Breast Cancer (Facts, Stages) (cont.)

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What are the signs and symptoms of breast cancer?

Breast cancer may not cause signs and symptoms until the disease has spread significantly, which is one reason why screening mammograms are essential. When symptoms do occur, the most common symptom is a mass or painless lump in the breast. Other symptoms that can occur are nipple discharge, redness or nipple retraction (inward turning), changes in the skin of the breast (such as dimpling or an orange-peel appearance), and size and shape changes or swelling of part of the breast. Breast pain can occur but is usually a late symptom. Breast cancer tends to spread through the lymphatic system to lymph nodes. Lymph nodes under the arm can be affected (causing swelling of the armpit) as can be lymph nodes around the collar bone. These areas can present with swellings or nodes even before the tumor in the breast is palpable.

How is breast cancer diagnosed?

A variety of tests are used for the diagnosis of breast cancer.

Screening

Screening mammography has made it possible to detect many breast cancers before they produce any signs or symptoms. While there is no doubt that mammography is important, recommendations regarding frequency and age at which women should begin receiving screening mammography differ slightly between different organizations and task forces.

The American Cancer Society (ACS) recommendations for breast cancer screening are as follows:

  • Women age 40 and older should have a screening mammogram every year. They should continue to do so as long as they are in good health.
  • Women should have a clinical breast exam (CBE) as part of regular health exams by a health care professional about every 3 years for women in their 20s and 30s and every year for women 40 years of age and over.

Mammography is generally of greater benefit in older women than in younger women, because younger women frequently have more dense breasts, and there is a higher incidence of false positive mammography results in younger women. The addition of ultrasound examination to screening mammography can be of value in screening younger women at higher risk or who have dense breast tissue.

Because of these limitations of mammography in younger women, the U.S. Preventive Services Task Force recommends that routine yearly screening mammography begin at age 50. Women aged 40 to 49 are encouraged to discuss their situation with their health care practitioner to decide on the appropriate time to begin screening mammography.

Breast self-examination (BSE) is an option for women starting in their 20s. Women should report any breast changes to their health care professional.

If a woman wishes to do BSE, the technique should be reviewed with her health care professional. The goal is to feel comfortable with the way the woman's breasts feel and look and, therefore, detect changes.

For some women at higher risk of developing breast cancer, the addition of MRI scanning is recommended as a screening tool. The American Cancer Society recommends that women at high risk for breast cancer (greater than 20% lifetime risk) receive an MRI and a mammogram every year. Women at moderately increased risk (15% to 20% lifetime risk) discuss the benefits and limitations of adding MRI screening with their health care professional.

Medically Reviewed by a Doctor on 3/19/2014

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