WHEN SHOULD I WORRY ABOUT...

5 Signs of Breast Cancer Beyond Feeling a Lump

Oct. 20, 2022 - Katie McCallum

The most common breast cancer symptom that every woman knows about is a breast lump. A lump in the breast doesn't necessarily mean cancer, but it should always be taken seriously.

Lumps aren't the only way breast cancer is caught, though. They're not even the most common way.

"Most breast cancers are now diagnosed early via screening mammogram, before a lump can even be felt," says Dr. Arthy Yoga, a breast surgical oncologist at Houston Methodist. "The next most common way they're diagnosed is through a breast lump, whether a woman notices one herself at home or her doctor finds one during an exam."

(Related: When to Worry About a Breast Lump)

But Dr. Yoga emphasizes that breast lumps aren't the only sign of breast cancer that women need to be familiar with.

The breast cancer symptoms to watch out for beyond a breast lump

"The other signs of breast cancer to be aware of are related to nipple discharge and skin changes on the breast," says Dr. Yoga. "While breast pain is a common reason people come in concerned about breast cancer, most breast pain is actually benign and not associated with cancer."

Breast lumps aside, here are five more breast cancer signs that Dr. Yoga wants women to know and take seriously.

1. Nipple discharge

Not all nipple discharge is concerning, but if it's bloody discharge that's happening on only one side — "unilaterally" — it can be a sign of breast cancer.

"Bloody nipple discharge can have benign causes, but we have to keep breast cancer in our minds as a possible differential diagnosis," says Dr. Yoga. "A diagnostic mammogram, ultrasound and, in some cases, even additional imaging, like an MRI, are needed in order to safely rule out breast cancer."

Nipple discharge that is bilateral — in both nipples — and that isn't bloody is less concerning.

"Fibrocystic changes — when fluid builds up in the ducts of the breasts and forms cysts — can lead to green, yellow or brown nipple discharge," says Dr. Yoga. "These cysts are most common when the breasts tend to be most active due to hormonal changes, such as in younger women around a menstrual cycle or women taking hormone replacement therapy after menopause."

The nipple discharge caused by fibrocystic changes isn't a sign of breast cancer. It's also not overly concerning and can sometimes be resolved by reducing caffeine consumption or stopping hormone replacement therapy.

2. Feeling a mass near the breast

"When women do their breast self-exams, they know to examine their breast but, oftentimes, we find that they're not lifting their arms and feeling the armpit area, called the axilla," says Dr. Yoga.

Lumps that occur in that area can be a possible sign of cancer.

"Some breast cancers start in the breast but travel to the nearby lymph nodes in the axilla rather than forming a mass in the breast," explains Dr. Yoga. "When this happens, it's called an axillary mass. And it's why feeling in this area is important."

3. Swelling and redness

When the breast is swollen and red, it's most commonly related to an infection. Breast infections are common in smokers and women with nipple piercings.

But in certain rare cases, redness and swelling can also be a sign of breast cancer — particularly inflammatory breast cancer, a rarer but highly aggressive form.

"If the swelling and redness is accompanied by other symptoms of a breast infection, like pain and itchiness, your doctor is likely going to prescribe antibiotics," says Dr. Yoga. "But in rare cases where there's swelling and redness without infection — no tenderness or pain, no abscess and no improvement with antibiotics — this could be a sign of breast cancer. Additional work-up with a diagnostic mammogram is needed to rule out breast cancer."

4. Dimpling or divot in breast or nipple

Changes in the contour of one of the breasts or how the skin looks can be another sign of cancer.

"As a breast mass grows larger, it can pull the skin inward," explains Dr. Yoga. "This can cause the skin to look dimpled or like there is a divot in it. If the mass is below the nipple, it can cause the nipple to pull inward."

These changes are typically only worrisome when they are new and occur unilaterally — on one breast or the other, not both.

"If you have bilateral nipple inversion and you've had it since you were young, then that's benign and not a sign of breast cancer," says Dr. Yoga. "But if this is new and it's happening on one side of the breast, it could be that there's cancer behind there causing the contour of the breast to change."

5. Sudden changes in the size of one breast

"If one breast is starting to look smaller than the other or like it's getting firmer, tighter and sitting higher than before, it could be a sign that cancer is growing diffusely through the breast," explains Dr. Yoga. "Similar to how a breast mass growing under the skin causes a dimple or divot, diffuse growth pulls the entire skin of the breast inward."

The opposite is also true. If one breast has become larger, heavier or fuller than the other, it can also be concerning.

"If a diffuse cancer is growing and blocks the lymphatics of the breast, lymph cannot drain and this fluid can build up and cause enlargement of the breast," says Dr. Yoga.

In most women, one breast is almost always slightly larger than the other. This is natural and common.

But a sudden, persistent enlargement of one breast — especially if you haven't recently gained weight and you're not pregnant — may be a sign of breast cancer.

The importance of the breast self-exam

To recognize many of the signs of breast cancer mentioned, Dr. Yoga points out that you first have to know what's normal for you.

"This is why breast self-exams are important," says Dr. Yoga. "It's a time to examine your breasts and notice what looks and feels normal for you."

She adds that this is increasingly important as more and more young women are being diagnosed with breast cancer.

"For most women, screening mammogram is recommended at age 40, but we're seeing more women in their 30s being diagnosed with breast cancer — particularly in the African-American community," says Dr. Yoga.

Before age 40, even if you're not yet eligible for a screening mammogram, a diagnostic mammogram can be done if a clinical finding is uncovered. This means it's still important to do breast self-exams now and then and consult your doctor if something feels off.

"As mentioned, fibrocystic changes can come and go — with your menstrual cycle as well as other factors," says Dr. Yoga. "But if you feel a mass and it's persistent, you need to be evaluated, even if it's not yet time for you to have a screening mammogram."

She adds that diagnostic mammogram and breast ultrasound are always options for a woman who feels a lump or is showing other signs of breast cancer.

"After imaging, at Houston Methodist, the radiologist and your patient navigator help you understand whether you can just go back to regular screening or should follow-up with your primary care doctor or gynecologist or be referred to a breast oncologist or surgeon if the mass requires treatment," explains Dr. Yoga. "They navigate you through it."

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