Nipple Issues: When to Worry, When to Wait

Nipple discharge is common and usually nothing to worry about. “For at least two-thirds of women, if they squeeze, they’re going to get discharge,” says Dr. Dominici. But if it happens suddenly, it’s coming from one particular spot, or it’s accompanied by pain or swelling, it’s time to get things checked out. Also, “nipple discharge can be all sorts of colors—brown, yellow, green, or clear,” she says, but if it’s bloody, it’s more likely to indicate a problem, so phone your doctor right away.

To have boobs is to know boob soreness—and same goes for your nipples. The feeling is fairly common, especially when it happens in both breasts at once. It could be a symptom of PMS, a side effect of pregnancy, nursing a baby, or a reaction to clothing or personal care products. But it can also be a sign of an infection, says Bora Lim, M.D., an assistant professor at the University of Texas MD Anderson Cancer Center in Houston. If soreness is combined with other issues, like bleeding, it’s time to see your doc.

Is your bra too tight? Is the fabric itchy? If so, your nipples may swell due to irritation, which—though uncomfortable as all heck—is probably benign, says Dr. Dominici. Then again, “if you also have a lump in the area, discharge, fever, or redness” that’s the time to seek out medical advice to make sure nothing more serious is going on. Look for puffiness in surrounding areas as well: The American Cancer Society lists swelling around the collarbone and armpit as a potential breast cancer symptom.

The look and feel of your breasts can change over time, and that’s not necessarily something to be concerned about. “This can happen naturally with the aging process, or with changes in pigment in the skin,” says Dr. Dominici. It could also be due to a change in blood supply or a previous breast cancer treatment. One change that's more worrisome: A newly inverted nipple, combined with other symptoms, could be a potential breast cancer warning sign.

It may be uncomfortable, but as a rule, you can relax on this one. There could be many reasons behind a burning sensation, including an allergic reaction, new hormonal medication, perimenopause, or previous radiation for breast cancer. “Most of the time, a burning sensation is not something that suggests cancer,” says Dr. Dominici. “The major things we would be looking for are other symptoms in addition to that,” such as a lump, obvious changes in the breast, redness, or a fever.

Scaly skin and rashes are often signs of an allergic reaction, fungal infection, or chemical irritation. On the other hand, “a rash may need attention if someone has fever, the breast is also red, or they’re having a lot of pain,” Dr. Dominici says. Pay attention to where the scaliness occurs. If it’s on the areola (pigmented area around the nipple) but not the nipple itself, it’s very unlikely to be cancer. But “if the nipple itself starts having scabbing, scaliness, or a rash, that can be a sign of Paget disease, a form of cancer,” she adds.

“If someone is having bloody discharge, it should definitely be checked out,” Dr. Dominici urges. The American Cancer Society classifies bloody discharge as a potential cancer warning, though it could also signal an infection of some kind. Bloody discharge is a known sign of Paget disease, along with flaky, thickened nipple skin, a flattened nipple, or redness. Better to be safe in this case and get it checked out by a doctor ASAP.

While most of these nipple issues may be no big deal, they can be signs of a potential problem if they persist, says Dr. Lim. When in doubt, see your doc—we’re talking about your breasts, after all. “Especially if these changes rapidly get worse over matter of days or weeks, or antibiotics and other medical treatment given does not seem to improve, then you may want to ask for breast cancer evaluation,” she says. That may include a mammogram as well as other screenings.

If you’re 40 or older, the American Cancer Society recommends getting mammograms every year (or every two years if you’re over 55). You may choose to start even earlier if breast cancer runs in your family. “Whenever someone is having a new breast symptom, particularly if it seems to be persisting, it’s never a bad idea to call your primary care doctor,” says Dr. Dominici. Catching breast cancer early greatly improves your odds of beating it. Bottom line: You know your body best. If something feels off, trust your intuition.