Nipple smear cytology (NSC) is commonly used in the management of patients with nipple discharge. A retrospective review was conducted to evaluate the results of NSC and determine if the test provided important information that potentially altered patient management. Two hundred twenty-two NSC specimens were obtained from 165 patients. No malignant cytologic diagnoses were made. Four patients were subsequently shown to have cancer. Three patients with cancer had negative NSC. All four cancers were detected as a result of surgical biopsies directed at associated clinical or imaging findings. In many instances the results of NSC, negative or abnormal, did not affect the subsequent management of these patients. The total cost of performing these tests was approximately $12,000. NSC is neither helpful nor useful in the management of patients with nipple discharge.