In a series of 8,703 breast operations, nipple discharge was the presenting symptom in 7.4% of cases. It is even more common in the office and clinic since many discharges can be treated medically. To be significant, a discharge should be true, spontaneous, persistent, and nonlactational. Of the 7 basic types, i.e., milky, multicolored and sticky, purulent, clear (watery), yellow (serous), pink (serosanguineous), and bloody (sanguineous), the last 4 are the surgically significant ones. Of the 586 patients operated on for one of these types of discharge, the majority had a benign etiology, i.e., intraductal papillomata (48.1%) and fibrocystic changes (32.9%), but 14.3% were due to cancer and another 7.3% to precancerous mastopathy. In the 84 patients with cancers, the false-negative rate for mammography was 9.5% and was 17.8% for cytology. There was no palpable mass in 13.1% of patients. There was an increasing likelihood of the discharge being due to cancer when the discharge was, in order of increasing frequency, yellow, pink, bloody, or watery, when it was accompanied by a lump, when it was unilateral and from a single duct, when the mammogram or galactogram and the cytology were positive, and when the patient was over 50 years of age. Milky discharges are usually treated medically unless they are due to a pituitary adenoma. If the cause cannot be found and eradicated, bromocriptine is the drug of choice. Multicolored sticky discharges are also treated medically, chiefly by nipple hygiene, except when advanced. Purulent discharges are treated with appropriate antibiotics but abscesses need drainage and a biopsy of the wall. Except in women under 35 years of age or in those anxious to have children, surgically significant discharges are treated by central duct excision. Good cosmetic results can be obtained with careful technique and the danger of a recurrent discharge is eliminated.

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Bilateral breast cancer is discussed as to 1) the criteria for determining whether a cancer in the other breast is primary or metastatic; 2) the incidence of simultaneous and subsequent primary cancers in the second breast and the factors that could account for the reported frequency variance by different authors; 3) the influence that a second primary cancer in the contralateral breast makes on the survival of the patient; 4) the psychologic and physical importance of the remaining breast to the patient; and 5) the management of the other breast using preoperative x-rays and random biopsies as added modalities for detection and reserving prophylactic mastectomy of the remaining breast for those patients at high risk for developing cancer in it with a definition of these risk factors. Forty-two simultaneous primary cancers were found in the other breast in a series of 500 (8.4%) patients undergoing primary therapy for cancer in their first breast of which 19 (45.2%) were invasive, and 23 (54.8%) were non-invasive. Two (0.4%) were detected clinically, 16 (3.2%) by x-rays, and 24 (7.5%) by random biopsies in 321 patients. In a series of 846 patients with potentially curable breast cancer, the absolute ten-year survival rate was 63%. They were operated on before the routine use of preoperative x-rays and random biopsies. Eleven (1.3%) had either clinical or x-ray detected simultaneous cancers in the other breast. Of the remaining 835, 48 had prophylactic mastectomies in which 8 (16.6%) unsuspected cancers were found. In the remaining 787, 70 (8.9%) developed subsequent cancers making a total subsequent rate of 78 of 835 (9.3%).