I'm an Oncologist: 5 Breast Cancer Symptoms That Are Consistently Overlooked

A woman is diagnosed with breast cancer in the UK every nine minutes, and a man is diagnosed every day, according to the UK's leading breast cancer charity, Breast Cancer Now. Every October marks Breast Cancer Awareness Month, an initiative designed to raise awareness of this, the most common cancer in the UK.

The chances are we all know someone who has been affected by breast cancer in some form or another, and most of us know that we should be checking our breasts on a regular basis for changes and irregularities that aren't normal for us. But many people are still only checking for obvious signs (a lump), and potentially overlooking other, more insidiously hidden symptoms.

So, this October, MC UK is on a mission to re-educate us all on the lesser-known signs of breast cancer, and how to check yourself properly. Because we know that early detection can, quite literally, be a matter of life and death. According to further research from Breast Cancer Now, in cases of breast cancer that are detected early (stage 1), 98% of people survive for five years or more.

With this firmly in mind, we've spoken to leading oncologists and cancer specialists about the symptoms we should all be aware of - keep scrolling for all the information you might need this month, and beyond, plus their advice on what to do if you do notice something out of the ordinary.

While you're here, do check out our excellent women's health content (if we do say so ourselves) on everything from the key breast cancer signs and symptoms, the truth about the biological clock, elite sportswomen speaking up about endometriosis and boring habits for PMOS right through to the top micro-habits for hormonal health, here.

I'm an Oncologist: 5 Breast Cancer Symptoms Women Still Miss

What are the most common signs and symptoms of breast cancer?

When we think about breast cancer signs and symptoms, it's highly likely most of us think about finding a lump. And it's a fact that in over 80% of cases, a lump is the first sign that there's anything suspicious going on.

But it's not just the breasts we should be checking for lumps. In fact, charity CoppaFeel uses the words 'breast' and 'chest' interchangeably to refer to the whole area from ribs to collarbone, including the armpits.

"Breast cancer can have many symptoms, though in some cases you may not feel or see anything at all," shares Dr Saleem Azeem, Clinical Oncologist and Trustee at Breast Cancer UK. "The most common symptoms are a lump in the breast or armpit, which can be painless. While most lumps are under the skin, meaning you need to apply some pressure to feel them, sometimes they can also be found on the surface of the breast or chest or on the skin leading up to the armpit. These look more like a bump or spot that can also feel hard to the touch."

It's important to note here that if you do find a lump, try not to panic.

"Most breast changes, including lumps, won’t be cancer," reassures Catherine Priestley, senior clinical nurse specialist on secondary breast cancer at Breast Cancer Now. "That being said, it’s important to get any new or unusual changes checked by your GP."

What are the other symptoms of breast cancer?

While 83% of breast cancers first present with a lump, not all breast cancers present this way. The experts caution that some of the more subtle warning signs are easily overlooked, with around one in six women reporting symptoms other than a lump.

Other common symptoms include:

• A change to the skin, such as puckering or dimpling;
• A change in the colour of the breast - it may look darker, red or inflamed;
• A nipple change, for example, it has become pulled in (inverted);
• Rash or crusting around the nipple;
• Unusual liquid (discharge) from either nipple;
• Changes in size or shape of the breast.

And most importantly, many breast cancers have absolutely no symptoms at all. "About a third of breast cancers in England are only identified through the NHS Breast Screening Programme," notes Dr Lucy Hooper, private GP and co-founder of Coyne Medical. "This is why screening is such an important part of early breast cancer detection."

What signs of breast cancer are women still missing?

"Around one in six people with symptoms of breast cancer present with symptoms other than a lump," notes Dr Hooper. "We know that people often delay seeking medical attention for these symptoms, and that delay might be important."

So, in addition to the above, what are women commonly still overlooking when it comes to breast checks?

1. Painless lumps

"It’s really important to be clear about breast pain," shares Dr Coyne. "Most breast cancers are painless, so people shouldn’t be falsely reassured if a lump doesn’t hurt. A painless lump doesn’t mean it can be ignored."

2. Skin changes

"Skin changes such as dimpling and puckering must never be ignored," urges specialist breast surgeon at Nuffield Health Leeds Hospital, Mr Philip Turton. "If you glance at your breast in the mirror and see subtle indrawing, particularly when raising your arm, never ignore this even if you feel nothing. Similarly, subtle thickening or an area that appears tethered deeply across the boundary of the breast, just as the crease line can easily be overlooked but is an important sign."

