Dr. Holmes point of view on the JAMA Oncology editorial that discusses advantages and disadvantages of de-escalating breast cancer surgery.
When must people think of early signs and symptoms of breast cancer, breast lumps and nipple discharge often come to mind. However, there are several subtle signs and symptoms of breast cancer that should be considered: a thickened area of the breast, skin or nipple retraction, skin redness and swelling, or breast pain.
Thickened area of the breast. Not all breast cancers appear as an obvious lump. Some breast cancers like “lobular” breast cancer typically develop as an area of breast thickening because the cancer cells extend over a broad area, rather than in a compact area. This also makes lobular cancers harder to detect by mammography and physical examination. Fortunately, lobular cancers make up fewer than 10% of breast cancer, and generally have better prognosis than typical breast cancers.
Skin retraction (or inversion) or Skin retraction. Breast cancers that are located near the skin or nipple may cause scarring within the breast that pulls at the nipple or nearby skin. Skin and nipple retraction are more obvious when a woman raises her arms above her head or leans forward. Nipple retraction and skin retraction might be normal if it has been present for several years. Recent onset skin or nipple retraction is more suspicious of a possible cancer.
Skin redness and breast swelling. Skin redness and breast swelling is an uncommon sign of breast cancer, but might be an early sign of inflammatory breast cancer, a rare breast cancer that looks like a breast infection. Swelling of the breast caused the skin of the breast to take on a pitted or dimpled appearance, similar to the texture of an orange peel. Skin redness and breast swelling can develop suddenly over a few days. Although breast infection is a much more common cause of skin redness or breast swelling, it is important to seek evaluation for breast cancer if these signs and symptoms appear.
While it is important to recognize subtle signs and symptoms of breast cancer, the most valuable means of detecting breast cancer is with breast cancer screening when there are absolutely no signs or symptoms. Early detection is best accomplished with the use of regular mammograms for women of average risk or with the combination of regular mammograms and breast MRI in high risk women.