What to Know About Breast Cancer Symptoms

Breast cancer is the most common cancer in women and can occur at any age. An awareness of symptoms is critical for detecting the disease as early as possible, especially in women who haven't yet reached the age at which they have regular mammograms. And, as many people are aware, mammograms do not detect all breast cancers. What should you know about the common as well as uncommon symptoms of breast cancer?

Most people are aware that a breast lump could mean breast cancer, but there are a number of different symptoms you should know. In addition to the signs of early breast cancer, other symptoms may be noted in people who have metastatic breast cancer or inflammatory breast cancer. Let's begin by looking at the symptoms of early breast cancer and then talk about less commonly understood, but not uncommon symptoms of advanced or inflammatory cancers.

Mammograms can detect breast cancer before it produces symptoms. Still, mammograms are not perfect and women often develop breast cancer before they reach the age of a first mammogram. So it's extremely important to also watch out for breast cancer symptoms, such as:

• Swelling or lump (mass) in the breast or armpit—this is the most classic symptom of breast cancer
• Swelling in the armpit (lymph nodes)
• Clear or bloody nipple discharge
• Pain in the nipple
• Inverted or retracted nipple
• Scaly or pitted skin on nipple
• Persistent tenderness of the breast
• Unusual breast pain or discomfort

Stage 4, or metastatic breast cancer is the most advanced stage of this disease. Metastatic breast cancer is defined as having spread beyond the breast and underarm lymph nodes to other parts of the body. Symptoms may include:

• A drop in appetite 
• Unintentional weight loss (unintentional weight loss should be investigated no matter the possible cause
• Bone pain (bone metastases)
• Shortness of breath (lung metastases)
• Jaundice (a yellowish discoloration of the skin)
• Headaches, neurological pain, or weakness (could be brain metastases)

One type of breast cancer that does not appear in lumps is called inflammatory breast cancer (IBC). This aggressive cancer grows in sheets instead of lumps and invades nearby skin—resembling a rash. It will not respond to topical creams or antibiotics and should be treated very promptly. Symptoms may include:

• Sudden increase in mature breast size (as much as a cup size in a few days)
• Itching in the skin of the breast that is continuous and not relieved by pills or creams
• Change in breast skin color—resulting in pink, red, or dark-colored areas
• A breast which is excessively warm to the touch or harder or firmer than usual
• Unusual pain which occurs out of the regular cycle
• Sometimes a change in skin texture, similar to the skin of an orange
• Breast skin ulcers (later stage IBC)

Recurrence of breast cancer is classified as local, regional, and distant. A distant recurrence is the same as advanced (metastatic) breast cancer. A local recurrence is breast cancer that has returned after treatment—in or close to the original tumor location. Regional recurrence may be in the chest wall muscles or in lymph nodes located beneath your sternum, just above your collarbones, and around your neck.

Local recurrence symptoms involve a small lump or rash in the excision scar on or under the skin. Regional recurrence symptoms include swollen lymph nodes in the same armpit in which cancer was previously removed or swollen lymph nodes above collarbones or sides of the neck.

If a new tumor appears and has a different pathology than the original breast cancer, it is not considered a recurrence. It is called a new primary and can occur in a different area of the breast that was originally affected or in the opposite breast. A new cancer is diagnosed and treated independently from the original tumor.

Doing your monthly breast self-exam (BSE) is a great way to be familiar with your breasts’ texture, cyclical changes, size, and skin condition. A mammogram can detect cancer before you can feel a lump, which is why your annual screening mammogram is so important. Early detection is the best way to protect your health and improve your odds of survival. It's very important to see your doctor if you have a question about a change in your breasts or if you feel a new breast mass or lump.

It's important that all women (and men) are aware of the most common symptoms of breast cancer. Survival is better when the disease is diagnosed in the earlier stages, and symptoms may be the only way to know a cancer is present. Even if you have a normal mammogram, make sure to talk to your doctor about any and all breast symptoms you experience. Breast cancer is far too common. It's common in young women who have not yet had a mammogram. It's common in women who do not have a family history of breast cancer. And it's common in women who eat healthily, exercise and have never smoked. In other words, nobody is immune. Make sure to be your own advocate for your breast health and ask questions. If you aren't getting answers you are comfortable with, get a second opinion. Nobody is more motivated than you are to make sure you are healthy and find anything abnormal at the earliest stage possible.