Presenting complaints common for women with clinical breast cancer
When women first see their doctor with concerns of breast abnormalities and possible breast cancer, the presenting complaint is most often of a painless, firm, lump in the breast.
This is the first ‘self discovered‘ symptom about 70% of the time. More infrequently reported symptoms include elargement or shrinking of the breast, breast pain, retraction, and nipple erosion (nipple getting smaller, less distinct). Often, nipple erosion is symptomatic of paget’s disease, which in turn often indicates an underlying ductal carcinoma.
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Women also sometimes complain of nipple discharge, which tends to be benign but is suspicious if it is unprovoked, unilateral, uni-orificial, and with serous or bloody discharge.
Most presenting complaints concerning breast cancer are given to the family doctor or GP
Most of the time, complaints which later turn out to be symptomatic of breast cancer are given to a woman’s general practitioner or family doctor.
The most common symptoms that a family physician encounters which leads to referral for breast cancer screening are a palpable lump (painful or painless), pain in the breast, ulceration, and nipple discharge. Statistically, presenting with the symptom of painless lump occurs about 56% of the time, and a painful lump about 17% of the time.
Ulceration is the main presenting complaint about 16% of the time, and nipple discharge accounts for 11% of presenting breast cancer symptoms. However, overall only about 3% of women who bring these kinds of presenting complaints actually turn out to have breast cancer.
Presenting with a lump has, statistically, an elevated potential to be breast cancer (about an 8% chance), while the chances of nipple complaints being related to breast cancer is only about 2%, and pain, only 1%.
Family physicians generally don’t consider breast pain to be indicative of an underlying malignant cancer growth. Only about 17% of women who present with ‘pain‘ symptoms are referred for a specialist assessment.
About 60% of women who speak to their family physician about a breast lump are referred for screening, while about 1/3 of women with nipple discharge are sent for potential breast cancer evaluation. On average, a woman will wait about 13 months before seeing their GP regarding breast symptoms potentially related to breast cancer.
The average age in which breast cancer is detected as a ‘lump’ is about 61
Women between the ages of 25 and 44 tend to present these kinds of breast symptoms to their GP most commonly, and also women over the age of 65. Again, the rate of actual confirmed breast cancers following GP visits for these common presenting breast symptoms is about 3%.
For women under 45, these types of symptoms are even less likely to be related to breast cancer. The average age in which a woman, who presents to her GP with a lump, has actually developed breast cancer, is about 61.
Rare presenting complaints may include lymphedema and venous thrombosis
Sometimes breast cancer can be ‘occult‘ and will first seem to present in other areas of the body. Arm lympedema, which is an accumulation of lymphatic fluid in the arms or axilla region, is associated with occult primary breast cancer in about 0.5% of cases more or less.
If ‘inflammatory’ breast cancer is the underlying cause, then presenting symptoms might include swelling as an ‘immune response‘ in various areas of the body, such as the arm, axillary region, and the chest, which might include a venous thrombosis, or large blood clot.
This is exceptionally rare, however, and would only result from a late stage breast cancer or possibly from an inflammatory breast cancer not yet diagnosed.
For further reading, I recommend you visit this page with information on Eosinophilic cytoplasm in breast cancer diagnosis.
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