Breast Cancer Early Warning Signs and Symptoms

What are breast cancer early warning signs and symptoms?

 Picture of breast cancer
Picture of breast cancer

In most cases, there are no early warning signs of breast cancer. Breast cancer may not produce any early symptoms, and in many cases, it is first discovered on screening mammography. The most common sign of breast cancer is a new lump or mass in the breast. In addition, the following are possible signs of breast cancer:

What are the different types of breast cancer?

There are many types of breast cancer. Some are more common than others, and there are also combinations of cancers. Some of the most common types of cancer are as follows:

  • Ductal carcinoma in situ: The most common type of non-invasive breast cancer is ductal carcinoma in situ (DCIS). This early-stage breast cancer has not spread and therefore usually has a very high cure rate.
  • Invasive ductal carcinoma: This cancer starts in the milk ducts of the breast and grows into other parts of the surrounding tissue. It is the most common form of breast cancer. About 80% of invasive breast cancers are invasive ductal carcinoma.
  • Invasive lobular carcinoma: This breast cancer starts in the milk-producing glands of the breast. Approximately 10% of invasive breast cancers are invasive lobular carcinoma.
    • Most Invasive ductal and lobular cancers express hormone receptors such as the estrogen receptor (ER) and progesterone receptor (PR). Some tumors express a growth protein known as HER2. Triple-negative breast cancers are a subtype of invasive cancer with cells that lack estrogen and progesterone receptors and have no excess of a specific protein (HER2) on their surface. It tends to appear more often in younger women and African-American women.
  • The remainder of breast cancers are much less common and include the following:
  • Mucinous carcinoma are formed from mucus-producing cancer cells. Mixed tumors contain a variety of cell types.
  • Medullary carcinoma is an infiltrating breast cancer that presents with well-defined boundaries between the cancerous and noncancerous tissue.
  • Inflammatory breast cancer: This cancer makes the skin of the breast appear red and feel warm (giving it the appearance of an infection). These changes are due to the blockage of lymph vessels by cancer cells.
  • Paget's disease of the nipple: This cancer starts in the ducts of the breast and spreads to the nipple and the area surrounding the nipple. It usually presents with crusting and redness around the nipple.
  • Adenoid cystic carcinoma: These cancers have both glandular and cystic features. They tend not to spread aggressively and have a good prognosis.
  • Lobular carcinoma in situ: This is not a cancer but an area of abnormal cell growth. This pre-cancer can increase the risk of invasive breast cancer later in life.

The following are other uncommon types of breast cancer:

  • Papillary carcinoma
  • Phyllodes tumor
  • Angiosarcoma
  • Tubular carcinoma

What causes breast cancer?

There are many risk factors that increase the chance of developing breast cancer. Although we know some of these risk factors, we don't know the cause of breast cancer or how these factors cause the development of a cancer cell.

  • We know that normal breast cells become cancerous because of mutations in the DNA, and although some of these are inherited, most DNA changes related to breast cells are acquired during one's life.
  • Proto-oncogenes help cells grow. If these cells mutate, they can increase the growth of cells without any control. Such mutations are referred to as oncogenes. Such uncontrolled cell growth can lead to cancer.

What are symptoms of a male breast cancer?

Breast cancer is rare in men (approximately 2,400 new cases diagnosed per year in the U.S.) but typically has a significantly worse outcome. This is partially related to the often late diagnosis of male breast cancer, when the cancer has already spread.

  • Symptoms are similar to the symptoms in women, with the most common symptom being a lump or change in skin of the breast tissue or nipple discharge.
  • Although it can occur at any age, male breast cancer usually occurs in men over 60 years of age.

SLIDESHOW

Breast Cancer Diagnosis and Treatment See Slideshow

What are breast cancer risk factors?

Some of the breast cancer risk factors can be modified (such as alcohol consumption) while others cannot be influenced (such as age). It is important to discuss these risks with a health care provider when starting new therapies (for example, postmenopausal hormone therapy).

Several risk factors are inconclusive (such as deodorants), while in other areas, the risk is being even more clearly defined (such as alcohol use).

