Symptoms of Breast Cancer

Breast cancer is the most prevalent type of cancer among women. The disease rarely causes symptoms until it reaches a relatively late stage, but it may produce noticeable ones such as pain or a lump in the breast, changes in nipple appearance, and others. Being aware of the possible signs and symptoms of breast cancer is an important strategy when it comes to detecting the disease.

The screening mammogram is considered the best tool for identifying breast cancer in people of average risk, but it does not detect all breast cancers. And while routine breast cancer screening tests are recommended for women over the age of 40, young women and men of all ages can develop the disease too.

Sometimes, the effects of breast cancer can appear before the disease is detected with a mammogram. Learn how to recognize the early signs and symptoms of breast cancer so you can be properly evaluated and diagnosed, if applicable, as early as possible, when treatment outcomes are usually their best.

Over the years, your breasts can change slightly in their appearance as you gain or lose weight or go through menopause. But major alterations or rapid changes in the appearance of your breasts are concerning. While uncommon, it is possible for early breast cancer to cause signs and symptoms even without a visible change on a mammogram. Mammograms are thought to miss roughly 15% of breast cancers.

The most common symptoms of breast cancer include:

• Swelling or lump (mass) in the breast
• Unusual breast pain or discomfort
• Swelling in the armpit (lymph nodes)
• Scaly or pitted skin
• Persistent tenderness of the breast
• Pain in the nipple
• Inverted or retracted nipple
• Change in the appearance of the nipple

Keep in mind that symptoms of breast cancer require prompt medical attention (call your physician within a few days to make an appointment), so you should not wait to see if the problems clear up on their own. There are other illnesses that can affect the breasts, but breast cancer is by far the most common.

There are a few uncommon types of breast cancer that are often symptomatic. For example, inflammatory breast cancer (IBC), an aggressive type of breast cancer, typically produces a rash on the skin of the affected breast rather than a lump. But any type of breast cancer can produce unexpected symptoms.

Rare symptoms of breast cancer, including IBC, include:

• A sudden increase in breast size (after puberty)
• Itching of the skin of the breast that is not relieved by pills or creams
• Change in breast skin color, which can produce pink, red, or dark-colored areas
• A breast that is warmer to the touch than the rest of the body
• Clear or bloody nipple discharge
• Ulcers of the skin of the breast skin or the nipples

While there has been debate on whether self-breast checks are effective in detecting breast cancer, many breast cancer survivors claim that doing these exams saved their life. From a scientific viewpoint there is evidence that supports this. The average size of a breast cancer at the time of detection is 1.0 centimeters in women who perform regular self-breast exams, and 2.62 centimeters in women who do not perform these exams.

Metastatic breast cancer is defined as cancer that spreads beyond the breast and lymph nodes to other parts of the body. It is the most advanced stage of breast cancer and is associated with a poorer prognosis than breast cancer that has not metastasized.

Roughly 5% to 10% of breast cancers are metastatic (stage 4) at the time they are diagnosed. This is referred to as "de novo" metastatic breast cancer. The remaining 90% to 95% of metastatic breast cancers are due to a distant recurrence of a previous early stage (stage 1, 2 or 3) breast cancer.

Symptoms of metastatic breast cancer may include:

• Decreased appetite
• Unintentional weight loss
• Abdominal pain, nausea, vomiting
• Fatigue
• Bone pain or back pain
• Shortness of breath
• Jaundice (a yellowish discoloration of the skin)
• Headaches
• Seizures
• Weakness or numbness of one or more limbs

Recurrence of breast cancer can occur after breast cancer of any stage is treated. Recurrence is classified as local, regional, and distant:

• A local recurrence is breast cancer that has returned in or close to the original tumor location. Symptoms of a local recurrence often involve a small lump or a rash, bleeding, or discoloration of the excision scar.
• Regional recurrence may occur in the chest wall or in the lymph nodes. Symptoms of a regional recurrence include pain or swelling in the chest, underneath the armpit, above the collarbone, or on the side of the neck (on the same side where the cancer was previously removed).
• A distant recurrence can affect any area of the body and it causes the same symptoms as metastatic breast cancer.

Many people know of someone who had a recurrence of their breast cancer many years or even decades after the original tumor. We are learning that this is not uncommon. In fact, for women who have estrogen receptor positive tumors, the cancer is more likely to recur after 5 years than in the first 5 years following diagnosis.

A new tumor with different pathology (microscopic appearance) than the original breast cancer is not considered a recurrence. It is called a new primary cancer and it can occur in a different area of the breast or in the opposite breast.

A new primary cancer has to be diagnosed with a biopsy and treated based on its characteristics, not based on the characteristics of the original tumor.

Early detection of breast cancer is the best way to protect your health. Women over the age of 40 are advised to have yearly screening mammograms. Even if you do not have any risk factors for breast cancer, you need to follow the recommendations regarding breast cancer screening.

And if you have an increased risk of breast cancer—due to a personal history of breast cancer, a family history of breast cancer, or a known genetic mutation—you may be advised to have genetic testing or special testing in addition to the recommended mammograms, even before you reach the age of 40. For example, with BRCA mutations breast MRI screening is recommended. Early screening with MRI is also recommended for some people who have non BRCA gene mutations that raise breast cancer risk as well as for childhood cancer survivors.

Special tests may also be recommended for women who have dense breasts. The term "dense breasts" is not based on how your breasts feel, but rather, is a term radiologists use to describe certain changes seen on a mammogram. Policy now requires women to be informed if they have dense breasts (which also raises the risk of breast cancer) so that further testing can be considered. Combination mammogram and ultrasound has been done in some cases, but newer testing combining mammogram with fast MRI may detect even more cancers.

In addition to recommended screening, it is important that you see a doctor promptly if you notice a change in your breasts or if you feel a new breast mass or lump. These issues could be due to benign concerns, but a doctor should make that determination. That said, be your own advocate. If you are concerned about a change in your breast and your doctor is not, honor your intuition and get a second opinion. One of the most common reasons for medical malpractice suits is missed breast cancer.

Breast cancer affects one out of every eight women throughout their lifetime. Learning to check for symptoms of breast cancer and being able to recognize them, should they present, is an important part of taking care of your health. Listen to your body, and if your doctor does not share your concern, consider a second opinion.