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5 signs of breast cancer that aren't a lump

May 17, 2018 | by CTCA

A female patient checking her breast for lumps
Lumps are not the only symptom for breast cancer. Learn about the others.

For decades, the medical community and the media have waged an effective awareness campaign about the signs and symptoms of breast cancer, educating the public about the importance of diligently monitoring their breasts for lumps. And the tactic has worked. Early detection has contributed to a 39 percent decline in breast cancer deaths in women from 1989 to 2015, according to the American Cancer  Society. While that’s an important step forward, many other abnormalities that may also indicate breast cancer are lesser known and discussed. Some, then, may be led to assume that no lump and no tumor mean no cancer, but that may be a dangerous conclusion to draw.

“The majority of the publicity assigned to breast cancer is a lump, and the majority of patients might feel a mass in the breast, but there are definitely other symptoms besides a lump,” says Ricardo H. Alvarez, MD, MSc, who leads the Breast Cancer Center Institute at Cancer Treatment Centers of America® (CTCA). Visual changes may be especially key in helping detect breast cancer early.

You can see a lot of things just by looking at your breasts in the mirror. When your arms are by your side, you don't always see everything. Put your hands on your hips or raise them up. Having arms in two different positions while looking is also helpful.” - Cynthia Lynch, MD, Medical Oncologist at our hospital near Phoenix

Warning signs

These other warning signs of breast cancer include:

Changes to the nipple and the surrounding area: “Changes in the nipple area can be a genetic malformation or alteration, but when there is nipple retraction—when the nipple becomes inverted—in many cases, that is a sign of cancer,” Dr. Alvarez says. If the nipple wasn’t inverted before and becomes inverted, consult with your doctor.

Bloody nipple discharge: Bleeding from the nipple may be limited and difficult to see, but if you notice blood stains on your bra, pay attention. Dr. Alvarez cautions women not to panic if they notice clear or milky secretions, since these may result from normal physiologic changes during pre-pubertal stages. But if the secretions are unusual, bloody or continuous, he recommends speaking to your health care provider.

Change in color and/or thickening of skin on the breast: Known in the medical community as peau d'orange (a French term meaning skin of an orange), any dimpling or thickening of breast skin that resembles an orange rind is a red flag. These symptoms are often associated with inflammatory breast cancer (IBC), a rare but aggressive disease that usually does not involve a lump and may not be detected by a mammogram. IBC symptoms are caused by cancer cells blocking lymph vessels in the skin. If the breast skin changes color, typically to a pink or reddish hue that covers more than half the breast, that may also be cause for concern.

“Sometimes these changes in coloration can be difficult to find in African Americans and in obese patients with very large breasts,” Dr. Alvarez says. “IBC is very aggressive, and it has common characteristics: rash, thickening of the skin and shooting pain. This type of cancer grows very fast, and patients often experience pain. Sometimes a patient may experience only one or two skin changes and sometimes all four. Sometimes changes are localized in the breast, upper abdomen and posterior (rear) part of the chest.”

Though IBC represents 1-3 percent of all breast cancers, Dr. Alvarez says it accounts for 10 to 15 percent of all breast cancer deaths. “It’s rare, but highly lethal,” he says. “You can see these changes from one day to the next. The majority of time, these skin changes occur in less than six months. Most of our patients woke up one morning and found the changes. It’s often confused with mastitis (inflammation of the breast), but mastitis is extremely rare if you’re not breastfeeding. A vast majority of IBC patients have first been treated first with antibiotics, thinking it’s inflammation, infection or something else.”

Other signs

Other possible signs of IBC include:

  • Increased warmth in the breast
  • One breast appearing larger and feeling warmer and/or heavier than the other
  • Pain, itching or tenderness in the breast

A non-healing sore anywhere on the breast, including the nipple: A red, scaly, flaky nipple, and any persistent skin change, including blood or fluid from the nipple, may be a sign of Paget’s disease of the breast, another rare form of breast cancer. This disease originates in the nipple. It’s not usually invasive and is most commonly diagnosed in patients in their 70s and 80s, Dr. Alvarez says.

Swelling of axillary lymph nodes (lymph nodes in the armpit): “Many patients who end up diagnosed with breast cancer that has spread to the lymph nodes have no symptoms in the breast, no changes in the structure of the breast, but they come in for a consult because they feel something under their arm,” Dr. Alvarez says. “This may mean that cancer from the breast has traveled to the lymph nodes, and now there is lymph node invasion. These affected nodes may also be in the lower part of the neck if the cancer is a little more advanced. Cancer cells are very smart and use the lymphatic system to invade distant organs.”

It’s important to also remember that not all breast lumps are signs of cancer, a fact that underscores why it’s important to be familiar with the look and feel of your breasts. “Have an awareness of your breasts,” Dr. Lynch says. “You need to touch them to be aware. Breast self-awareness is the terminology now used instead of a self-breast exam.”