Signs and symptoms

The first symptom, or subjective sign, of breast cancer is typically a lump that feels different from the rest of the breast tissue. More than 80% of breast cancer cases are discovered when the woman feels a lump.The first medical sign, or objective indication of breast cancer as detected by a physician, is discovered by mammogram. Lumps found in lymph nodes located in the armpits can also indicate breast cancer. Indications of breast cancer other than a lump may include changes in breast size or shape, skin dimpling, nipple inversion, or spontaneous single-nipple discharge. Pain ("mastodynia") is an unreliable tool in determining the presence or absence of breast cancer, but may be indicative of other breast health issues.When breast cancer cells invade the dermal lymphatics—small lymph vessels in the skin of the breast—its presentation can resemble skin inflammation and thus is known as inflammatory breast cancer (IBC). Symptoms of inflammatory breast cancer include pain, swelling, warmth and redness throughout the breast, as well as an orange-peel texture to the skin referred to as peau d'orange.Another reported symptom complex of breast cancer is Paget's disease of the breast. This syndrome presents as eczematoid skin changes such as redness and mild flaking of the nipple skin. As Paget's advances, symptoms may include tingling, itching, increased sensitivity, burning, and pain. There may also be discharge from the nipple. Approximately half of women diagnosed with Paget's also have a lump in the breast. Occasionally, breast cancer presents as metastatic disease, that is, cancer that has spread beyond the original organ. Metastatic breast cancer will cause symptoms that depend on the location of metastasis. Common sites of metastasis include bone, liver, lung and brain.Unexplained weight loss can occasionally herald an occult breast cancer, as can symptoms of fevers or chills. Bone or joint pains can sometimes be manifestations of metastatic breast cancer, as can jaundice or neurological symptoms. These symptoms are "non-specific", meaning they can also be manifestations of many other illnesses. Most symptoms of breast disorder do not turn out to represent underlying breast cancer. Benign breast diseases such as mastitis and fibroadenoma of the breast are more common causes of breast disorder symptoms. The appearance of a new symptom should be taken seriously by both patients and their doctors, because of the possibility of an underlying breast cancer at almost any age.

Risk factors

The primary risk factors that have been identified are sex, age, childbearing, hormones, a high-fat diet alcohol intake, obesity, and environmental factors such as tobacco use, radiation, endocrine disruptors and shiftwork. Well established risk factors account for 47% of cases while 5% are attributable to hereditary syndromes.

In particular, carriers of the breast cancer susceptibility genes, BRCA1 and BRCA2, are at a 30-40% increased risk for breast and ovarian cancer, depending on in which portion of the protein the mutation occurs.

• Personal history of breast cancer: A woman who had breast cancer in one breast has an increased risk of getting cancer in her other breast.
• Family history: A woman's risk of breast cancer is higher if her mother, sister, or daughter had breast cancer. The risk is higher if her family member got breast cancer before age 40. Having other relatives with breast cancer (in either her mother's or father's family) may also increase a woman's risk.
• Certain breast changes: Some women have cells in the breast that look abnormal under a microscope. Having certain types of abnormal cells (atypical hyperplasia and lobular carcinoma in situ [LCIS]) increases the risk of breast cancer.
• Race: Breast cancer is diagnosed more often in Caucasian women than Latina, Asian, or African American women.
• No physical activity: Women who are physically inactive throughout life may have an increased risk of breast cancer. Being active may help decrease risk.

Breast Self-Exam (BSE)

• Try to get in the habit of doing a breast self-examination once a month to familiarize yourself with how your breasts normally look and feel. Examine yourself several days after your period ends, when your breasts are least likely to be swollen and tender. If you are no longer having periods, choose a day that's easy to remember, such as the first or last day of the month.
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• Don’t panic if you think you feel a lump. Most women have some lumps or lumpy areas in their breasts all the time. In the United States, only 20% of women who have a suspicious lump biopsied turn out to have breast cancer.
• Breasts tend to have different “neighborhoods.” The upper, outer area — near your armpit — tends to have the most prominent lumps and bumps. The lower half of your breast can feel like a sandy or pebbly beach. The area under the nipple can feel like a collection of large grains. Another part might feel like a lumpy bowl of oatmeal.
  
  What’s important is that you get to know the look and feel of YOUR breasts' various neighborhoods. Does something stand out as different from the rest (like a rock on a sandy beach)? Has anything changed? Bring to the attention of your doctor any changes in your breasts that last over a full month's cycle OR seem to get worse or more obvious over time.
• You may want to start a journal where you record the findings of your breast self-exams. This can be like a small map of your breasts, with notes about where you feel lumps or irregularities. Especially in the beginning, this may help you remember, from month to month, what is “normal” for your breasts. It is not unusual for lumps to appear at certain times of the month, but then disappear, as your body changes with the menstrual cycle (if you are still menstruating). Only changes that last beyond one full cycle, or seem to get bigger or more prominent in some way, need your doctor's attention.

Recurrent and Metastatic Breast Cancer

We know you really don't want to be here, reading about breast cancer recurrence or metastasis. If you've had breast cancer, the possibility of recurrence and spread (metastasis) of breast cancer stays with you. You may be here because you fear this possibility. Or you may be here because it's already happened.

