Eight signs and symptoms of breast cancer

Forty-seven per cent of women do not regularly check their breasts – here are the unusual changes you need to be aware of

Almost everyone will know someone who has, or has had, breast cancer. Yet there is still a knowledge gap: research from Breast Cancer Now found that 47 per cent of women do not regularly check their breasts for unusual changes that could indicate breast cancer, and the latest NHS data shows that nearly 40 per cent of women offered routine breast screening don’t take it up.
“I think a lot of people are frightened of what they might find and what that might mean, and there might be people who aren’t aware of the signs and symptoms,” says Katy Goford, a clinical nurse specialist at Breast Cancer Now. 
But regular self-examination could be lifesaving. Around 11,500 women in the UK die from breast cancer each year, but if it is diagnosed early, at stage 1 or stage 2, between 90 and a hundred per cent of women will survive.
Here are the early signs and symptoms of breast cancer that you need to be aware of.
Most women are aware that lumps are a telltale sign of breast cancer. Yet identifying them can be difficult, as natural breast tissue itself often feels lumpy and many of these lumps will be benign.
“In premenopausal women, breasts are usually firm and lumpy and can feel like sweetcorn in jelly,” says Dr Liz O’Riordan, a breast surgeon who herself was diagnosed with breast cancer at the age of 40. 
But while normal lumpy tissue can feel like “a ridge heading towards the nipple,” cancer is a “discrete lump that you can get all the way around with your fingers, and that feels different to the other side,” she explains.
Similarly, breasts can change in shape and size throughout a woman’s life for a variety of reasons, so this is a sign of breast cancer that women may not quickly recognise as a red flag. 
Some women’s breasts “can grow by as much as a cup size” every menstrual cycle, Dr O’Riordan says. 
Such changes are a cause for worry when they are random and sudden, and especially “when it’s happening to one and not the other,” as breast cancer “normally happens in one breast at a time”. 
There are many different changes in breast skin that could indicate breast cancer – such as dimpling, redness, peeling and flaking or rashes.
Dimpling or puckering is often the most common change to the appearance of breast skin when cancer is present, as “breast cancer constricts fibrous tissue in the breast so that it can’t stretch as it usually would,” Dr O’Riordan says.
Changes can be subtle, and may only be revealed when a woman lifts up her arms to breast check. 
“This is why it’s important to check your breasts each month so that you know what’s normal,” says Dr O’Riordan. “If you see any changes, make a note in your diary to check again two weeks later, and if the change has remained then it’s time to see a doctor.”
“Creamy nipple discharge is normal for many women,” Dr O’Riordan says, and discharge that’s white, greenish or yellowish is not typically a symptom of cancer. 
Discharge that’s bloody or crystal clear, however, “could be coming from a cancer or papilloma in the nipple ducts”.
Similarly, nipple flattening or inversion may not always be a sign of cancer, but if this happens suddenly and a woman’s nipples do not revert, it is a cause for concern as there could be “a cancer that’s pulling the nipple inwards, so a new permanent inversion needs checking out.” 
Breast pain on its own is rarely a sign of cancer, as a woman’s breasts can be painful for a huge range of ordinary reasons, such as pregnancy or menstruation.
“99 per cent of the time, pain on its own is not a sign of cancer,” Dr O’Riordan says. “But if the pain is new and inexplicable, and hasn’t gone away after two or three weeks, and particularly if the pain is in one breast only, it’s well worth seeing your doctor.” 
While it’s still unlikely in this case that cancer is the cause, “90 per cent of the women who come through clinics don’t have breast cancer, but we still want to stop you worrying.” 
When redness and swelling appear together, this can indicate a type of breast cancer called inflammatory breast cancer, where there is a buildup of fluid in the skin over a woman’s breasts.
Though rare, this type of cancer does occur in women in their 20s and 30s, who could confuse these symptoms for mastitis, an infection in the breast during pregnancy or breastfeeding.
“If your breasts are red, hot or swollen and you aren’t pregnant or breastfeeding, or you are pregnant or breastfeeding but the symptoms haven’t responded to antibiotics, you need to get checked out, as it could be inflammatory cancer” says Dr O’Riordan.
Dr O’Riordan also notes that redness may be harder to identify in women with dark skin, so if you have dark skin and “just feel like your breast is hot and swollen, you should also speak to your doctor.” 
Though more often a sign of infections, cysts or allergies, armpit lumps or armpit pain can be a sign of breast cancer. 
“Large lymph nodes in the armpit are very common when we have coughs, colds and sore throats,” says Dr O’Riordan. “They help your body fight the infection and might be as big as a marble or an egg, and they will either be an infection like this or cancer.”
Often such lumps are harmless signs that your body is fighting off a cold, “but if they’re still there in a week or two after you’ve found them, it’s worth getting them looked at.” 
Pain, hardness and discomfort in the breast are all potential signs of breast cancer, if these are new sensations. 
“This is why it’s important to check regularly, so that you know what your breasts typically feel like,” says Dr O’Riordan. Hardness might also be a result of beginning to take the contraceptive pill or unexpected pregnancy. 
Breast cancer does not cause symptoms that are felt in the rest of the body, unless it has spread. “Early breast cancers are so small that they don’t cause symptoms at all, and are only picked up on a scan,” says Dr Liz O’Riordan, a breast surgeon who herself was diagnosed with breast cancer at the age of 40. 
Stage 0 breast cancer is typically only picked up on a mammogram, but some stage 1 cancers (which typically measure less than 2 cm across, and have not yet spread into a woman’s lymph nodes) might be picked up through breast checking or by identifying physical changes in breast tissue. 
Any visual changes in breast tissue can be called “early signs” of breast cancer, as only breast cancer that has spread to other parts of the body will cause symptoms that a woman will notice affecting different parts of the body – such as fatigue, weight loss or a persistent cough. 
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