Learn about symptoms of breast cancer, as well as risk factors for developing breast cancer.

Symptoms of Breast Cancer

Patients with Clinical Symptoms

Some patients with breast cancer present with clinical symptoms. They are diagnosed when the patient or a healthcare provider notices a mass in the breast, a mass in the axilla (underarm), or changes to the breast skin or nipple. Some masses in the breast are detected by patient self-examination of the breast.

Does a mass in the breast or underarm mean breast cancer?

No, not all masses or lumps in the breast or axilla (underarm) are due to breast cancer. Benign lesions, such as fibroadenomas or cysts, can also cause lumps in the breast tissue. A lump in the axilla may represent a primary breast cancer, a benign neoplasm, an enlarged reactive lymph node, or a metastasis to a lymph node.

Other clinical symptoms that might be seen with breast cancer include skin changes, such as skin dimpling, redness, scaling, and ulceration, which may look like a large sore. Nipple changes such as scaling or new nipple inversion may also be seen.

Patients with No Clinical Symptoms

Other patients have no clinical symptoms of breast cancer. These patients are diagnosed on screening imaging such as mammography, magnetic resonance imaging (MRI), or ultrasound. The radiographic findings on imaging that may be seen with a cancer include atypical appearing microcalcifications, the presence of a spiculated mass, asymmetry in the breast tissue density, and non-mass like enhancement on MRI. However, it is important to note that there is not one radiographic finding that is absolutely diagnostic of a cancer; a tissue biopsy and examination by a pathologist is necessary to make the diagnosis.

Male Patient
Male Breast Cancer Patient

Breast Cancer in Men, Adolescents, and Children

Breast cancer can also occur in men, adolescents, and children, and the possible symptoms are the same as in females. Breast carcinoma in males accounts for less that 1% of all breast cancer cases, and the cancers may be either invasive or in situ. The breast cancers in men can look identical to those seen in women, and most cases consist of invasive ductal carcinoma with positive estrogen receptor (ER) expression. However, the most common breast lesion in males is not breast cancer but is rather gynecomastia, or breast enlargement, which may either involve one breast (unilateral) or both breasts (bilateral).

Breast lesions in children and adolescents are also uncommon and include benign lesions, such as juvenile fibroadenoma, as well as malignant lesions, such as secretory carcinoma. In these pediatric patients, metastatic tumors to the breast, such as lymphoma or alveolar rhabdomyosarcoma, are more common than primary breast cancers.

How is Breast Cancer Diagnosed?

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Risk Factors

There are a variety of genetic and environmental factors that can increase a person's risk for breast cancer. These factors include older age, female gender, personal or family history of breast cancer, known genetic mutations, reproductive and hormonal factors, and other environmental factors such as exposure to radiation.

Hormonal Risk Factors

Hormonal factors play a large role in a patient's risk of developing breast cancer. Most breast cancers are driven to proliferate from exposure to the hormone estrogen, so a woman's history of "estrogen exposure" over her lifetime can influence her risk of breast cancer. A woman's body usually starts producing estrogens at the start of menstruation (menarche) until menopause, with breaks in estrogen production during pregnancy. This is why physicians will ask detailed history questions such as age of first menstruation (menarche), number of pregnancies, and age of menopause.

Family History and Genetics

In addition to hormonal factors, family history and genetics an important factor in assessing the risk of developing of breast cancer. However, it's important to note that over 80% of patients who develop breast cancer do not have a first degree relative with breast cancer. There are specific genetic mutations that can predispose individuals to developing breast cancer and other cancers, and mutations in these genes can account for approximately 5% of all breast cancers. These genes include BRCA1, BRCA2, TP53 and PTEN. Genetic testing and counseling is available for patients and families who fit the criteria for possibly carrying a mutation in one of these genes.