Symptoms of Breast Cancer

A new painless lump, swelling, and skin changes to your breasts may be a warning of breast cancer.

Breast cancer is the most prevalent type of cancer among women, so knowing the symptoms of breast cancer is important. However, the disease rarely causes symptoms until it reaches a relatively late stage, so preventive tests like mammograms are crucial in receiving an early diagnosis.

Black women are disproportionately burdened by breast cancer. Not only are Black women more likely to get and die from breast cancer, but younger Black women are more likely to present with the triple-negative subtype of the disease, which is more aggressive and associated with higher mortality.

This article discusses the symptoms of breast cancer, along with specific details about how breast cancer affects Black women.

Frequent Symptoms

Breast cancer typically has no symptoms, especially in its early stages when the tumor is small, hard to notice, and most easily treated, underscoring the importance of yearly mammograms for early detection. 

The most common physical sign of breast cancer in Black women is a painless lump. Most lumps are benign and some women may even be accustomed to feeling new ones pop up from time to time, but any lump that feels harder or different from the rest of the breast should be checked by a healthcare provider.

Every breast feels different. There is no typical or normal feeling breast, but some changes to your breasts can be warning signs of breast cancer, including:

• New lump in the breast or underarm (armpit)
• Thickening or swelling of part of the breast
• Irritation or dimpling of breast skin
• Redness or flaky skin in the nipple area or the breast
• Pulling in of the nipple or pain in the nipple area
• Nipple discharge other than breast milk, including blood
• Change in the size or the shape of the breast
• Pain in any area of the breast

Finding a new lump on your breast can be scary, especially if breast cancer runs in your family, but not all lumps turn out to be breast cancer. Fibrocystic breast condition and cysts are common causes of lumps.

Monitoring for additional symptoms like fever, bloody nipple discharge, unexplained weight loss, and localized redness and pain can shed more light on your condition. No matter the case, see a healthcare provider right away if you experience any new changes to your breasts that worry you. 

Rare Symptoms

Some uncommon symptoms to look for include:

• Dimpling: Skin that begins to resemble an orange peel can be a sign that a tumor is developing underneath.
• Breast puckering: If you develop an indentation of the breasts when your arm is up that retracts when you put your arms down, you may have breast puckering, a sometimes subtle sign of breast cancer.
• Swelling, redness, or darkening of the breast: Inflammatory breast cancer (IBC) is an aggressive form of breast cancer that can present with symptoms that mimic an infection.
• Change in size or shape: Uneven breasts and changes in breast size are natural, but rapid changes in shape and size may be an early warning sign of breast cancer.
• Itchy, scaly rash on the nipple: An itchy nipple can resemble eczema, but if you have never had eczema in the past, do not assume that it has developed out of nowhere. See a healthcare professional immediately. 
• Breast pain after menopause: This is rare, but it may be an early sign of breast cancer. 

Sub-Group Indications

Some cancers are sensitive to the hormones estrogen and progesterone, so the growth of cancer cells can be limited by the use of hormone-blocking drugs. Breast cancers all fall within one of the following hormonal status categories:

• Estrogen positive and/or progesterone positive breast cancers: These are treated with hormone therapy drugs that lower estrogen levels or block estrogen receptors.
• Hormone-receptor positive or negative (HR+/HR-): HR+ breast cancer cells can be treated with estrogen-blocking, progesterone-blocking, or estrogen-plus-progesterone-blocking drugs. HR- tumor cells do not have estrogen or progesterone receptors that govern growth, so they do not respond to hormone-blocking drugs. 

Black women are more likely than White women to have HR- breast cancers that do not respond to hormone-blocking drugs. In fact, one major national study found that Black women under age 45 are 70% more likely to develop ER- breast cancer than White women of the same age regardless of socioeconomic status.

Black women were also more likely to have aggressive tumor features, such as more distant vs. localized disease, large tumor size, and more highly mutated cells, highlighting the need for inclusive research that looks into differences in tumor biology among races and ethnicities. 

Some other breast cancers have cells that overproduce a growth-promoting protein, HER2. Growth of HER2+ breast cancer cells can be inhibited by HER2-blocking drugs.

Black women are more likely to have HER2- breast cancer, and according to the American Cancer Society, are twice as likely to have triple-negative breast cancer than White women in the United States.

Triple-negative breast cancer is:

• Estrogen-receptor-negative
• Progesterone-receptor-negative
• HER2-negative

Triple-negative breast cancer is a significant contributor to mortality in Black women because it is the most aggressive and resistant cancer to breast cancer treatment. 

