Introduction

When one hears nipple discharge (ND), most people automatically assume that it is a symptom of something more serious like breast cancer. Fortunately, that is not always the case. Nipple discharge is any fluid that leaks out of the nipple. Many women experience normal nipple discharge, and even some babies have been documented to experience normal milky nipple discharge in the first few weeks of their lives.¹ 

Although ND is normal, the association of this symptom with breast cancer can cause a variety of negative emotions in people. It is common to be fearful, confused and particularly anxious when one discovers nipple discharge.² It is understandable that one would experience these emotions, particularly if you are not sure of what is causing it. This is why it is important that healthcare providers address the impact that a condition might have on the psychological wellbeing of a patient. 

Understanding nipple discharge

Being able to distinguish between normal and abnormal nipple discharge can help alleviate the anxiety associated with this symptom. 

Normal nipple discharge

Normal nipple discharge can occur due to hormonal changes which occur during the menstrual cycle or pregnancy. Another cause of normal ND is breast stimulation particularly during intercourse or breast examinations.

Abnormal nipple discharge

Abnormal nipple discharge is almost always the result of a disease medical condition. Diseases like intraductal papilloma, mammary duct ectasia, and breast cancer, are all potential causes of abnormal ND. Additionally, it is important to be aware of possible red flags associated with abnormal ND. These include: 

• Spontaneous nipple discharge³
• Unilateral nipple discharge - this is considered pathological, and warrants a visit to a clinical provider⁴ 
• Nipple discharge accompanied by other symptoms⁴
• ND in men - this is abnormal and requires urgent medical attention⁵

Psychological impact

Anxiety and fear

People experiencing nipple discharge often feel many emotions at once. Anxiety is the most common, and it stems from the fear that ND might be a symptom of something sinister. The main concern is the possibility of breast cancer, as it was the most common type of cancer in women in 2022, according to the World Health Organisation.⁶ 

Embarrassment and stigma

Many people with nipple discharge often feel too embarrassed to seek help. This embarrassment and reluctance to seek help is due in part to the stigma associated with breast related conditions.⁷ This continues to add on to the anxiety that one feels while experiencing ND. 

Uncertainty and stress during investigations

Due to the increased campaigns on breast cancer awareness more people are willing to ask their healthcare providers about symptoms like nipple discharge. However it can be nerve wracking waiting to get test results back, with the results of mammograms and ultrasounds taking you up to two weeks.⁸ This period of waiting is both stressful and psychologically harmful. ¹⁰ In order to alleviate some of this stress there are some practical things you can do like: 

• Breathing exercises to calm yourself 
• Engaging in hobbies to distract yourself 
• Reaching out to friends and family for support

Role of reassurance

Importance of effective communication by healthcare providers

A vital approach that healthcare providers can use to offer reassurance to patients dealing with nipple discharge, is to ensure that they are effectively communicating. Some of the ways in which this can be facilitated includes:

• Explaining the common causes of ND in simple and clear language 
• Reassuring patients when you are certain that discharge is normal 

Building trust during clinical evaluation

Ensuring there is rapport and trust between clinicians and patients is important. Patients who are able to trust their healthcare provider are in turn able to open up about their symptoms. Adopting a patient centered care approach has been shown to decrease patient anxiety.¹¹ Furthermore, being empathetic and listening to the emotional concerns of the patient is crucial. This allows clinicians to find ways to effectively reassure patients.

Psychological support

Offering psychological support to patients can be reassuring and help ease any anxiety. Your healthcare provider may refer you for counselling or psychiatric consultations to better support your mental health.¹² Pamphlets or online educational resources can also be used as psychological support. They may offer some answers to questions you might have. In turn, this will reduce the worry you might have from your symptoms. 

FAQs

Is nipple discharge always a sign of breast cancer?

No, most cases of nipple discharge are not related to breast cancer.

Can anxiety make my symptoms worse?

Yes, anxiety can worsen mild symptoms. Additionally, it can affect your sleep, mood and concentration. 

Should I feel embarrassed about talking about my nipple discharge?

No, you should not feel embarrassed talking about your nipple discharge. It is a normal symptom in some women.

What can I expect from a breast examination?

A breast examination includes the doctor palpating your breasts, followed by additional tests such as a mammogram.

How long will I wait for my mammogram results?

Mammogram results can take up to two weeks before they are available. 

Summary 

Nipple discharge is any fluid that comes out of the nipple and although it is mostly normal it can be quite psychologically distressing and cause anxiety. Pregnancy and breast stimulation are some causes of normal ND. On the other hand, conditions like breast cancer can be responsible for abnormal nipple discharge. Overcoming any fear or shame associated with seeking medical attention is important as this will guarantee that you get a prompt diagnosis. Furthermore, any anxiety you might be experiencing will be eased, by being assessed by a qualified professional. Also, further reassurance can be offered by clinicians. This can be through showing empathy, and referring patients to their mental health colleagues to offer psychological support.