This post was written by Megan Goetz, NP-C, and Sarah Brady, NP-C, General Surgery, Oral and Maxillofacial Surgery, Breast Surgery, and Surgical Oncology. 

When you think about breast cancer, a lump may be the first sign that comes to mind. While a new lump is an important reason to contact your healthcare provider, it is not the only possible sign. Changes in the skin, nipple or appearance of the breast also deserve attention. During Breast Cancer Awareness Month, understanding a few common myths can help you know what to watch for and when to ask for guidance.

Myth: A lump is the only sign of breast cancer.

Fact: Breast cancer can cause changes even when there is no lump you can feel. In one study of more than 2,300 women who had symptoms when their breast cancer was diagnosed, about one in six did not report a breast lump.[1]

Other changes to discuss with your provider include:

• A new change in the size or shape of a breast.
• Dimpling, puckering or thickening of the skin, including a texture that resembles an orange peel.
• New swelling, redness or warmth in a breast.
• A nipple that begins to turn inward or deviate toward a different direction.
• New nipple discharge, especially bloody discharge or fluid that appears without squeezing the nipple.
• A persistent scaly, crusted or irritated area on the nipple.
• A new lump or swelling under the arm.

A rare form called inflammatory breast cancer can cause swelling and skin changes that develop quickly, sometimes without a distinct lump. Contact your provider promptly if these changes occur.[3]
 

Myth: If a breast change does not hurt, it is nothing to worry about.

Fact: Pain is not a reliable way to tell whether a breast change is cancer. A cancerous lump may be painless, and a change that does not hurt still needs evaluation. [1,2]

At the same time, breast pain alone is rarely caused by cancer. Tell your provider about new pain that persists, particularly when it stays in one area, or pain that comes with another breast change.[4]

Myth: A recent normal mammogram means I can ignore a new change.

Fact: A normal mammogram is reassuring, but a new symptom still needs attention. Depending on the change, your provider may recommend a breast exam, additional mammogram images, an ultrasound or other testing. [2]

Routine screening looks for cancer before symptoms appear. Evaluating a new breast change is a separate process, so contact your provider rather than waiting for your next screening appointment. If you see a change or feel a change, please report it!
 

Myth: Any breast change means I have cancer.

Fact: Many breast changes have causes other than cancer. For example, fluid-filled cysts can cause lumps, and infections or skin conditions can cause redness or irritation. Symptoms alone cannot tell you the cause; an evaluation helps determine what is happening and whether treatment is needed. [2,3,5]

Know your normal and speak up about changes

Being familiar with how your breasts normally look and feel can help you notice something new. You do not need to decide whether a change is serious before contacting your health care provider.

If you notice a new lump, nipple change, skin change or other unusual symptom, ask for an appointment. Continue recommended breast screening, and work with your provider to choose a screening plan based on your age, health and personal risk.

If you are newly diagnosed with breast cancer, a referral will be made to the Breast Surgical Oncology team at Parkview Packnett Family Cancer Institute to help you understand your diagnosis and discuss the next steps in your care.

References 

1. Koo MM, et al. Typical and atypical presenting symptoms of breast cancer and their associations with diagnostic intervals: Evidence from a national audit of cancer diagnosis. Cancer Epidemiology. 2017;48:140–146. https://pmc.ncbi.nlm.nih.gov/articles/PMC5482318/

2. Expert Panel on Breast Imaging. ACR Appropriateness Criteria® Palpable Breast Masses: 2022 Update. Journal of the American College of Radiology. 2023. https://pubmed.ncbi.nlm.nih.gov/37236740/

3. Ueno NT, et al. International Consensus on the Clinical Management of Inflammatory Breast Cancer from the Morgan Welch Inflammatory Breast Cancer Research Program 10th Anniversary Conference. Journal of Cancer. 2018;9:1437–1447. https://www.jcancer.org/v09p1437.htm

4. Expert Panel on Breast Imaging. ACR Appropriateness Criteria® Breast Pain. Journal of the American College of Radiology. 2018. https://pubmed.ncbi.nlm.nih.gov/30392596/

5. Mammary Paget’s Disease: An Update. Cancers. 2022;14:2422. https://pmc.ncbi.nlm.nih.gov/articles/PMC9139704/

6. Oeffinger KC, et al. Breast Cancer Screening for Women at Average Risk: 2015 Guideline Update From the American Cancer Society. JAMA. 2015;314:1599–1614. https://pubmed.ncbi.nlm.nih.gov/26501536/