Is The First Sign Of Breast Cancer Always A Lump?

Mention the words breast and lump and most people immediately think of cancer; and certainly it is true, an unusual mass felt in the breast is often the first symptom that a woman who goes on to receive a breast cancer diagnosis will notice. However, it is essential to remember that:

1) Not all breast lumps are cancerous

2) There are other symptoms that can precede a breast cancer diagnosis, so having a good awareness of the way your breasts normally look and feel is essential.

1. Not all breast lumps are cancerous

A newly discovered breast lump should always be examined by a doctor; however, in up to 90% of cases it will not be cancer.

There are many things that can cause lumps to form in the breasts. Fibrous tissue can form non-cancerous growths and a build-up of fluid can cause cysts. Lumps can also form during the menstrual cycle, which is why it is so important to understand your own body and self examine your breasts regularly. During pregnancy, your breasts may feel lumpy as the milk glands start to fill with colostrum in preparation for your baby’s arrival. Some women also notice more lumps as they approach menopause.

There is no absolute rule with regards to how a lump that is cancerous will feel. Often those that are cancer will feel solid and have irregular edges; but some tumorous masses are tender, soft and round.

2. Other symptoms of breast cancer

 A study of 2316 women with breast cancer found that 83% of them reported a breast lump as one of the earliest symptoms. However, one in six of the women presented without a noticeable breast lump. In these cases, there were other early warning signs, which, broadly speaking, could be split into two categories:

Non-lump breast symptoms –

• Nipple abnormalities (becoming sunken or retracted)
• Breast pain
• Breast skin abnormalities (usually a dimpling that resembles orange peel, or a rash with dry, flaking skin)
• Discharge or bleeding from the nipples.

Non-breast symptoms –

• Swelling of the lymph nodes under the armpit
• Fatigue
• Weight loss
• Back pain.

It immediately becomes obvious why without a palpable breast lump, breast cancer diagnosis is often significantly delayed. Many of the symptoms, particularly the non-breast ones, are vague and could be indicative of a number of different conditions. They have low predictive value in terms of diagnosis.

One thing to be particularly aware of is new lumps under the armpit. Sometimes the lymph nodes swell before the tumour in the breast is large enough to be felt. It is always advisable to seek medical advice if the lymph nodes become sore or distended.

Regarding the other potential symptoms, it would be very easy to panic and assume the worst; remember, many breast-related changes are hormonally-driven; alternatively they may be due to infections or cysts, which are undeniably uncomfortable and inconvenient, but usually relatively harmless.

To conclude, try to regularly self examine your breasts, with a view to understanding what your ‘normal’ is. Identify whether your breasts undergo any changes in the run up to, or during your period, and monitor any abnormalities you see or feel. Finally, if you have any concerns at all, see a doctor.

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Sources:

• “Breast Cancer Signs and Symptoms: Most Common Symptoms.” American Cancer Society, https://www.cancer.org/cancer/breast-cancer/about/breast-cancer-signs-and-symptoms.html.
• “Breast Cancer: Symptoms, Diagnosis, Types, and More.” Breastcancer.org, 6 Aug. 2019, https://www.breastcancer.org/symptoms.
• “Breast Changes and Conditions.” National Cancer Institute, https://www.cancer.gov/types/breast/breast-changes.
• Koo, M M, et al. “Typical and Atypical Presenting Symptoms of Breast Cancer and Their Associations with Diagnostic Intervals: Evidence from a National Audit of Cancer Diagnosis.” Cancer Epidemiology, vol. 48, June 2017, pp. 140–146., doi:10.1016/j.canep.2017.04.010.
• “Symptoms – Breast Cancer in Women .” NHS Choices, NHS, https://www.nhs.uk/conditions/breast-cancer/symptoms/.