The early warning signs of breast cancer
Understanding the various parts of the breast and their function can help people be more aware of any changes or abnormalities.
This article looks at the early warning signs of breast cancer, who might be at risk, and what people should do if they spot one or more of these warning signs.
A lump can be an early sign of breast cancer.
When most people think of breast cancer detection, they think of a lump in the breast. This is a possible warning sign, but it is not the only one. It may also not be the first one to develop.
Some other common signs of breast cancer include:
- lumps inside the breast or underarm area
- changes in breast size and shape
- pain in a specific area that does not go away
- prominent veins on the surface of the breast
- nipple discharge that starts suddenly
- a sore or rash on the nipple
- swelling, redness, or darkening of the breast
- dimpling of the skin on the breast
- inversion of the nipple or other parts of the breast
That being said, the same changes are often the result of benign breast conditions. They do not necessarily mean that cancer is present. However, if a person notices these changes, they should see a doctor to make sure.
There are different types of breast cancer, and they can affect individuals in different ways.
Specific signs of inflammatory breast cancer
This is a rare but aggressive type of cancer that can appear differently to other types.
- a pink, reddish purple, or bruised appearance
- ridged or pitted skin
- in some cases, a palpable tumor
- a rapid increase in breast size
- heaviness and tenderness in the breast
- a burning sensation
- inversion of the nipple
- swollen lymph nodes in the collarbone or underarm area
Inflammatory breast cancer tends to occur at a younger age than other types of cancer. Doctors sometimes misdiagnose it because it can resemble an infection, trauma, or another problem.
Is it cancer?
The same warning signs that occur with cancer can also signify other benign conditions. It is therefore important to know how to recognize which signs might indicate the presence of cancer and which do not.
Dimpling and nipple discharge may also be signs of breast cancer.
It is not unusual to have lumpy breasts, as breast tissue is often lumpy in texture. Lumpiness can vary widely and does not always indicate cancer, particularly if it feels the same throughout both breasts.
However, a person should see their doctor if they notice:
- changes in breast texture that are not due to the menstrual cycle
- a harder lump that feels different from the rest of the breast
- a lump that is not present in the other breast
Lumps that are cancerous:
- usually have uneven edges
- are usually painless
- are usually hard
However, the lump can also be soft, rounded, and tender.
People tend to seek medical advice when they are worried about a new lump. However, there may be no lump at all, or the lump may be too small to feel. In fact, a mammogram or other type of screening method may be the first sign of a lump.
If a mammogram reveals a lump, a doctor may suggest further tests — such as an ultrasound or a biopsy — to confirm the diagnosis.
Benign conditions that can involve lumps or lumpiness include:
Fibroadenomas consist of glandular and connective tissue. These are very common and not cancerous. Most types do not increase the risk of breast cancer.
Fibroadenomas can be up to an inch in diameter and have a smooth, rubbery feel. They can also move under the skin.
In this article, learn more about fibroadenoma of the breast.
Nipple discharge can result from:
- squeezing the nipples
- an infection
A person should see their doctor if they have:
- discharge that occurs without squeezing the nipple
- discharge in one breast and not the other
- discharge that contains blood
Whether or not the discharge relates to cancer, it may need treatment.
Normal breast changes
Hormonal changes can happen at different stages of life, and these can lead to lumps, changes in shape, and other changes that are not due to cancer.
Some people have a higher chance than others of developing breast cancer. If they notice any of the above symptoms, they should be sure to see a doctor.
Factors that increase the risk, according to the American College of Physicians (ACP), include:
- a personal history of breast cancer or a high-risk lesion
- genetic factors, such as the BRCA 1 or BRCA 2 gene mutation
- exposure to chest radiation during childhood
Every case will be different. Knowing about any personal or family history of breast cancer and discussing this with a doctor can help a person know what to look out for.
What to do if you spot symptoms
Anyone who notices a change in their breast that develops without a clear cause should see a doctor, especially if the changes affect only one breast. In many cases, routine screening will reveal any significant changes.
Breast cancer is highly treatable if diagnosis occurs in the early stages. Regular screening can help with this.
