unilateral and spontaneous, involving a single affected duct.44 Approximately 11% of female patients presenting with nipple discharge will have an underlying malignancy.43

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