3. Nipple changes

"Spontaneous nipple discharge, particularly if it is bloodstained or comes from one breast, should also always be checked," continues Mr Turton. "Persistent redness, scaling or eczema-like changes affecting the nipple can occasionally indicate an underlying cancer, with no lump; we call this Paget's disease of the nipple, which is cancer starting in the tiny terminal ducts within the nipple itself."

4. Inflammed breasts

"Inflammatory breast cancer is another particular type of breast cancer that people should be aware of because, rather than causing a specific lump, it often causes the whole breast to become swollen, warm, red or painful," advises Dr Hooper. "These kinds of symptoms can easily be mistaken for mastitis. Many people might initially be treated for this, but if their symptoms are not getting better, they should have further checks on the breast."

5. Dense breasts

Dense breasts are not a sign of breast cancer, but it's absolutely worth knowing if you have them, Dr Hooper advises.

"Breast density is a topic that really deserves more attention," she tells MC UK. "In the UK, it isn’t routinely reported as part of NHS breast screening, despite women in other countries, such as the United States and France, being routinely informed about their breast density on mammograms.

"It’s really important because breast density is something you can only see on a mammogram. You can’t check or feel it yourself, and women with extremely dense breasts not only have a higher risk of developing breast cancer, but mammograms can also miss about one in two cancers in this group.

"This is because dense breast tissue appears white on a mammogram, which is the same appearance as most breast cancers. Women who are having private screening, especially, should know about their breast density and be informed about whether supplemental imaging, such as ultrasound or MRI, could improve early detection of breast cancer for them."

How to be breast aware

It's clear that early detection is vital, and for this, the experts are unequivocal that we all need to be 'breast aware'. This means becoming familiar with what is normal for you and your breasts, whether they're natural or enhanced.

“I encourage women to become familiar with the normal appearance and feel of their breasts rather than relying on a rigid examination technique," advises Mr Turton. "Look at your breasts in the mirror, both with your arms relaxed and raised, paying attention to any new asymmetry, indrawing, skin changes or alterations in nipple position (retraction).

"When feeling your breasts, use the flat pads of your fingers to examine the whole breast and surrounding area, including towards the armpit. This can be done in the shower, but my preference is for women to do it lying down as they will feel the breast tissue better."

Don't forget, though, that fluctuations in lumpiness, size and sensation are totally normal within the menstrual cycle, so it's good to get to know how you feel at different times of the month, too.

"The most important thing is recognising what is normal for you and noticing when something changes," continues Mr Turton. "Breasts naturally vary in texture, and hormonal fluctuations can make them feel different at different times of the month.”

Ideally, you should conduct a thorough check at least once a month, around a week after your period. The experts recommend a four-weekly check even if you don't have periods due to, for example, the coil or other contraception. But don't become so concerned that you're checking every day.

"There is no need to examine your breasts obsessively or worry about performing a perfect technique," reassures Mr Turton. "Breast awareness is about recognising changes, not searching for abnormalities every day.”

What to do if you're concerned about breast changes

You've found a lump or one of the other symptoms discussed above, and you're fearing the worst. It can be difficult to think clearly when this happens, but it's important to try not to panic. We are incredibly fortunate in the UK that the breast cancer pathway is straightforward and, most importantly, fast.

“The first step is to arrange an appointment with your GP, who will assess the symptoms and examine the breasts," shares Mr Turton. "A GP will usually refer the patient to a specialist breast clinic under the two-week referral system, giving rapid access.

"In the UK, women with any symptoms with any possible suspicion for breast cancer are generally referred through this urgent suspected cancer pathway."

Make sure you tell a friend or family member, as you'll want someone to go to the appointment with you - and stay calm.

"At the breast clinic, assessment usually involves what we call triple assessment: a specialist clinical examination, appropriate breast imaging using ultrasound and/or mammography, and a needle biopsy if an abnormality requires tissue sampling," Mr Turton goes on. "These investigations often allow us to establish a diagnosis quickly.

"It is important to reassure women that the majority of breast symptoms turn out to be benign. However, early assessment is essential because identifying breast cancer at an earlier stage can significantly improve treatment options and outcomes.”

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