Bleeding from the Nipple

A study of the literature of the past four decades reveals a wide divergence of views on the significance and management of bleeding from the nipple. At one extreme we find the opinion of Bloodgood (1922) that' discharge from the nipple, like pain, is not an indication of a lesion of the breast for which operation is indicated,' and that 'the prevailing view that a woman with a discharge from the nipple should be protected from cancer by the removal of the breast is based on fear and not fact.' At the other extreme is the view of MacCarty of the Mayo Clinic, quoted by Gray and Wood (I94I), that 'a breast with continued serous or bloody discharge should be removed by simple mastectomy.' Little dispute exists regarding the treatment of bleeding from the nipple due to carcinoma. Where the lesion concerned is considered to be benign, however, as in papillomatosis or fibro-adenosis, so we enter the sphere of controversy. Pathologists who see in these lesions potential or actual malignancy have influenced surgical opinion towards radical treatment; those who consider these lesions to be benign have swayed opinion towards conservatism. Until we are able to determine accurately the precise extent to which these benign lesions are precancerous, so long will the bleeding nipple remain a subject for dispute. Recent contributions to the literature (Wakeley I947, Adair I949, Haagensen, Stout and Phillips 195I) have favoured the conservative approach in the management of these patients. It was in an attempt to see how far our own clinical experience justifies this view that the records of Hammersmith Hospital were searched for a series of patients with bloodstained discharge from the nipple, and a review of this material and a discussion of the management forms the basis of this paper.