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Breast Cancer: Symptoms and Diagnosis

Jessica Evert, MD, edited by Benjamin McDonald, MD

Breast cancer is a disease that progresses in stages, building in intensity over time. During the early stages of breast cancer there may be no discernable symptoms. When symptoms are present they may be subtle and easy to confuse with benign conditions. During the early and middle stages of breast cancer symptoms can include the following:

  • A lump, dimple or thickening in the breast
  • A lump or swelling in the armpit (an enlarged lymph node)
  • Change in the shape of the breast
  • Change in the size of the breast, including swelling
  • Change in the color or texture of the breast and/or nipple, including redness, scaly, dimpled, retracted, or puckered appearance
  • Breast pain, especially if in one breast only
  • Abnormal discharge from the nipple

It is important to remember that the appearance of these symptoms do not indicate that a person certainly has breast cancer.  It is a good idea to consult with your doctor if you notice any of these symptoms are present.

Breast cancer is far easier to treat when it is identified earlier rather than later. Early identification of breast cancer can present a problem, however, as breast cancer often occurs without producing symptoms. In the absence of obvious symptoms, only a doctor's careful examination and testing can bring hidden cancer to light. Regular professionally administered breast cancer screenings are thus an essential part of proper health care for all persons who are at heightened risk for breast cancer, and (as advancing age is a risk factor) for all women over age 40.

Doctors use several methods to screen women for breast cancer. What follows is some general information on two of the most commonly used tests.

  • Clinical Breast Exam. During a clinical breast exam (CBE for short) a doctor first observe your breasts for any inequalities or changes in size or shape, then palpates (feels) your breasts and armpits looking for lumps and swellings. It can be awkward to receive a breast exam, especially when it is given by a male doctor. You should know that many doctors' offices have women available who are trained to give clinical breast exams. Do not hesitate to ask for a woman to perform the procedure if this would make you more comfortable.

  • Mammogram. A mammogram is basically an x-ray image of the breast's interior tissues and any lumps or irregularities that may exist therein. During this procedure a doctor or specialist will have you undress and place your breast between two plates which are then slightly compressed. Your breast is then subject to a beam of radiation and an x-ray picture is taken. Though uncomfortable, the pressure on your breast is necessary to improve the clarity of the x-ray image. Fortunately, it does not last long. Also, it is good to know that the radiation used during the procedure does not significantly increase your risk of breast or any other form of cancer.

  • Axillary Dissection and Biopsy. Recall that breast cancer starts as a tumor in the breast, and then later spreads through the body via the lymph system. If your doctor comes to believe that you may have cancer, he or she will want to know whether that cancer is still localized inside your breast, or whether it has spread. A test called an Axillary Dissection can help answer this question. An axillary dissection involves a small surgery wherein cells from the lymph nodes in the armpit are removed and then studied under the microscope to determine if they are cancerous. The general name for this tissue sampling and study is "biopsy".

  • Hormone receptor testing. Recent advances in testing of biopsy specimens allow doctors to test tumor samples for certain hormone receptors. If these hormone receptors are present in the tumor it allows doctors to use certain medications to help fight the cancer and can improve a person's likelihood of survival. These will be discussed further in the treatment section.

Although only your doctor can do a definitive breast cancer screening, it is a good idea for all women to learn to do breast cancer self-screening so as to identify any potential symptoms as early as possible. Breast self examinations are easy to perform. They involve a regular and systematic checking of your breasts for lumps, irregularities and other changes that may indicate cancer. A great number of women who survive breast cancer have been able to discover its presence while the cancer is still in its early stages. You should practice breast self-examination regularly so that you become familiar with your breasts and are thus in a better position to identify changes that may be early warning signs.