Breast Cancer: Signs, Symptoms, and Early Detection (2024)

Introduction

Knowing how our breasts normally look and feel is an important part of our breast health as only then can we be more aware of any changes in our breasts. Early detection is crucial for successful breast cancer treatment. When caught early, the chances of a full recovery are significantly higher. Partners can play a crucial role here; many of the ladies (and men) that I see in my symptomatic breast clinic present with lumps which were first felt by their partners.

What Is Breast Cancer?

Breast cancer is a condition where cells in the breast tissue grow abnormally and form tumours. It's the most common cancer affecting women, but it can also occur in men. While the exact cause remains unknown, a combination of genetic and environmental factors is believed to be at play.

Diagnosis of Breast Cancer

There are some signs and symptoms we can look and feel for that may raise alarms and warrant further evaluation by a healthcare provider. However, the definitive diagnosis of breast cancer is made only after the completion of a triple assessment. This includes 3 components: 

1. Clinical breast examination by a trained healthcare provider or breast specialist
2. Breast imaging which usually takes the form of a mammogram and an ultrasound scan of the breast (and armpit)
3. Tissue diagnosis or biopsy done either under image guidance by a radiologist or clinically by your doctor

12 signs of breast cancer revealed

1. Lump or bump in the breast
2. Lump in the armpit
   
3. Thick area or thickening in the breast
   
4. Dimpling
   
5. Rash or crusting on the nipple
   
6. Red and hot breasts
   
7. Nipple discharge
   
8. Ulcers or sores in the breast skin
   
9. Prominent or growing veins on the breast
   
10. Sunken or indrawn or inverted nipples
    
11. Change in shape or size of one breast
    
12. Orange peel skin

1. Lump or bump in the breast

The most common sign of breast cancer is a new lump or mass. However, having noticed a lump in the breast does not mean you have cancer. Most lumps turn out to be harmless such as a fluid-filled cyst or fibroadenomas.

Cancers are usually painless, hard, and have irregular edges but they can also be soft, round and tender, or even painful. If you find a lump in the breast, contact your healthcare provider for an examination.

Sometimes after a direct injury to the breast especially due to seat belts crushing the breasts, you may notice some bruising and feel a lump. A direct hit to the breast cannot cause cancer but it can draw your attention to a lump in that area. Sometimes an injury can lead to a lump known as “fat necrosis”.

2. Lump in the armpit

A lump or swelling in the armpit is another common symptom with which we see women in our clinics. It is harmless in most cases but can be an alarming sign as breast cancer can spread to the lymph glands in the armpit.

A steep rise was noticed in women and men presenting to breast clinics with this symptom post-COVID vaccinations. The lymph glands in the armpit can enlarge as a normal reaction to the vaccine. However, an armpit lump that is hard and does not change or is associated with systemic features like weight loss, fever, and night sweats warrants evaluation.

In most situations, small superficial lumps are sebaceous cysts (blocked oil glands), infections (commonly due to grazes caused by re-using blunt razors), and skin problems like Hidradenitis suppurativa (HS) (a painful, long-term skin condition that causes skin abscesses and scarring on the skin).

3. Thick area or thickening in the breast

You may notice a part of your breast feels different either more dense or squishy from the rest of the breast. This may be a normal part of your menstrual cycle. However, if this persists or gets worse then contact your healthcare provider. 

4. Dimpling

A dimple or indentation can be seen in the breast when tight clothing leaves a temporary mark on the skin (commonly due to an ill-fitting bra). However, if this does not go away it may warrant further evaluation. Dimpling is made more obvious when arms are raised above the head.

5. Rash or crusting on the nipple

Rash or crusting on the nipple can be a harmless skin condition like eczema or is a common problem with breastfeeding especially if it is on both sides and you have a history of eczema anywhere else on the body.

However, if a trial of skin remedy especially containing topical steroids is not effective further evaluation by a healthcare provider is recommended to rule out a type of breast cancer known as Paget's disease.

6. Red and hot breasts

Typically, this is an infection common in women who are breastfeeding. It is usually associated with systemic symptoms of fever and feeling generally unwell. However, if antibiotics or other treatments don't improve it, then it warrants further evaluation by your healthcare provider to rule out Inflammatory carcinoma breast.

This cancer blocks the flow of lymph in the breast, which causes swelling and redness but without an obvious hard lump. This may also make the breast feel warm or hot, or cause a burning sensation. The skin of the breast may also appear pink, reddish purple, or bruised.

