Breast Cancer Doesn't Always Begin with a Lump

When most people think of breast cancer, they think of finding that tell-tale lump in the breast, but one is six people don’t report having a lump when diagnosed. In some cases there are no signs or symptoms at all, and the cancer is found on a normal screening mammogram, but in other cases, there are other breast abnormalities that can help catch potential problem. Early detection campaigns have helped to reinforce the importance of regular breast exams and self-assessments that can help catch issues like a suspicious lump early, but it’s important to understand different ways breast cancer can present itself.

Visual symptoms or changes to the breast often noticed when looking in the mirror or by a partner can be key in helping detect cancer early. Here are a few things to look out for.

Nipple Changes

Changes to the nipple or nipple area including pain or itching, discharge or bleeding can be a cause for concern. Clear or milky discharge can be a result of normal physiological changes leading into puberty, however unusual or bloody discharge should be discussed with your doctor.

Lobular carcinoma is an invasive type of breast cancer that makes up about 10% of all breast cancers. It begins in the milk glands and while it doesn’t form a lump in the breast, it creates thick breast tissue and spreads through the lymphatic tissue into other parts of the body. It isn’t typically associated with any signs or symptoms in its earliest stages, but as it grows larger, it can cause an inverted nipple.

Breast Dimpling

Dimpling of the skin on the breast is known as peau d ’orange, a French term meaning skin of an orange, and is a red flag for inflammatory breast cancer (IBC). Although rare, IBC is an aggressive disease that is not usually associated with a lump in the breast tissue and can be overlooked on a mammogram. Thickening of the skin on the breast with dimpling and swelling of the breast tissue is also a possibility with lobular carcinoma.

Swollen Lymph Nodes in the Armpits

Enlarged lymph nodes in the armpits can signal that an infection or disease has spread into the lymphatic tissue with no changes to the breast. Most often people will feel mild discomfort under the arm or in more serious cases, in the base of the neck.

A Sore on the Breast That Isn’t Healing

Persistent skin changes to the nipple including red, scaly or flaky skin on or around the nipple can be a sign of Paget’s disease of the breast. This rare form of breast cancer originates in the nipple, is typically non-invasive and is most often diagnosed in those between the age of 70 and 80 years old.

Tenderness or Redness

Inflammatory breast cancers cause redness and swelling as the disease blocks the lymphatic vessels of the skin. Symptoms can range from a rash and the breast feeling warm to the touch to breast tenderness, itching and thickening of the skin.

Breast Pain with No Lump

While not all breast pain is associated with cancer, it is still cause for concern. It can be associated with various conditions including water retention and hormonal changed during menstruation, a breast infection or injury, pregnancy or breastfeeding, or because of a medication. If your breast pain continues daily for more than a couple of weeks, occurs in one specific area of the breast, or seems to be getting worse over time, see your doctor.

Breast pain and menstruation are closely aligned and occur more often in premenopausal women than those who have already gone through menopause. While breast pain can occur with breast cancer, it’s often not a symptom, but could indicate a potential heart problem if it occurs in the left breast due to its proximity to the heart.

When detected early, breast cancer survival rates are higher, which is why annual mammograms are so important, in addition to paying attention to changes in your body. If you are concerned about your risk of breast cancer, have a lump, pain or any other symptoms, don’t wait to talk to your doctor. It’s important to maintain self-breast exams at home, see your doctor annually for a physical assessment and begin mammograms at the age 40, unless your doctor suggest you begin earlier.

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