Key points
- There are nine symptoms of breast cancer.
- Patients presenting with one or more of these symptoms should be referred to a breast clinic, regardless of age or the date of their last mammogram. See the pathway for managing symptomatic patients.
- Clinical breast examination (CBE) should be performed when a patient presents with breast cancer symptoms.
- Breast Cancer Foundation NZ recommends patients know how their breasts normally look and feel.
Symptoms of breast cancer
There are nine signs of breast cancer to be aware of in patients. Patients may present with one or more of the following symptoms:
Lump or thickening
Lumps or thickened tissue can occur anywhere in the breast, including up to the collarbone and in the axilla. Breast lumps can present differently in different patients, e.g. they may be hard, soft, painless, painful, fixated, mobile, near the skin’s surface or deep in the breast tissue. A lump can also present as a thickened area of breast tissue that feels different from the rest of the breast.
Inverted nipple
A newly retracted or inverted nipple can indicate that breast cancer is growing in a duct behind the nipple, gradually pulling it into the breast. Inflammation and scarring of the tissue behind the nipple can also cause nipple inversion, but a new retraction should be investigated to exclude breast cancer. Partial retractions and deviations should also be investigated, as should other changes, such as the nipple pointing in an unusual direction or changing shape.
Orange-peel-like skin
Thickened skin that looks like an orange peel needs to be investigated to exclude inflammatory breast cancer. The patient may also have a change in the colour of their breast, e.g. redness or a pink flush occupying at least one-third of the breast or a bruised appearance. The breast may be inflamed, swollen and feel heavy or achy. This symptom can be confused with a breast infection, but if the patient does not respond to antibiotics, a referral to a breast clinic is recommended, as inflammatory breast cancer is an aggressive cancer.
Unusual pain or change in shape
Unusual breast pain
Cyclical breast pain is common during a woman’s menstrual cycle, but patients with an unusual, new or persistent pain should be investigated.
Changes in shape
It is common for women to have asymmetric breasts, but patients presenting with unexplained swelling or shrinkage of the breast, particularly unilateral change should have these changes investigated.
Breast Cancer Foundation NZ recommends breast self-examination for women starting from age 20. Knowing what their breasts usually look and feel like aids early detection of new or unusual changes, even for women having regular mammograms. Talk to patients about checking their breasts, and what changes to look for, and advise them to report changes to their GP as soon as possible.
Dimples and puckering
These can appear anywhere on the breast, including on the underside, and may be caused by a tumour pulling the overlying skin inwards.
Crusty nipple
Crustiness on or around the nipple can present as a red rash or flaky, scaly skin. Patients may also experience an itch or a burning sensation. Benign conditions, such as eczema, breast-feeding or an allergic reaction to products used in the area, can cause crustiness on the nipple, but it should be investigated to exclude Paget’s Disease of the Breast.
Nipple discharge
Spontaneous nipple discharge should be investigated, especially if clear or blood-stained. Benign conditions that cause nipple discharge include taking certain medicines, infection or a benign growth in the breast ducts, but any discharge should be investigated to exclude breast cancer.
