All of us, at one time or another, have had nipple issues. Perhaps it’s discharge, with clear, milky, dark, or even bloody fluid leaking (or being squeezed) out. Often it’s pain—anything from slight sensitivity to a burning soreness. And sometimes it’s a rash, what looks like an infection, or even an inversion, when your nipple decides to retreat into your breast.
What’s up with all of this? And when should you call the doctor?
Nipple discharge: This is seldom a sign of breast cancer, but can signal some other underlying problem (a hormonal imbalance, an infection) that should be checked by a doctor. For more information, read our post on nipple discharge.
Sore nipples: When both nipples are sore, it’s almost certainly nothing to do with breast cancer. In fact, any time you’re experiencing an issue with both of your breasts at once—pain, soreness, lumps—it would be very unusual for breast cancer to be the cause. Breast cancer symptoms almost always appear in just one breast at a time.
Your nipples are one of the most sensitive parts of your body; they’re easily irritated. Sore nipples can be caused by something as simple as a change in your body wash or laundry detergent. They’re a classic sign of early pregnancy—and also of the approach of your period. Sore nipples may be due to a hormonal imbalance. Cold compresses sometimes help; but generally, it’s just something you have to wait out.
Itchy nipples: See sore nipples, above. Your nipples respond to very minor changes in their environment. Again, a change in shower gel or laundry soap may be the culprit here; as may cold winter weather (nipples can get chapped, just like your hands). If soap isn’t the issue, try applying some soothing cream, or anti-itch ointment; that may help.
Change in appearance: What if one nipple suddenly seems darker than the other? This could be related to your period; wait and see if the change disappears over the course of your cycle. If it lasts longer than a month or so, ask your doctor about it.
And what if your nipple suddenly becomes inverted—it pulls in, instead of sticking out? This can be a bona fide breast cancer symptom; you should see a doctor sooner rather than later.
Scaliness, or a rash: You may notice what seems like eczema or another skin condition on your nipple. This may sometimes extend to the areola (the dark area surrounding the nipple). You may notice oozing, flaking or scaling skin, or redness; you may experience pain, burning, or itching. What causes this?
You might simply be experiencing a more severe irritation due to any of the above causes for itchy or sore nipples. You might have an infection of the milk ducts beneath the nipple that’s spread to the nipple itself.
But you might also have Paget’s Disease of the Breast, a rare (about 5% of all cases) breast cancer that’s usually a sign of an underlying invasive ductal carcinoma (IDC); rarely does Paget’s Disease happen by itself.
So, how do you know if you should consider Paget’s? It’s almost always confined to one breast; and about half the time you’ll feel a lump underneath your nipple. If your nipple doesn’t respond to treatment for skin issues or infections (antibiotics, creams), you might consider asking about Paget’s. Unfortunately, it’s hard to diagnose; the average amount of time to reach a diagnosis is 6 to 8 months after the first appearance of symptoms.
When to call the doctor for a nipple issue: Generally speaking, you should call the doctor if your nipple issue is confined to one breast; and if it lasts longer than a month (longer than one menstrual cycle).
You should also call the doctor if your symptoms are clearly worsening—if it looks like an infection is developing, or if the pain/itching are increasing in intensity and frequency.
In rare cases, itchy or irritated nipples might be an early symptom of inflammatory breast cancer, another rare cancer that sometimes starts with general breast itchiness, or what looks like a localized infection or insect bite. Track your symptoms, and call the doctor following the guidelines above.
Bottom line: Give whatever’s bothering your nipple a few weeks to resolve itself. But if it doesn’t, treat it like any other breast change: call the doctor. It’s important to rule out cancer; and the doctor just may be able to offer you a solution to that irritating itchiness and pain.