7. Nipple discharge

Discharge from the nipple is a common symptom and is harmless (benign) most of the time. It is usually related to developing breasts, infection, cysts, pregnancy, or breastfeeding. However, blood-stained nipple discharge, brownish discharge, or a clear discharge should raise alarm bells.

It should also be highlighted that blood-stained discharge does not always mean breast cancer. The most common cause of blood-stained discharge is a papilloma. Greenish colour discharge is seen in women who smoke due to duct ectasia.

8. Ulcers or sores in the breast skin

Breast cancer can sometimes build up to the point that it breaks down the skin of the breast to form an open wound. Infection may cause a bad smell and/or leakage. This is usually accompanied by an obvious hard lump. This is an advanced sign of the disease.

Due to rising awareness and screening programs, we see far less of this presentation in clinics. Commonly, a short-duration ulcer or break in the skin may be due to a ruptured and infected sebaceous cyst that forms due to a blocked oil gland. When in doubt always see your doctor.

9. Prominent or growing veins on the breast

Newly appearing blood vessels or veins are usually not a sign of cancer. More often it is connected to weight gain, breastfeeding, or Mondor's disease which inflammation in the veins of the breast or chest wall. Topical use of anti-inflammatory ointments usually helps.

If large engorged veins are seen in association with a lump in the breast or a generalised increase in the size of the breast, then it warrants review by a specialist to complete a triple assessment and rule out anything sinister.

10. Sunken or indrawn or inverted nipples

Long-standing retracted or inverted nipples can be a normal shape of the breast (from when the breast was first developed). However, if you notice a recent sinking, flattening, or turning in your nipple then it could be a sign of a new breast cancer tumour forming underneath, pulling the nipple toward it as it grows.

However, not all new onset nipple retractions are a sign of cancer. Women who smoke can have nipple retraction secondary to duct ectasia and peri-ductal mastitis which is an inflammation and infection around the ducts in the nipple area.

11. Change in shape or size of one breast

It’s common for one breast to be different in size and shape from the other. Breastfeeding can also cause changes in size or shape as a result of milk production.

But if one breast changes size, flattens, swells, or droops unexpectedly — and doesn't seem to be connected to your menstruation cycle, then it warrants evaluation by a specialist.

12. Orange peel skin

When the skin of the breast looks like the dimpled skin of an orange, this is a symptom of breast cancer known as “peau d’orange,” (how the French say "orange peel"). With peau d’orange, the breast swells to the point it causes hair follicles to look like lots of little dimples.

The skin may or may not change colour. Peau d'orange is a sign of Inflammatory Breast Cancer or a cancer that is invading the skin lymphatics. When noticed an evaluation by a specialist is warranted to rule out a sinister pathology.

In some cases, breast edema from various other causes can give a similar appearance but that judgment should be made by a trained breast specialist.

Treatment for breast cancer

There are several effective treatment options available for breast cancer, tailored to the specific stage and type of cancer such as surgery, radiation therapy, and chemotherapy.

I will go deeper into the available treatment options in a separate blog post, so stay tuned.

Conclusion of breast cancer

Although having regular screening mammograms is important for early detection of breast cancer; not every cancer is picked up on mammograms. Hence, knowing our breasts and checking for any changes can be life-saving.

Sources: 

American Cancer Society 

Breast Cancer Now

Know your Lemons

Frequently Asked Questions (FAQs)

How long can you have breast cancer without knowing?

It's impossible to give a definitive answer on how long someone can have breast cancer without knowing. There are several reasons why:

• Breast cancers vary in growth speed. Aggressive tumours might show symptoms sooner, while slow-growing ones might remain undetected for years.
• Early breast cancer may not cause any noticeable symptoms. Lumps are a common sign, but they can also be benign (non-cancerous).

However, attending regular screenings and being familiar with your breasts can significantly increase the chances of early detection.

What does breast cancer feel like in the beginning?

Breast cancer often doesn't cause any noticeable symptoms in the early stages. 

Is stage 1 breast cancer curable?

Stage 1 breast cancer is considered highly treatable with a very good prognosis. Here's why:

• The cancer is localised, meaning it's confined to the breast tissue and hasn't spread to lymph nodes or other parts of the body.
• Statistics from the American Cancer Society show a 99% five-year relative survival rate for stage 1 breast cancer. This means that women with stage 1 breast cancer who receive treatment have a 99% chance of living at least five years after diagnosis compared to a similar group of women without the disease.

While "curable" isn't a guaranteed term in medicine, stage 1 breast cancer has a very high success rate with treatment. If you have concerns, talking to your doctor about your specific case is always recommended.