Effect on Black Women

Many Black women do not present with any symptoms of breast cancer. Subtle signs like a darkening of the breasts or dimpling of the skin may be warning signs of breast cancer, but Black women tend to have denser breast tissue, which may mask these signs.

To stay on top of your breast health, it’s important to:

• See a primary care doctor regularly
• Perform a routine self-breast examination
• Follow the American Heart Association and USPFTF guidelines on mammograms

Triple-negative breast cancer is harder to treat and more likely to come back. Black women are also more likely to have larger tumors, requiring longer courses of treatment.

The effect of triple-negative breast cancer on Black women can be devastating. Its aggressive nature often does not provide Black women with enough time to adapt to their diagnosis, symptoms, and treatment regimens.

Triple-negative breast cancer is extremely lethal, with a five-year survival rate of 12% when diagnosed in late stage, compared to 91% when found early and localized. This underscores the importance of mammogram screening and early detection in Black communities.

When to See a Healthcare Provider

You find a new lump and it doesn’t feel like the rest of your breast. What should you do?

Lumps in your breasts are fairly common but can be frightening. If a new lump appears, it is better to be safe than sorry. All breast lumps need to be evaluated by a healthcare provider, regardless of your age or where in your breast you feel the lump. 

If you have a history of cysts, mastitis, or fibrosis, you may feel compelled to take a wait-and-see approach, but the following changes to your lump may be particularly concerning and should prompt you to see a healthcare provider: 

• Changes in the skin over the lump
• Nipple changes, including enlargement or bloody discharge
• Changes in the size of the lump

The earlier you catch breast cancer, the more likely you are to beat it, but Black women are more likely to have delays in diagnosis and present with advanced disease for many reasons that are simply out of their control, like unequal medical treatment and access.

Even with a prompt diagnosis, there are several barriers to health care, like:

• Lack of insurance
• Transportation challenges
• Financial strain

These are compounded by the wealth gap between Black and White families in the United States that can lead to delayed initiation of treatment. This can have wide-ranging and devastating consequences.

Still, research has also shown that Black women fare far worse than White women even when socioeconomic differences are accounted for. If you have any suspicion of breast cancer, seek immediate medical attention.

Access to Care

Black women are at high risk for getting and dying from breast cancer, and early detection is not happening sufficiently to stop this from occurring.

According to the American Cancer Society, 65% of White women are diagnosed at an early stage vs. only 55% of Black women; and nearly twice as many Black women are diagnosed with late-stage breast cancer vs. White women.

Survival rates are predicated on early detection, therefore getting a yearly mammogram is of the utmost importance for Black women starting at age 40. Recommendations do vary, however. The U.S. Preventive Services Task Force recommends biennial screening from 50 to 74, while the American Society of Breast Surgeons takes an even more aggressive approach, recommending that risk assessment actually be done at age 25.

Getting a mammogram before the age of 50 is an individual choice that should be based on your risk profile. No matter the case, lack of insurance, misinformation, and healthcare provider bias should never stand in the way of you getting the preventative services you need. 

Some healthcare providers may be hesitant to address breast cancer with Black people when they come in with other conditions. Health disparities are so pervasive that it may seem as if there are too many conditions to discuss.

Remember that you are entitled to information regarding your overall health, not just the condition that brought you in. Open and honest dialogue with your healthcare provider will make it easier to have the discussions you need. 

According to a recent study, the three most commonly reported barriers to mammography were:

• Fear of cost
• Fear of mammogram-associated pain
• Fear of getting bad news

Systemic problems such as lack of insurance, concerns over the ability to pay, no primary care physician, and biased physician care add another level of difficulty to an already tenuous situation. 

Some factors associated with lower mammogram completion rates include:

• Age lower than 60 
• Health plan membership less than five years
• Family income less than $40,000 per year
• Obesity: Obese women were more likely than non-obese women to report “too much pain” from mammograms.
• Recent immigration
• Rural residency

No Black woman should go without a mammogram, whether there are concerns about pain, bad news, or cost. Going to an appointment with a friend may ease your fears, and many providers will work with you to offset the cost of your mammogram. 

More needs to be done to meet Black women where they are. Patient reminders via mail and social media, as well as telephone reminders using live callers or automated calls are excellent ways to raise screening rates. Ask your healthcare provider to provide these services for you if they haven’t already.

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A Word From Verywell

Even if you don’t have signs or symptoms of breast cancer, finding a culturally competent and trustworthy healthcare provider who can set you up with routine visits will help mitigate your risk of developing breast cancer moving forward.