Breast cancer: Know the early symptoms and signs

The peak incidence of breast cancer in Sri Lanka is in the 50-60 age group. We have a sub group of young patients in the 30-40 age group, as do other countries in the South Asian region, unlike in the West. Our incidence rate is 23.4, which simply means that in every 100,000 of the female population there will be about 24 women with breast cancer.

What are the symptoms and signs of early breast cancer?

Gender plays a big role. Male breast cancer is rare – about 1 percent of all breast cancers.

The main reason is as follows.

A woman’s breast undergoes cyclical hormonal surges. During these hormonal surges the breast cells fluctuate in number unlike in the male breast cells. This constant fluctuation due to estrogen and progesterone hormones makes the woman’s breast cell continuously active.

This increased workload on the cell can result in malfunction of the mechanism in the cell nucleus which controls cell division and proliferation, especially after many years. In that case, abnormal cells form and if the body cannot destroy them, they may proceed to develop into cancers.

Pregnancy protects due to complete maturation of breast cells into breast milk glands to produce milk.

What could be early symptoms or signs of breast cancer? Is pain by itself a symptom of breast cancer?

Pain in the breast is either due to a local abscess or infection but is often due to the hormonal changes that affect a woman’s breasts. During the menses, there is pain due to congestion and cell proliferation within the breast. That is present in many women.

Non-cyclical pain is of unknown aerology but is again most likely related to restructuring of the breast cells.

With every decade of age, the proportion of milk glands to supporting fat within the breast changes. By the time a woman reaches 70, most of the breast glands have disappeared and the breast is predominantly composed of fat. This gradual process takes place over many years and could result in bouts of pain, cysts and sometimes tender masses within the breast.

However, repeated pain in one area of the breast could be significant. Often anxiety accompanies the pain. Such women should consult a doctor.

Nipple discharge without active squeezing is important. If a woman notices spotting on her night dress, undergarment or sheet, she should consider it significant.

Even though we cannot see them, the milk ducts open on the nipple. A persistent discharge of any colour is important. The commonest cause is a benign Duct Papilloma, but this could also be due to malignancy.

Perhaps the earliest warning is the presence of micro-calcification seen on a mammogram of women over 40 years. When a breast cell is on its way to becoming cancerous, it lays down a particular type and pattern of calcium.

This can only be detected by a mammogram. A mammogram is an essential annual test for women over 50 years of age, and when combined with an ultrasound scan, it can give an accuracy of diagnosis of up to 99 percent before the formation of a lump which can be felt.

A mammogram would show a particular pattern of calcification which is significant and can predict cells that can turn cancerous.

When detected, the patient will not feel any lump in the breast. At that point this area of cells, which can be located by special means, should be removed. If left in situ, they could slowly develop into a cancerous mass.

Any form of a mass in a woman’s breast should be seen by a doctor. Women cannot afford to dismiss a mass in the breast at any age. It must be checked out.

Watchfulness is the way forward in women who have a first degree relative with breast cancer or any type of cancer. If they are over 40, they should undergo a mammogram and scan annually.

Even women without a family history of breast cancer would do well to have annual ultrasound scan and a mammogram once in two years when they reach 50 years.

Rarely, a mass in the armpit might be the first warning sign, and again is usually painless. Such masses could be arising from the outer part of the breast or could be lymph nodes from a minute lesion in the breast which is not felt.

A rare presentation of early breast cancer is an abnormal nipple.

Irritation and flaking, and rarely ulceration: This is a sign of Paget’s disease. This is a type of early breast cancer.

With this sign, the breast could be completely free of any masses. Any lesion of the nipple which persists should be biopsied.

If detected by these early signs and symptoms, breast cancer is easy to manage. This ensures a long disease-free interval and a good overall survival.