From the Guidelines
The patient's inverted nipple on the right breast, which has not changed, does not require further action, and regular breast examinations should continue as recommended based on the patient's age and risk factors. The breast examination was conducted with a chaperone present, and both breasts were normal without any lesions, masses, discharge, or redness. Inverted nipples can be congenital (present from birth) or acquired, and when a patient reports no change in an inverted nipple, this is typically reassuring as new nipple inversion could potentially indicate underlying pathology 1.
According to the American College of Radiology, nipple discharge is common, with a prevalence of 4.8% to 7.4%, and can be characterized as physiologic or pathologic 1. However, in this case, there is no nipple discharge, and the patient's inverted nipple is stable. The clinical history and physical examination are essential in assessing the risk of breast cancer, and the patient's age and risk factors should guide the frequency of breast examinations 1.
The most recent study on the evaluation of nipple discharge, published in 2022, emphasizes the importance of characterizing nipple discharge as physiologic or pathologic and provides guidelines for imaging examinations based on the patient's age and symptoms 1. However, this study does not change the recommendation for this patient, as there is no nipple discharge, and the inverted nipple is stable.
Therefore, no further action is needed regarding the inverted nipple, and regular breast examinations should continue as recommended based on the patient's age and risk factors. The spelling in the original note appears correct, though "unverted" should be "inverted" when describing the nipple.
From the Research
Breast Exam Findings
- The patient's breast exam is normal without lesions or masses, discharge, or erythema.
- The right breast has an unverted nipple, which the patient reports is no change for her.
Relevance of Genetic Counseling
- There is no direct evidence in the provided studies that links an unverted nipple to an increased risk of breast cancer or the need for genetic counseling 2, 3, 4, 5, 6.
- However, genetic counseling and testing are important components in the management of breast cancer, particularly for individuals with a family history of the disease 2, 3, 4, 5, 6.
Genetic Counseling and Testing
- Studies have shown that genetic counseling and testing can identify individuals with actionable BRCA1/2 mutations and those with a high risk of breast cancer 2, 3, 4, 5.
- Genetic counseling and testing can inform treatment decisions and improve clinical risk management for individuals with breast cancer 2, 3, 4, 5.
- The use of screening tools and pathways can increase referrals for genetic counseling and testing among eligible patients 2, 4.