Breast Lump

The most common symptom of breast cancer is a lump in the breast.  Most breast lumps are not cancerous and can be a cyst or fibroadenoma.

A cancerous lump in the breast can be any size from smaller than the size of a pea to as large as a tennis ball. Cancerous lumps are nearly always pain free. A painful lump in the breast is much less likely to be cancerous, but we would advise that all lumps whether they are painful or not should be checked out by a specialist.

A very important feature of cancerous lumps is that they tend to pull the overlying skin inwards causing a visible dimple (like an orange peel). This is called skin tethering.  It does not necessarily mean that the cancer has invaded the skin, but it is a sign you should have a breast examination by a specialist.

Change of breast shape

It is always important to look out for any change in the overall shape of your breast. This can be a sign of underlying breast cancer and careful inspection in a mirror is an important part of breast self-examination.

It is common for the breast to gradually change in shape or size during life. This is particularly obvious during pregnancy and the period after breast feeding. Usually both breasts either enlarge or change shape in a similar way, although sometimes the changes are more marked in one breast than the other. Changes in only one breast should always be checked by a specialist.

General enlargement of the breasts occurs either during pregnancy or when there are hormonal changes that affect the breast tissue. This may occur after starting or stopping the contraceptive pill, using the depo-contraceptive injection or with hormone replacement treatment.

Hormonal breast swelling is a fairly common occurrence and is usually associated with breast pain and tenderness. The changes are often worse prior to each menstrual period. An increase in size of just one of the breasts, should always be investigated by a specialist.

Localised changes in the shape of the breast such as dimpling, distortion or pulling in of the nipple can all be signs of breast cancer although there may be other reasons. If there are any changes in the gentle curvature of the shape of the breast it is important to have your breasts checked by a specialist.

Nipple Discharge

Nipple discharge should alwasy be checked as it can be a sign of breast cancer.

Nipple Inversion

Nipple inversion can be a sign of underlying breast cancer, especially if the cancer is close to the nipple.

Skin Changes

Redness of the breast skin, such as occurs in an infection, can also be a sign of underlying breast cancer. This is usually associated with a rarer type of breast cancer, termed inflammatory carcinoma. The redness associated with inflammatory carcinoma progresses slowly and does not regress with antibiotics. Any area of redness of the breast skin, which persists for more than two weeks, particularly whilst taking antibiotics, should be checked as soon as possible by a breast specialist.

Eczema of breast skin is not common, but can occur particularly in women who have already developed eczema in other parts of the body.  The skin of the nipple is more prone to allergies and to eczema. Short treatment with steroid cream will usually resolve this problem. Eczema of the nipple should be checked if it persists, particularly after treatment with steroids. A similar appearance can be seen in a disease called Paget’s disease of the nipple, which is a manifestation of underlying breast cancer or DCIS (ductal carcinoma in-situ). The difference between eczema and Paget’s disease can be very difficult to diagnose and a skin biopsy is often advised to be sure of the diagnosis.

Skin Ulceration

Ulceration of the skin of the breast can be a sign of advanced breast cancer and should always be checked immediately. The ulceration associated with breast cancer is painless and develops gradually (over months or even years).

Breast Pain

Breast pain is nearly always caused by either hormonal changes or infections in the breast.    It is very uncommon for breast pain to be a sign of breast cancer. It is only the areas of breast pain that are very localised to one spot that require urgent checking. This is not to say that breast pain may sometimes be quite severe and can interfere with peoples’ lives. In these cases treatment is usually very effective but the pain is not a sign of anything more serious (see common breast problems).

Changes on a Mammogram

With the advent of breast screening, many women first become aware of a problem in their breast because of an abnormal mammogram. In these instances there are usually no other symptoms at all and most women feel entirely healthy. Indeed they are usually very healthy and the mammogram has caught the problem at a very early stage before the cancer has spread.

Changes that can show up on a mammogram that signify breast cancer are either a lump, a distortion of the breast or an area of calcium deposition. It should be noted that the majority of lumps diagnosed on mammograms are harmless. Sometimes this is sufficiently obvious that nothing further needs to be done but in the case of any doubt, an ultrasound scan or a needle biopsy can confirm the diagnosis.