Breast cancer is a malignancy of the tissues of the breast; usually the ducts or the breast lobules, the systems that carry the milk to the nipple and the glands that produce milk, respectively. While it is more common in women, men can also suffer from breast cancer. In fact, it is estimated that approximately 207,090 females and 1,970 males will be diagnosed with breast cancer and 39,840 females and 390 males will die from the disease this year in the United States alone. Certain factors increase the risk of breast cancer. These factors include: age, history of breast cancer, family history of breast cancer, genetic mutations (BRCA1 or BRCA2), exposure to radiation, reproductive complications, breast density and obesity.
The high incidence of breast cancer and a large population of at risk individuals make early detection and diagnosis essential for treatment success. The best means of ensuring early detection is to inform women (and men) about the warning signs of breast cancer.
The common signs and symptoms of breast cancer
Early breast cancer is usually not associated with medical symptoms. But as the cancer progresses, the tumor grows and changes in the appearance of the breast become more evident. The common changes in the breast tissue include:
- Presence of a lump in or near the breast or underarm area
- A change in the size and shape of the breast
- Puckering of the skin of the breast
- Inward turning of the nipple
- Nipple discharge
- Reddening, swelling of the breast, nipple and/or areola (dark area of skin in center of the breast)
How does the breast feel?
In general, the first sign of breast cancer is marked by a noticeable change in how the breast feels. The change in how the breast feels may be caused by multiple changes within the breast. One cause is calcification, the presence of tiny mineral deposits within the breast tissue. Calcifications can be caused by both noncancerous and cancerous conditions. There are two main forms of calcifications:
- Macrocalcifications – large calcium deposits that are most likely caused by age (50 percent of women over 50 years of age), aging breast arteries, old injuries and inflammation. The majority of these calcifications are noncancerous in nature.
- Microcalcifications - tiny specks of calcium appearing alone or in clusters around the breast. While rarely associated with cancer, doctors use microcalcifications as a means of judging the likelihood of breast cancer.
The second cause of breast shape change is the presence of a mass. They can occur with or without calcification. While masses can be either noncancerous cyst or noncancerous solid tumors (fibroadenomas), they can also be cancerous. Masses are generally biopsied to determine whether it is cancerous or not. When biopsy is not an option, imaging tests can determine whether a mass is cancerous. The size, shape and margins of the mass are key to assisting a radiologist ability to determine if cancer is present.
What does the breast look like?
Even if no noticeable changes in size and shape of the breast are present, a woman can still be suffering from breast cancer. Another clue that something is wrong with a breast is changes in the appearance of the breast. The most common noticeable changes include: centuated blood veins on the surface of the breast, reddish colored skin, orange peel appearance and a dimpled, puckered or scaly appearance. The change in appearance can occur in the breast tissue, nipple and areola skin.
Is nipple discharge normal?
Another warning sign for breast cancer is abnormal nipple discharge, usually containing blood. However, nipple discharge is a quite rare symptom of breast cancer. In fact, only 3 to 9 percent of breast cancer patients experience nipple discharge. Abnormalities of the nipple normally consist of the retraction/ enlargement of the nipple, a purulent appearance, a bloody, clear-to-yellow, or green fluid secretion that weeps from the nipple and itching sensations. However, there is controversy on whether nipple discharge is actually a warning sign for breast cancer or a condition stemming from breast cancer warning signs such as a presence of lump or mass. This controversy stems from the fact that the majority of women presenting with nipple discharge also have breast masses.
What are the signs of male breast cancer?
In general, men and women present with similar breast cancer symptoms. In fact, the majority of breast cancer diagnosis in both men and women occur following the discovery of a lump in the chest. However, unlike women, men tend to present with more severe symptoms that often include: bleeding from the nipple and abnormalities in the skin surrounding the cancerous area. Moreover, men also present with more advanced breast cancer, as the majority of men present with lymph node involvement. Thus, both men and women keep an eye open for the warning signs of breast cancer
What are natural changes of the breast?
As a woman matures and ages, there are many normal, noncancerous changes that occur within the breast tissue. These changes are usually caused by alterations in hormone levels, such as tenderness and lumps during menstrual cycle and size and shape change during menopause. Natural changes include:
- Dense breast tissue in younger, non-menopausal women that can make breast cancer diagnosis hard
- Tenderness, swelling and pain of breasts before and during menstrual periods
- Lumps present during pregnancy are usually caused by the glands that produce milk are increasing in number and size
- Mastitis – the blockage of milk ducts during breastfeeding causes the breast to look red and feel lumpy, warm and tender
- Increased breast tenderness and lumpiness as a woman approaches menopause
- Hormonal therapy (menopausal hormone therapy and birth control) increases breast density
- Drop in hormones during menopause results in a decrease in breast density, lumps, pain or nipple discharge
National Cancer Institute - https://www.cancer.gov/cancertopics/types/breast
American Cancer Society - https://www.cancer.org/Cancer/BreastCancer/DetailedGuide/breast-cancer-detection
T Richards, A Hunt, S Courtney, and H Umeh. Nipple Discharge: A Sign of Breast Cancer? Ann R Coll Surg Engl. 2007 March; 89(2): 124–126.