Common Presenting Breast Cancer Symptoms

i) A painless, firm breast lump

The most common presenting breast complaint, for most women who visit their family physician, is a painless, firm breast lump.

In about 70% of cases, a woman discovers the lump herself during a self breast examination.

ii) Other Less Common Symptoms of Breast Cancer

However, there are a few less common symptoms of breast cancer that some people may not be aware of. These more infrequent symptoms include:-

enlargement of the breast (and not in a good way)
shrinking of the breast
pain in the breast
nipple retraction (when the nipple suddenly appears to be going inwards, rather than outwards)
nipple erosion (whereby the nipple gets smaller and often has a crusty layer around it). Often, nipple erosion is symptomatic of Paget’s disease, which in turn often indicates an underlying ductal carcinoma.
ulceration

I just want to let you know that this page is getting a little old, but still has great information. However, I have a newer version of this page with more up-to-date material on Clinical Breast Cancer.

iii) Nipple Discharge

Women also sometimes complain of nipple discharge. Indeed, nipple discharge usually tends to be benign. However, a discharge is more suspicious if it is:-

Unprovoked: That is you are not breast feeding. Furthermore, nothing has damaged or irritated the nipple.
Unilateral: That is the nipple charge only occurs on one side
Uni-orificial: So this means occurring in a single duct
A serous or bloody discharge.

First port of call is the family Physician

A woman who suspects that she has symptoms of breast cancer will usually first present to her general practitioner or family physician.

The Most Common Symptoms of Breast Cancer

The most common symptoms of breast cancer that a family physician encounters are:-

a palpable lump (painful or painless)
pain in the breast
ulceration
nipple discharge

Indeed all of the above symptoms will lead to a referral for breast cancer screening. Statistically speaking, presenting with a painless breast 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, the really good news is that overall only about 3% of women who present with these complaints actually turn out to have breast cancer.

… and a few more Statistics

Statistically, there is an elevation in the risk of breast cancer if the patient presents with a breast lump.

In the case of a presenting breast lump, an eventual diagnosis of breast cancer occurs around 8% of the time.

However, the chances of breast cancer in the patient presenting with nipple complaints is only about 2%. Even better news for those presenting with breast pain, this turns out to be breast cancer in only 1% of cases.

Family physicians generally do not consider breast pain to be indicative of underlying malignant breast cancer. Indeed, doctors will only refer to a specialist about 17% of women who present with breast pain.

So, a family physician will refer about 60% of women with a breast lump for screening. Around one-third of women with nipple discharge are sent for potential breast cancer evaluation.

On average, and this is shocking, ladies, a woman will wait about 13 months before seeing their GP regarding breast symptoms that could be 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 breast cancers following GP visits for these common presenting breast symptoms is only 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 presents to her GP with a lump, has actual breast cancer is about 61.

Rare Symptoms of Breast Cancer

Sometimes breast cancer can be ‘occult’ and will first present in other areas of the body. For example arm lymphedema, (or swelling). This is an accumulation of lymphatic fluid in the arms or axilla (under the arm) region. Lymphedema is a symptom of 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 (under the arm),
the chest which might include venous thrombosis or large blood clot.

This is exceptionally rare, however, and would only result from late-stage breast cancer or possibly from inflammatory breast cancer.

References

Bhattacharya S, Adhikary S. (2006) Evaluation of risk factors, diagnosis and treatment in carcinoma breast – A retrospective study. Kathmandu University Medical Journal (2006), Vol. 4, No. 1, Issue 13, 54-60 https://www.ncbi.nlm.nih.gov/pubmed/18603869
Eberl MM, Phillips RL Jr, Lamberts H, Okkes I, Mahoney MC. (2008) Characterizing breast symptoms in family practice. Ann Fam Med. 2008 Nov-Dec;6(6):528-33. https://www.ncbi.nlm.nih.gov/pubmed/19001305

More references for this post are on this page.