Which signs to watch for
The most common sign of breast cancer is a newly noticed, firm and usually painless lump in the breast or armpit. The absence of pain does not make it harmless; cancerous lumps are in fact often painless.
- A new change in the shape or size of the breast
- Dimpling, orange-peel texture or redness of the breast skin
- Inward pulling, crusting or bloody discharge at the nipple
- A firm area felt in the armpit
- Persistent pain fixed at a single point in the breast
None of these findings means cancer on its own. Most breast changes are benign. But which is which is decided by examination and imaging, not by waiting.
How the diagnosis is made
The diagnosis becomes clear in three steps: examination, imaging and pathology. None replaces the others; they are read together.
Both breasts and the armpits are examined by hand. When your symptoms began, how they relate to your menstrual cycle and your family history are all recorded.
Above the age of forty, mammography and ultrasound are usually used together. In young, dense breast tissue ultrasound comes first. Breast MRI is requested when needed.
A sample is taken from the suspicious lump with a needle. Pathology gives the definitive diagnosis; the type and grade of the tumour and its hormone receptor status also appear in that report.
A biopsy does not cause cancer to spread. This is one of the most common worries we hear at the practice; it is not a scientifically supported finding.
What the stage means
The stage is determined by the size of the tumour, whether it has spread to the lymph nodes in the armpit and whether there is spread to other organs. The stage sets the order of treatment: for some patients surgery comes first, for others drug treatment does.
The stage alone is not a verdict. The biological subtype of the tumour, its hormone receptors and HER2 status determine the response to treatment at least as much as the stage does.
Risk factors and screening
Being a woman and growing older are the two most decisive factors; neither can be changed. A family history of breast or ovarian cancer, early menstruation, late menopause, never having given birth and long-term hormone use all increase the risk.
On the other hand, a substantial proportion of women with breast cancer have no known risk factor at all. That is why screening is recommended regardless of risk group.
The general approach is annual mammography from the age of forty, with an earlier programme for those with a family history of breast cancer. We decide the right interval for you after listening to your history.