What are The Symptoms of Breast Cancer?
Breast cancer usually presents as a persistent lump or swelling in the breast. Other warning signs of breast cancer may include a change in color or texture of the breast, nipple discharge, or inversion (pointing downward). Any persistent mass or swelling in the breast requires further evaluation by your physician and usually requires medical imaging.
What does a Cancerous Lump feel or look like?
Whether breast cancer can be felt depends on the size and position of the tumor. Large tumors or those close to the surface of the skin or close to the nipple are more likely to be felt. Masses in the back of the breast where the tissue is thickest or in the upper outer quadrants where the tissue is densest may be difficult to feel even if they are large. Some very small cancer cells are less than the size of a grain of sand. The smallest of cancers develop in the ducts called Ductal Carcinoma In Situ (DCIS) or develop in the lobules called Lobular Carcinoma in Situ (LCIS).
Breast cancer tends to feel like an irregular hard rock like the kind you pick up hiking or a hard pea. It is usually immobile and doesn’t move like the rest of the tissue. It can also feel like thickening or swelling of a particular area.
Sometimes a focal or generalized swelling of the breast or underarm (axilla) may be the first sign of cancer. The breast is considered a modified sweat gland, so the underarm is considered a part of the breast and should be observed for any changes in feel or appearance. Some types of cancer change the appearance of the skin causing it to look thickened like an orange peel (peau d’orange).
The normal breast may produce discharge at times like white or thin yellow. However, any blood-colored discharge may be a sign of cancerous cells in the ducts of the breast. Observe for any color of discharge related to blood like bright or dark blood, maroon, or rust. Never squeeze the breast hard to check for discharge as you may cause bloody discharge because of trauma.
Does Breast Cancer Hurt?
Although some breast cancers may be painful, we don’t use pain to determine if a lump is cancerous or not. Cancers may grow so slowly over the years and can become very large without ever causing pain, while other cancers may grow quickly stretching or pushing on adjacent structures resulting in the sensation of pain. The most common reason for growing masses in the breasts are monthly hormonal cysts which is why some people erroneously conclude that their painful mass is a cyst. Any persistent mass, painful or not, that does not resolve after the menstrual cycle should be evaluated further.
Are all Breast Lumps Cancer?
No, most breast lumps are one of several benign (non-cancerous) lumps like cysts or fibroadenomas. Clinical examination is helpful to try to distinguish these benign tumors from malignant breast lumps. However, specialized equipment designed to evaluate breast tissue like mammography, ultrasound or MRI can best distinguish these lumps. Even imaging sometimes can’t distinguish these tumors completely. And a needle biopsy may be required to determine if the tumor is cancerous or a fibroadenoma.
Am I Too Young to Develop Breast Cancer?
Although less common in younger women, breast cancer can develop at any age. All women from adolescence on should be familiar with how their breasts feel and look. The American Cancer Society used to recommend breast self-examination (BSE) for all women on a regular monthly basis, but studies have been inconsistent regarding results. The new recommendation is breast self-awareness (BSA) which is a more relaxed version with emphasis on awareness of any breast changes including physical and visual inspection for women who feel comfortable performing the exam. Certain races/ethnicities may have an increased risk of developing breast cancer at younger ages. White women overall are more likely to develop breast cancer, but black women are more likely to develop aggressive breast cancer at a younger age.
What Kind of Imaging Detects Breast Cancer?
Most cancers of the breast can be detected by ultrasound or mammography before they present as a palpable lump on self-examination. The American Cancer Society recommends screening mammography for women at average risk to consider starting at age 40. Many women who feel breast lumps are younger than this so careful breast self-examination (or breast self-awareness) is important starting in adolescence. If you notice a lump that doesn’t resolve by the end of one menstrual cycle, you should see your doctor to evaluate the lump.
What Imaging is Recommended for Women with a strong family history or who have been treated with radiation for Lymphoma?
Talk to your physician about what conditions are right for you based on your personalized family history. Some women with strong risk factors including a strong family history of breast cancer may start screening mammography by 30 and MRI of the breast by age 25. Although most breast cancer is not genetic related (about 15 percent of breast cancer are). Some families may pass down genetic mutations that predispose to the early or increased development of cancers including breast. We may also see increases in other cancers in these families like ovarian, colon, pancreatic, or melanoma. You may be eligible for hereditary counseling or genetic testing that will help determine your risk for breast cancer and the timing of your imaging examinations. Women with Hodgkin’s Disease, a type of Lymphoma, who had radiation to the chest at a young age are 20 times more likely to have an increased risk of developing breast cancer compared to the average woman. These women may undergo contrast breast MRI on a regular basis and start screening mammography earlier than other women.
What do I do if I Feel a Breast Lump?
First, don’t panic. Most breast lumps are not cancerous. Obtain as much information as you can recall about what the lump feels or looks like and call your physician’s office to schedule an appointment with them. They will listen to your description of the lump you found. A description of a hard ill-defined mass will certainly be more helpful than just the word lump. If your clinician’s office isn’t able to get you in right away, ask if they can send you for an imaging evaluation right away. Simply starting with a diagnostic breast ultrasound will be a good way to begin. Additional imaging like a diagnostic mammogram may be indicated depending on your age and the concern level of the finding. After they examine you, they may send you for imaging at a center dedicated to women’s radiology like The Women’s Imaging Center. If you have a breast concern and you do not have a referring physician, we will be happy to see you as self-referred. If we do find a suspicious finding, we can assist you in establishing a clinician in your community to provide care. We will work with your clinical care team to determine the best evaluation for you.
About the Author:
The author of this article is the Medical Director and head radiologist of The Women’s Imaging Centers for twenty-six years. Dr. Kelly McAleese is a lifelong advocate for women’s health issues and access for all Coloradans. She has published numerous articles on the topics that affect women’s health and is nationally recognized as one of the founding members of the concept of Women’s Imaging.