The following are risk factors for breast cancer:

  • Age: The chances of breast cancer increase as one gets older.
  • Family history: The risk of breast cancer is higher among women who have relatives with the disease. Having a close relative with the disease (sister, mother, daughter) doubles a woman's risk.
  • Personal history: Having a breast cancer diagnosis in one breast increases the risk of cancer in the other breast or the chance of an additional cancer in the original breast.
  • Women diagnosed with certain benign (non-cancerous) breast conditions have an increased risk of breast cancer. These include atypical hyperplasia, a condition in which there is abnormal proliferation of breast cells but no cancer has developed.
  • Menstruation: Women who started their menstrual cycle at a younger age (before 12) or went through menopause later (after 55) have a slightly increased risk.
  • Breast tissue: Women with dense breast tissue (as documented by mammogram) have a higher risk of breast cancer.
  • Race: White women have a higher risk of developing breast cancer, but African-American women tend to have more tumors that are aggressive when they do develop breast cancer.
  • Exposure to previous chest radiation or use of diethylstilbestrol (DES) increases the risk of breast cancer.
  • Having no children or the first child after age 30 increases the risk of breast cancer.
  • Breastfeeding for 1½ to 2 years might slightly lower the risk of breast cancer.
  • Being overweight or obese increases the risk of breast cancer both in pre- and postmenopausal women but at different rates.
  • Use of oral contraceptives in the last 10 years increases the risk of breast cancer slightly.
  • Using combined hormone therapy after menopause increases the risk of breast cancer.
  • Alcohol consumption increases the risk of breast cancer, and this seems to be proportional to the amount of alcohol used. A recent meta-analysis reviewing the research on alcohol use and breast cancer concluded that all levels of alcohol use are associated with an increased risk for breast cancer. This includes even light drinking.
  • Exercise seems to lower the risk of breast cancer.
  • Genetic risk factors: The most common causes are mutations in the BRCA1 and BRCA2 genes (breast cancer and ovarian cancer genes). Inheriting a mutated gene from a parent means that one has a significantly higher risk of developing breast cancer.

Are there any other questions I should ask my doctor about breast cancer?

Yes. There are surely other questions you will wish to ask. Do not hesitate to be very open about your concerns with your doctor.

  • There is constantly new information and new research available about breast cancer, whether BRCA-related new treatments or drugs (for example, olaparib [Lynparza]) or new treatment regiments and recommendations.
  • The foregoing questions and comments should demonstrate that the diagnosis and treatment of breast cancer may not be a simple process.
  • Even when all the information is available, there may be difficulties in deciding a proper course of action.
  • However, this decision-making process has a better chance of success when you and the doctor are well informed and communicating effectively.

Although the information here cannot be all-inclusive, we hope it will help you work through this process.

What tests do physicians use to diagnose breast cancer?

Although the above signs and symptoms can diagnose breast cancer, the use of screening mammography has made it possible to detect many of the cancers early before they cause any symptoms.

The American Cancer Society (ACS) has the following recommendations for breast cancer screenings:

  • Women should have the choice to begin annual screening between 40-44 years of age.
  • Women age 45 and older should have a screening mammogram every year until age 54.
  • Women 55 years of age and older should have biennial screening or have the opportunity to continue screening annually.
  • Women should continue screening mammography as long as their overall health is good and they have a life expectancy of 10 years or longer.

Mammograms are a very good tool for breast cancer screening. As with any test, mammograms have limitations and will miss some cancers. Patients should discuss their family history and mammogram and breast exam results with their health care provider.

The ACS does not recommend clinical screening exams in women of any age.

Women at high risk (greater than 20% lifetime risk) should get an MRI and a mammogram every year. Women at moderate risk (15%-20%) should talk to their doctor about the benefits and limitations of adding MRI screening to their yearly mammogram.

QUESTION

A lump in the breast is almost always cancer. See Answer

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Medically Reviewed on 2/5/2020
References
Kroener, L., D. Dumesic, and Z. Al-Safi. "Use of fertility medications and cancer risk: a review and update." Curr Opin Obstet Gynecol May 22, 2017.

Salerno, K.E. "NCCN Guidelines Update: Evolving Radiation Therapy Recommendations for Breast Cancer." J Natl Compr Canc Netw 15(5S) May 2017: 682-684.

Shield, Kevin D., et al. "Alcohol Use and Breast Cancer: A Critical Review." Alcoholism: Clinical and Experimental Research Apr. 30, 2016.
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