Keep in mind that a recurrence of breast cancer or metastatic (advanced) disease is NOT hopeless. Many women continue to live long, productive lives with breast cancer in this stage. It is also likely that your experience with treatment this time will be somewhat different from last time. There are so many options for your care and so many ways to chart your progress as you move through diagnosis, treatment, and beyond.

Because there are so many options, this is a long section. You may want to read just a few pages at a time. You might find it very difficult to concentrate, think straight, and remember what you've read. That's natural when you're anxious, uncertain, overwhelmed. We'll do our best to help you find what you're looking for.

Male Breast Cancer

Breast cancer in men is a rare disease. Less than 1% of all breast cancers occur in men. In 2005, when 211,400 women were diagnosed with breast cancer in the United States, 1,690 men were diagnosed with the disease.

You may be thinking: Men don't have breasts, so how can they get breast cancer? The truth is that boys and girls, men and women all have breast tissue. The various hormones in girls' and women's bodies stimulate the breast tissue to grow into full breasts. Boys' and men's bodies normally don't make much of the breast-stimulating hormones. As a result, their breast tissue usually stays flat and small. Still, you may have seen boys and men with medium-sized or big breasts. Usually these breasts are just mounds of fat. But sometimes men can develop real breast gland tissue because they take certain medicines or have abnormal hormone levels.

Because breast cancer in men is rare, few cases are available to study. Most studies of men with breast cancer are very small. But when a number of these small studies are grouped together, we can learn more from them.

Inflammatory Breast Cancer

Inflammatory breast cancer (IBC) is a rare and aggressive form of breast cancer. According to the National Cancer Institute, about 1-5% of all breast cancer cases in the United States are inflammatory breast cancers.

Inflammatory breast cancer usually starts with the reddening and swelling of the breast instead of a distinct lump. IBC tends to grow and spread quickly, with symptoms worsening within days or even hours. It’s important to recognize symptoms and seek prompt treatment. Although inflammatory breast cancer is a serious diagnosis, keep in mind that treatments today are better at controlling the disease than they used to be.

The average age at diagnosis for inflammatory breast cancer in the United States is 57 for white women and 52 for African American women. These ages are about 5 years younger than the average ages at diagnosis for other forms of breast cancer. According to the American Cancer Society, inflammatory breast cancer is more common in African American women. A 2008 study found that being overweight makes a person more likely to develop IBC. Like other forms of breast cancer, IBC can also affect men.

Paget's Disease of the Nipple

Paget's disease of the nipple is a rare form of breast cancer in which cancer cells collect in or around the nipple. The cancer usually affects the ducts of the nipple first (small milk-carrying tubes), then spreads to the nipple surface and the areola (the dark circle of skin around the nipple). The nipple and areola often become scaly, red, itchy, and irritated.

According to the National Cancer Institute, Paget's disease of the nipple accounts for less than 5% of all breast cancer cases in the United States. Being aware of the symptoms is important, given that more than 97% of people with Paget's disease also have cancer, either DCIS or invasive cancer, somewhere else in the breast. The unusual changes in the nipple and areola are often the first indication that breast cancer is present.

Doctors are not yet completely sure how Paget's disease develops. One possibility is that the cancer cells start growing inside the milk ducts within the breast and then make their way out to the nipple surface. This would appear to explain why so many people with Paget's disease of the nipple have a second area of cancer within the breast. Another theory is that the cells of the nipple itself become cancerous. This theory would explain the small number of people who: (1) only have Paget's disease in the nipple, or (2) have a second breast cancer that appears to be completely separate from the Paget's disease.

Paget's disease of the nipple is more common in women, but like other forms of breast cancer, it can also affect men. The disease usually develops after age 50. According to the National Cancer Institute, the average age of diagnosis in women is 62, and in men, 69. In this section you can read about:

Invasive lobular carcinoma (ILC)

Invasive lobular carcinoma (ILC), sometimes called infiltrating lobular carcinoma, is the second most common type of breast cancer after invasive ductal carcinoma (cancer that begins in the milk-carrying ducts and spreads beyond it). According to the American Cancer Society, more than 180,000 women in the United States find out they have invasive breast cancer each year. About 10% of all invasive breast cancers are invasive lobular carcinomas. (About 80% are invasive ductal carcinomas.)

Invasive means that the cancer has “invaded” or spread to the surrounding breast tissues. Lobular means that the cancer began in the milk-producing lobules, which empty out into the ducts that carry milk to the nipple. Carcinoma refers to any cancer that begins in the skin or other tissues that cover internal organs — such as breast tissue. All together, “invasive lobular carcinoma” refers to cancer that has broken through the wall of the lobule and begun to invade the tissues of the breast. Over time, invasive lobular carcinoma can spread to the lymph nodes and possibly to other areas of the body.

Although invasive lobular carcinoma can affect women at any age, it is more common as women grow older. According to the American Cancer Society, about two-thirds of women are 55 or older when they are diagnosed with an invasive breast cancer. ILC tends to occur later in life than invasive ductal carcinoma — the early 60s as opposed to the mid- to late 50s.

Some research has suggested that the use of hormone replacement therapy during and after menopause can increase the risk of ILC.