As of April 2019, the ACP make four recommendations for screening for women with an average risk of breast cancer and other guidelines for those with a higher risk.
For those with an average risk:
Women ages 40–49 should ask their doctor about whether they should start having a routine mammogram.
Women aged 50–74 who have an average risk should have a mammogram every 2 years.
Women with an average risk should stop screening when they reach 75 years of age, or if they expect to live another 10 years or fewer.
Women of all ages with an average risk should not undergo clinical breast examination to screen for breast cancer.
Other organizations, such as the American Cancer Society, make different recommendations. Each person should ask their doctor for advice on the best strategy for them.
What the doctor will do
It is helpful for people to be aware of how their breasts feel so that they can get used to any regular changes that occur. If they notice anything unusual, they should see their doctor.
At their visit, the doctor may use one of the following methods:
Clinical breast exam
The ACP guidelines no longer recommend a clinical physical examination as part of routine screening. That said, a doctor may carry out a physical examination if a person suspects a change.
The individual will need to remove the clothing from the top half of their body.
The doctor may then carry out a:
Visual check: They will ask the person to raise and lower their arms, as this can show differences in the size and shape of the breasts. They will also look for any rashes, dimpling, or nipple discharge.
Manual check: The doctor will use the pads of their fingers to check the entire breast, underarm, and collarbone for any abnormalities and suspicious lumps. They will also check any enlarged lymph nodes.
The doctor will note any changes or unusual features, and they may recommend further tests.
The doctor may recommend a mammogram.
Further tests include:
Mammogram: An X-ray of the breast.
Ultrasound: This does not involve radiation and may show more detail than a mammogram or confirm the results of a mammogram.
MRI: This can provide a detailed picture of the breast.
Biopsy: A doctor uses a needle or other device to take tissue or fluid from the area for further tests.
If a doctor recommends these tests, it does not mean that a person has breast cancer. In many cases, the results will show that there is no cancer.
Breast anatomy and cancer risk
Knowing about the different parts of the breast can help people understand how cancer forms and spreads.
A female breast is made up of:
- body fat (adipose tissue)
- milk ducts
- lymph nodes
- blood vessels
The female breast consists mostly of adipose tissue, or body fat. Adipose tissue stretches from the collarbone, down to the underarm, and across to the ribcage.
Adipose tissue also contains nerve cells and blood vessels. It is important for storing and releasing energy.
Lobes, lobules, and milk ducts
A female breast will generally have 12–20 sections called lobes. Each of these is made up of smaller areas of milk glands, called lobules.
Milk ducts connect the lobes and lobules, and they carry milk to the nipple. Breast cancer is most likely to affect the lobes, lobules, and milk ducts.
Lymphatic and vascular system
There is a lymphatic and vascular network inside the breast. The vascular system consists of blood vessels, and the lymphatic system consists of lymph channels.
These two systems work together to carry blood and fluid to and from the breast tissue to the rest of the body.
If breast cancer enters these systems, it can travel throughout the body, increasing the chance of it spreading or coming back.
Lymph nodes are clusters of bean-shaped cells present throughout the lymphatic system. These are immune cells that act as filters. They are the first place breast cancer is likely to spread.
With current treatment options, a person who has a diagnosis of early stage breast cancer has a 99% chance of living for at least another 5 years.
To ensure early diagnosis, it is important to recognize any changes in the breast and to raise any concerns with a doctor. Most breast changes do not indicate cancer, but it is always worthwhile to check.
Doctors used to tell us to do a breast self-examination every month. Do they not recommend this any more? If not, why not?
Formal screening for breast cancer doesn't include self-exams anymore. However, it's still very important for people to know the look and feel of their breasts for their own breast awareness. This way, they can understand what's normal and what's unusual.
In the past, it seemed to be a good idea to encourage women to practice monthly breast self-exams. However, this has proven ineffective, and the harms of this outweigh the benefits. Research has shown that these self-exams triggered more tests and false positives in women who regularly practiced them than in women who did not.
If a person notices changes in their breast or breasts, they should speak to their doctor. They can determine whether or not further tests are necessary.Christina Chun, MPH Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.