Breast cancer danger signs many women haven’t heard of
Fiona LEWIS thought she knew the warning signs of breast cancer: lumps in the breast, nipple discharge and pain. So when she felt a small, coarse patch on her right breast, she wasn’t worried.
‘The changes weren’t visible on the surface — it was only when i was checking for lumps that i could feel an area of about 2cm to 3cm across with a slightly different, coarser texture,’ says Fiona, 44, a maths teacher.
She lives with her partner andy, 44, a landscape gardener, in Taunton, Somerset with her daughter, Corrie, 15.
‘Just a week before, everything seemed normal and i couldn’t feel any lumps and the nipple looked normal, so i just dismissed it.’
But the coarse patch didn’t go away. Four months later, Fiona noticed that the area had also hardened, though it didn’t feel lumpy.
She mentioned it to andy, who urged her to see their GP, which she did the next morning. ‘Though i still thought it would be nothing,’ she says.
However, the GP said the changes were suspicious, referring Fiona to a breast clinic at the local hospital, where she went less than two weeks later, accompanied by andy.
after a mammogram, ultrasound scan and a needle biopsy, she was told she had ductal carcinoma in situ (DCiS), an early form of breast cancer where cancerous cells are contained within the milk ducts.
She underwent a mastectomy, which revealed that as well as the DCiS, she had two tumours in her right breast unrelated to the DCiS, and this had spread to one of her lymph nodes.
‘i was told the cancer was on the move and i’d need chemotherapy, too. Thankfully, no more cancer was found in any more of my lymph nodes. The cancer had been caught in time.
‘While i was shocked, i’m lucky because it was on the cusp of spreading. if i’d waited for a lump, it might have been too late.’
Fiona has been clear of cancer for the past three years and is HoWEvEr, back at work.
her narrow escape highlights the fact that while lumps are t he best- known symptoms of breast cancer, there are other more subtle signs that women need to be vigilant about.
These i nclude skin texture changes, such as skin that feels grainy or has an ‘ orange peel’ appearance, puckering or thickening, rashes around the nipple, discharge, as well as changes in the size and shape of the breast, pain in the breast and armpit and dilated, more visible veins.
The different symptoms sometimes relate to the position of the cancer in the breast, says Dr Emma Pennery, clinical director of the charity Breast Cancer Care.
‘For example, cancer confined to the breast ducts may not produce a lump because the disease can extend down the length of the duct inside the breast tissue.
‘Some people notice a dip, or dent, in the breast. This can be because the cancer is tethered to the breast tissue and so pulls it inwards.’
Changes such as dilated veins can be a sign that cancer is blocking a blood vessel.
Though there are not usually specific symptoms for different types of breast cancer, there are some exceptions.
a scaly red eczema-type rash around the nipple is sometimes associated with a rare breast cancer called Paget’s disease, which starts in the nipple or the area of darker skin surrounding it and can be itchy.
Dr Julie Cooke, a consultant radiologist at the Jarvis Breast Centre at the royal Surrey County Hospital, Guildford, says it’s vital that women l earn what their breasts look and feel like normally so they can be aware of any changes early on.
‘not all changes will be due to breast cancer, but subtle changes in the skin can be due to the breast pulling itself in and trying to “wall off ” the cancer,’ she says.
‘Sometimes you get dimpling and puckering of the skin due to natural changes in the breast — in older women with larger breasts for instance, especially on the lower part of the breast — but don’t assume it’s normal. Get it checked out.’
She advises women should examine themselves in front of a mirror so they know what their breasts look like and inspect the view from the side, as well as underneath, making sure that they also check their armpits and the chest area up to the collarbone.
‘Women should check their breasts are roughly the same size — it’s normal to have one breast slightly larger than the other — but not if new change.
‘The skin on your breast should feel smooth to touch. Look out for changes in the nipples, such as one pointing outwards and another inwards, check for redness, skin flakiness around the nipple or itching.
‘Spontaneous nipple discharge on one side, which may be blood stained, brown or clear, might mean there is something in the breast that is causing irritation.
‘Though if the discharge is on both sides, milky and coming out of more than one point it’s unlikely to be cancer.’ (This is more likely to be a sign of a hormonal problem.)
Jackie Harris, a clinical nurse specialist at Breast Cancer Care, says nearly a fifth of women who notice a change in their breasts wait at least a month before get- ting the problem checked out. ‘Many women know to look for a lump as it’s the most common breast cancer symptom, which is fantastic, but women need to look out for other changes, too.
‘We know that among women who don’t go to their GP until their breast cancer is at a later stage there’s a greater proportion with non-lump symptoms, so that suggests recognition of other symptoms is lower.’
For Mandee Castle, a 47-year-old part-time shop assistant from Deal, in Kent, the only symptom of breast cancer was a tiny ‘dip’ in her left breast, which she says appeared practically overnight. ‘it looked as if someone had left a finger impression in putty and was j ust above my nipple,’ says Mandee, who is married to Steve, 42, an electrical engineer, and has a son Tom, 14.
‘Because i’m over 40 and had breastfed i thought i just had the beginnings of droopy boobs.
‘i couldn’t see or feel any lumps, so didn’t do anything about it immediately. i was brought up to check for lumps, not dips, so wasn’t too worried.’
it was four weeks before she mentioned it to her GP after seeing a campaign on daytime Tv by the charity Breast Cancer now about unusual breast cancer symptoms.
‘i’d gone to the GP about something else, but i asked them to check my breast “dip” as well — something from the campaign must have struck a chord at the back of my mind,’ she says.
‘He couldn’t find any lumps, but luckily he decided to refer me to hospital anyway as i was in my mid- 40s and had some f amily members who’d had breast cancer — though not immediate family.’
Two weeks later, a mammogram revealed a suspect area just above the dip near her nipple.
a follow-up ultrasound scan revealed two tumours the size of olives, which biopsies confirmed ManDEE were cancerous.
was devast ated. ‘i certainly hadn’t felt them. i thought i was going to get a pat on the back for being so vigilant. i never expected something so innocuous could be a cancer symptom.
‘My specialist explained the skin was indented because the tumours were pulling it back.
‘Later tests before my surgery to remove the breast revealed i also had five lobular carcinomas — cancer in the cells that line the lobules (tiny parts of the breast that make milk).
‘They were grade 2, which meant they were spreading, but hadn’t yet reached the lymph nodes. They ranged in size from 1mm to 13mm — so small i would never have found them if looking for a lump.’
in fact, invasive lobular carcinomas, which account for about 10 per cent of breast cancer cases, don’t always form a definite lump; i nstead breast tissue may feel thicker.
Thankfully, after a mastectomy and chemotherapy, which ended in summer 2013, Mandee is cancer free, but she says things could have been very different.
‘if i’d waited until the tumours had grown enough to be a noticeable lump it’s likely the cancer would have been much harder to treat. My advice to other women is don’t get fixated looking only for lumps.
‘of course, not all changes will be due to breast cancer, but it’s better to be safe than sorry.’
breastcancercare.com; breastcancernow.org