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In the majority of women, breast cancer is first noticed as a painless lump in the breast.
There are however other signs to be aware of:
- Change in size or shape
- Dimpling of the skin
- Lump or thickening
- Blood-stained discharge (very rare)
- Rash on nipple and surrounding skin (also very rare)
- Nipple becoming inverted (turned inwards)
- Lump or thickening, especially if associated with nipple discharge
- Nipple discharge is very common and is normally due to benign breast conditions. There may be some cause for concern if there is blood stained or bloody discharge.
- In Paget’s disease of the nipple, there is an association with breast cancer. However, rashes on the nipple or around the nipple (areola region) may also be due to eczema. See your doctor to find out exactly what is the diagnosis.
- Nipple inversion may be “normal” in some women and they may be born that way. However, if there is recent nipple inversion for no apparent reason, you should see your doctor immediately.
- Lump or swelling in the armpit
This may be due to enlarged lymph nodes, or a mass in the accessory glandular tissue in the armpit. Sometimes, this may be due to infection and not necessarily due to breast cancer. Other conditions such as lymph node malignancy (Lymphoma) may present with enlarged armpit lymph nodes.
Pain in the breast or mastalgia deserves a special mention because this is one of the most common reasons why a woman would see the doctor. However, pain in the breast is not usually a symptom of breast cancer. In fact, many healthy women find their breasts lumpy and tender before menstruation and some types of benign breast lumps are painful. Pain is usually due to fibrocystic changes in the breast.
Aberrations of Normal Development and Involution of the breast
This section on the symptoms and signs of breast cancer would be incomplete without a brief mention of the more common but benign conditions of the breast. In the course of investigation or screening for breast cancer, these would be diagnosed.
Over her lifetime, a woman can encounter a broad variety of breast conditions. These include normal changes that occur during the menstrual cycle as well as several types of benign lumps. It is only when the aberrations of normal development and involution (aging) are more pronounced that a “disease” state is reached and you complain of symptoms. These breast conditions are not cancer. Even for breast lumps that require a biopsy, some 80-90% prove to be benign.
In the early reproductive period (about 15-25 years), owing to the changes in the different tissues of the breast, one may develop discrete lumps such as fibroadenoma. This condition may be multiple or a single lump can grow to a very large size. The breast may also “enlarge” more than normal (juvenile hypertrophy).
In the mature reproductive period (about 25-40 years), there may be exaggerated hormonal effects resulting in cyclical breast pain, lumpiness of the breast which may be localised and discrete.
In the involution period (about 35–55 years), depending again on which tissues are affected, cysts (fluid filled sacs) may develop, duct dilatation, periductal fibrosis and inflammation may occur. There may also be changes at the cellular level either with increased proliferation or atypical looking cells.