Breast Cancer Symptoms

This article describes common symptoms of breast cancer.  Symptoms of breast cancer are more significant in someone who has multiple risk factors for breast cancer so these will also be described briefly.  Many of these symptoms are not specific for breast cancer and do not always indicate the presence of cancer.  These symptoms should still be noted however and brought to the attention of your doctor so further investigation can occur.  No other disease has received the significant public health efforts and media visibility, in recent years, as breast cancer has.  Breast cancer is a significant concern for women in the United States.  Breast cancer is the most common cancer diagnosed in women in the United States.

The top 10 most common cancers diagnosed in women in the United States from 2003-2007.(Source: apps.nccd.cdc.gov/uscs/toptencancers.aspx#All

There are several established risk factors for breast cancer that can alert a woman to her risk for breast cancer.  Knowing that one is at an increased risk for breast cancer can lead to several different kinds of action plans.  One might undergo screening for breast cancer with mammogram, physical examination and possibly MRI at a younger age and more frequently than recommended for the average risk woman.  More dramatic measures to reduce the risk of breast cancer might include hormone blocking medications and even “prophylactic” or pre-emptive removal of the breasts with surgery before a cancer is ever found.  These are less common strategies but may be considered for women with a very strong family history of breast cancer and documented breast cancer genes such as the BRCA-I gene.

There is some controversy about precisely how much a certain risk factor actually contributes to the development of breast cancer.  Some of these risk factors for breast cancer include:

  • Age (older women are at an increased risk of breast cancer.  If a woman lives long enough, about 1 in 8 will eventually develop a breast cancer.)
  • Nulliparity (never having had children)
  • Having close relatives with breast cancer (the risk is increased most with “first-degree” relatives such as a sister or mother)
  • Having had prior breast tumors or biopsies
  • Early menarche (early age at menstruation)
  • Older age at first pregnancy
  • Obesity

Some of these risk factors are modifiable and some are not.  The most important risk factors for breast cancer (age and family history) are not modifiable.  Thus, knowledge of these should help guide early screening and detection.  The other component of early detection is to be aware of the symptoms of breast cancer.  Unfortunately, many of the symptoms of breast cancer are not specific to breast cancer and may be difficult to interpret.  Some symptoms which might indicate breast cancer include:

  • A new lump in the breast: Many women complain of “lumpy breasts” when actually this is normal breast tissue.  Young women have denser breasts as well and as women age the breast becomes replaced with mostly fat.  During the hormonal changes of the menstrual cycle, the breasts can change shape as part of the breasts glands react to estrogen.  A woman’s breast may feel differently at different times of the month.  Sometimes a woman may notice a “new” breast lump after significant weight loss.  Many of these new lumps are actually fatty deposits (lipomas) or benign lumps (fibroadenomas) that have always been present that the woman was less likely to notice when she was heavier.
  • New dimpling of the skin of the breast: Ligaments hat help holds the breast to the chest wall and suspend the breast are called Cooper’s ligaments.  A breast cancer may interfere with these ligaments and cause deformation of the breast or dimpling of the skin.
  • New inversion of the nipple
  • Bloody nipple discharge: As described below, the actual risk of breast cancer with bloody discharge is low but it is still a symptom that cannot be ignored.
  • Rash of the breast / thickening and redness of the breast skin: Rash of the breast is most commonly infection from either yeast in the bottom fold of the breast or can represent infection particularly with breast feeding.  Rash and redness of the breast can also represent breast cancer.  Paget’s disease of the breast is a type of breast cancer that starts or presents as a rash.  Inflammatory breast cancer is a very aggressive cancer that creates an “orange peel” like look to the breast skin and should never be ignored.  Any rash that does not clear with antibiotics or has an unusual appearance should have further investigation for the possibility of breast cancer.

The actual risk of cancer with the above symptoms is actually small but they are changes that should not be dismissed and should be brought to the attention of your doctor.  For example, bloody nipple discharge proves to be related to breast cancer about 5% of the time.  This means that 95% of women complaining of bloody nipple discharge DO NOT have breast cancer.  Similarly, some women think that any new rash of the breast might indicate cancer when this is quite rare.

With advanced breast cancer, more dramatic symptoms can occur such as:

  • Swollen “knots” (i.e. lymph nodes) in the armpit
  • Bone pain or unexplained fractures
  • Unexplained weight loss
  • Ulceration of the breast skin and foul odor with drainage of pus

Further investigation of concerning symptoms usually involves a complete examination in your doctor’s office, a mammogram of BOTH breasts, and an ultrasound of any palpable concerning spots.  Based upon these three pieces of data if a spot is found that might be cancer more information will be needed in the form of a biopsy or possible more advanced imaging such as an MRI or even CAT scan.  A biopsy involves taking a sample of cells for examination under a microscope to prove the presence of cancer.  A biopsy might be done by simple passing a needle (large or small) into the area or even removing a lump of breast tissue for examination.  Removing a small lump of breast for biopsy is known as an excisional breast biopsy and is done in the operating room by a breast surgeon.

RERFERENCES:

  1. Katz, VL; Lentz GM; Lobo RA; Gershenson DM. (2007) Katz: Comprehensive Gynecology, 5th ed. Chapter 15. Philadelphia, PA: Mosby Elsevier
  2. www.womenshealth.gov/breast-cancer/what-is-breast-cancer/
  3. US Female College Students’ Breast Health Knowledge, Attitudes, and Determinants of Screening Practices: New Implications for Health Education.Early J, Armstrong SN, Burke S, Thompson DL.J Am Coll Health. 2011 Aug-Oct;59(7):640-7.PMID: 21823959
  4. This article was originally published on September 3, 2012 and last revision and update was 9/4/2015.