The incidence of cancer in women presenting with bloody nipple discharge at a specialist breast clinic

Objectives : To determine the frequency of breast cancer in patients presenting with bloody nipple discharge at the Komfo Anokye Teaching Hospital Breast Care Centre (KATH –BCC) Kumasi. Setting : Komfo Anokye Teaching Hospital Breast Care Centre (KATH –BCC) Kumasi. Materials and Methods : All patients reporting to the centre for the assessment and treatment of a bloody nipple discharge. The age of the patients, the duration of the discharge, whether the discharge was spontaneous or provoked and whether it was unilateral or bilateral, a single or multiple duct discharge and the presence of a lump. The mammographic findings and the histology of the excised ducts or lump were also recorded. Results :. The most common age group affected was 35-44 years (56.7 %). A palpable mass was detected in 25 women or (20.8%). Mammographic abnormalities were found in 15 (12.5%) of the women. In 80 patients (66.7%) there were no palpable masses or abnormal mammographic findings. Of the 120 patients carcinoma (CA) was found in 31(25.8%),, duct papilloma (DP) was the cause of the bleeding in 80(66.7%), duct ectasia (DE) in 7(5.8%) and fibrocystic breast changes (FBC) in 2 (1.7%). Of the 80 patients with bleeding only and no palpable mass or abnormal mammogram, DP was the cause in 73 (91.3%), CA in 2 (2.5 %) and DE in 5 (6.1%). In bleeding with associated palpable mass, DP was the cause in 3 (12%), CA in19 (76.0 %), DE in 1(4%) and FBC in 2 (8%). Of the 31 cases of carcinoma, 19 (61.5%) had a palpable mass, 10 (29.0%) had an abnormal mammogram and 2 (6.5%) only a bloody discharge. Conclusion : This paper concludes that carcinoma of the breast is found in one out of four women attending the Komfo Anokye Teaching Hospital Breast Care Centre (KATH –BCC.) with a bloody nipple discharge. The evaluation of these patients must always include the excision of the discharging ducts for histopathologic examination.