Warning signs of breast cancer

Content provided by the Faculty of the Harvard Medical School

Warning signs of breast cancer

Often breast cancer has no symptoms, but there are certain clues that can serve as a warning for breast cancer. When examining your breasts every month, pay attention to their appearance and consult your doctor about any changes you see, such as the following:

Nipple discharge. It's not unusual for nipples to leak fluid; after all, they're built to discharge milk. If the nipples are stimulated — during sex, by persistent squeezing, or during a mammogram — the breasts may react and produce whatever fluid they contain. Birth control pills, blood pressure drugs such as Aldomet, tranquilizers such as Thorazine, or marijuana can cause normal, nipple discharge, usually in both breasts and from multiple ducts. This finding is usually not associated with cancer.

Another type of nipple discharge is galactorrhea, a spontaneous, persistent production of milk from both breasts when the woman isn't breast-feeding. In certain circumstances, your physician may want to evaluate various hormone or endocrine levels in the blood, imbalances of which can occasionally be associated with breast discharge. Rarely these imbalances may be associated with tiny growths in the pituitary gland, a small gland in the central portion of the brain.

The kind of discharge that may indicate breast disease usually occurs only from one duct of one nipple and is spontaneous (not caused by nipple stimulation). The cause most often is one or several papillomas (nonmalignant, pimple-like growths in the lining of a breast duct) or duct ectasia (an inflammation of the lining of the milk gland). Less commonly, the discharge is the sign of a cancer, either ductal carcinoma in situ (DCIS) or an invasive cancer. Surgery usually is required to make a diagnosis. The surgeon identifies the involved duct and removes it through an incision in the skin. In the laboratory, a pathologist examines the tissue for cancer cells.

Inverted nipples. Inverted nipples are not uncommon, and some women live with one or both nipples inverted for most of their lives. However, if the nipple inversion is a recent occurrence, it may be a sign of cancer. Arrange to be seen promptly by your doctor. Your doctor will examine you and likely refer you for a mammogram.

Paget's disease of the breast. This form of cancer may first appear as an itchy sore on the nipple and can progress to crustiness and oozing that fails to improve. It is a rare cancer, accounting for less than 3% of all new diagnoses of female breast cancer. Although it resembles eczema, eczema almost always affects only the areola, the dark area around the nipple.

Paget's disease looks different: It affects the nipple and not the areola. Your doctor will examine both breasts, order a mammogram and arrange for a biopsy of the nipple skin. If it's cancer, the cancer cells can be seen under a microscope, growing into the skin.

In most patients with Paget's, there's an underlying breast cancer below the level of the skin.

If the cancer does appear to only involve the nipple, Paget's disease has a better prognosis than other breast cancers. Historically, many breast surgeons preferred to remove the entire breast to treat this cancer, even when only the nipple area was affected. Today, however, just the nipple and the areola are removed, along with the underlying cancer. The unaffected portion of the breast is spared.

Note: Paget's disease of the breast should not be confused with Paget's disease of the bone. Both are named for their discoverer, English surgeon James Paget, but they are very different diseases.

Last updated:	April 23, 2007