Morrison C
Johns Hopkins University School of Nursing in Baltimore, Maryland 21205, USA.
Lippincotts Prim Care Pract. 1998 Mar-Apr;2(2):129-40.
Breast cancer is one of the most dreaded diseases affecting women and is associated with a high degree of morbidity and mortality. Any breast complaint has the potential for creating a great deal of anxiety for patients and providers alike. An in-depth understanding of the pathophysiology of common breast complaints, particularly those with low probability of association with cancer such as nipple discharge, can serve to allay anxiety and prevent the financial and emotional burden of unnecessary diagnostic evaluations. It will then improve the quality of care for each patient experiencing the symptom. Although the greatest incidence of nipple discharge is not secondary to malignant processes, the fact that some are requires that all persons with nipple discharge receive the benefit of a thorough assessment. When planning a course of action to assess and treat nipple discharge, a thoughtful stepwise, planned approach is necessary. The evaluation of nipple discharge can be undertaken with minimal difficulty by performing a thorough history, a careful physical examination, and following a logical thought process in linking the type of discharge with the suitable adjunct diagnostic testing. Appropriate management evolves from this process. It is important to view the patient in total, considering such issues as family history, other risk factors, how disruptive the level of anxiety about the symptom. Primary care providers, working with their parents, are well positioned to design appropriate diagnostic and treatment regimes to assess and treat nipple discharge. A thoughtful, prudent approach to this symptom can save both health care dollars and lives.
乳腺癌是影响女性的最可怕疾病之一，具有高度的发病率和死亡率。任何乳房问题都可能给患者和医护人员带来极大的焦虑。深入了解常见乳房问题的病理生理学，尤其是那些与癌症关联可能性低的问题，如乳头溢液，有助于缓解焦虑，避免不必要诊断评估带来的经济和情感负担。这将提高每个有相关症状患者的护理质量。尽管乳头溢液最常见的原因并非恶性病变，但部分是恶性病变这一事实要求所有乳头溢液患者都能接受全面评估。在规划评估和治疗乳头溢液的行动方案时，需要采取深思熟虑的逐步规划方法。通过全面了解病史、仔细进行体格检查，并按照合理的思维流程将溢液类型与合适的辅助诊断测试相联系，对乳头溢液的评估可以轻松完成。恰当的治疗方案由此过程得出。全面看待患者很重要，要考虑家族病史、其他风险因素以及症状引发的焦虑程度等问题。初级保健医生与患者共同协作，完全有能力设计出合适的诊断和治疗方案来评估和治疗乳头溢液。对这种症状采取深思熟虑、谨慎的处理方法既能节省医疗费用，又能挽救生命。
