Early symptoms and signs of Breast Cancer

by Dr. Indranee Amarasinghe

Consultant Surgical Oncologist

The peak incidence of Breast Cancer in Sri Lanka is between the ages of 50 to 60 years. We have a  sub group of young patients  between 30 to  40 years as do other countries in this region, unlike in the west. Our incidence is 23.4 which simply means that every 100,000 of the female population there will be 24 women with Breast Cancer.

What are the symptoms and signs of early Breast Cancer?

Gender  plays a big role.

Male Breast Cancer is low, approximately  one 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 be 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 70 yrs. most of the breast glands have disappeared and the breast is predominantly composed of fat. This process is very gradual 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. Very often anxiety accompanies the pain, so women should consult with a doctor.

Nipple discharge without active squeezing is important. The woman noticed spotting on her  night dress or sheet or undergarment in the area of a tree single duct unilateral nipple discharge is  significant. 

Even though we cannot see them, the milk ducts open on the nipple. A persistent discharge of any color Is  important. The commonest cause is a benign Duct Papilloma , but 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 test annually for women over 50 years of age, and when  combined with an Ultrasound scan can give an accuracy of diagnosis of up to 99%.

Before the formation of a lump which can be felt, in those individuals. A Mammogram would show a particular pattern of calcification which is significant and can predict cells which are going to become a Cancer.

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 the Breast of women should be seen by a Doctor. Women cannot 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 Cancer or Breast Cancer. Ideally with a mammogram and scan annually after 40 yrs. 

Even women without 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 Pagets 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.