If you do your breast exams regularly and get your mammograms every year or two, you probably think you're being proactive about breast cancer. The problem is, looking for lumps isn't as easy as it sounds. Studies show that breast lumps often aren't detectable by feel (they're not "palpable," in doctor-speak) until they're at least 10 to 15 millimeters -- the size of a dime -- and then only 48 percent of the time. It's really not until a lump is 20 mm or more that you're likely to feel it. Meanwhile, mammograms also miss approximately one in ten tumors, and they're less reliable in younger women and women with dense breast tissue.
So what works to catch breast cancer early? Science is hard at work on the problem: In spring 2012, researchers in Canada announced the invention of a sophisticated new computer software system capable of analyzing mammograms for "architectural distortion" -- subtle but specific patterns in breast tissue that can appear more than a year before the development of a lump. But that technology is years away from general use. In the meantime, top breast cancer experts say women should become as familiar with their own bodies as possible and be alert for any changes. Here are some of the earliest and most surprising signs and symptoms of breast cancer, as described by the women who know: breast cancer survivors themselves.
Breast cancer warning sign #1: Pain in the breast or chest
Whether it's an ache, throb, twinge, or sharp stab, pain or discomfort in the breast or chest area isn't a good sign.
How it feels: One breast cancer survivor describes the pain she brought to her doctor's attention as a "sharp pain that comes and goes." Another describes it as "a mild electric sensation that went from my left breast to my right nipple."
What causes it: Breast tumors can take many different forms; there can be a single lump, but there can also be an area of scattered seed-like tumors or an amorphous shape with multiple tentacles extending into the tissue. The tumor might also be directly behind the nipple or in one of the milk ducts. All of these growths cause different types of pain and discomfort.
Scary stat: As many as 30 percent of all breast cancer tumors aren't lumps, which makes them harder to detect.
What to do: Keep track of when, where, and how often the pain occurs. Tell your doctor, being as specific as possible. Make sure to be clear that this is a new symptom, different from any other sensation (such as the sore breasts of PMS) you've experienced before. If your doctor diagnoses mastitis and prescribes antibiotics (a typical response to breast pain), take the full cycle. But if the pain hasn't gone away, inform your doctor and ask for additional tests. Many women are told repeatedly that they have mastitis before they're able to make clear to the doctor that this isn't the case.
Breast cancer warning sign #2: Itchy breasts
This symptom, primarily associated with inflammatory breast cancer, is often missed. Some women may be sent home with topical medications for a rash by their doctor, when in fact they have inflammatory breast cancer.
How it feels: Extremely itchy -- the type of itch you might have with poison oak or ivy, which makes you feel like you absolutely have to scratch. Except scratching doesn't help, and neither do the creams nor ointments that typically relieve itchiness. Your breast may also feel irritated, or the skin may be scaly or dimpled like cellulite.
What causes it: Fast-growing cancer cells block blood and lymph vessels that feed the skin. The normal flow of lymph through breast tissues is impeded, and fluid builds up in and under the skin.
Scary stat: The median age of diagnosis for inflammatory breast cancer is 57 (54 among African-American women), and it's typically more aggressive than other types of breast cancer, with a five-year survival rate of 34 percent.
What to do: If the skin of your breast looks odd or your breasts feel different, see your doctor right away. If the doctor suggests a skin ailment or an infection and sends you home with a prescription, return immediately if your symptoms don't go away.
Breast cancer warning sign #3: Upper back, shoulder, and neck pain
In some women, breast cancer is felt in the back or shoulders rather than in the chest or breasts. For this reason, spine specialists routinely look for the presence of tumors when treating chronic back pain that's unrelieved by physical therapy.
How it feels: The pain, which is typically in the upper back or between the shoulder blades, is easily confused with sore muscles, a pulled tendon or ligament, or osteoarthritis of the spine. The difference is that it doesn't go away with stretching muscles or changing position. Bone pain feels like a deep ache or throbbing.
What causes it: Most breast tumors develop in the glandular tissue of the breast, which extends deep into the chest, close to the chest wall. If tumor growth pushes backward toward the ribs and spine, the resulting pain may be felt in the back rather than in the breast. A common place breast cancer metastasizes, or spreads, is to the spine or ribs, becoming secondary bone cancer.
Scary stat: According to one study, the five-year survival rate for breast cancer patients whose cancer has spread to the bone is only 8.3 percent, compared with an overall survival rate of 75 percent.
What to do: Pay close attention to how back pain feels. If it doesn't go away with rest, stretching, or physical therapy, see your doctor. Keep the doctor informed if back pain continues despite treatment, and request a bone scan.
Breast cancer warning sign #4: Changes in breast shape, size, or appearance
Contrary to popular belief, not all breast tumors cause a hard lump close enough to the surface to be noticeable. "Instead of feeling a lump, I noticed that one of my breasts was more oval than the other, hanging down lower and sort of sticking out to one side," says a California woman who discovered she had breast cancer at the age of 42.
How it feels: Because this change is one of appearance more than feel, your partner may notice it before you do. Or you might become aware of it as you put on your bra or look at yourself in the mirror at the gym.
What causes it: Tissue growth that's deeper in the breast or masked by dense breast tissue may push out the shape or size of the breast without causing a noticeable lump. If you've been told you have dense breast tissue, be particularly alert for this sign.
Scary stat: Mammograms miss up to 50 percent of tumors in women with dense breasts.
What to do: Study the size and shape of your breasts in a mirror. Sit facing the mirror and look at both breasts dead-on, then raise your arms, turn sideways, and look from each side. If there's a difference in size or shape you haven't noticed before, bring it to your doctor's attention.
Breast cancer warning sign #5: A change in nipple appearance or sensitivity
One of the most common locations for a breast tumor is just beneath the nipple, which can cause changes in the appearance and feel of the nipple itself. In particular, nipple changes are often the giveaway for men with breast cancer.
How it feels: You may notice that one of your nipples sticks up less than it used to, or it might have become inverted, flattened, or indented. Women with breast cancer often recall that they noticed a decrease in nipple sensitivity, which is most likely to come to your attention -- or your partner's attention -- during sex. Another nipple change to take seriously is discharge when you're not breastfeeding, whether it's bloody, milky, or watery. The skin of the nipple may become crusty, scaly, or inflamed.
What causes it: Many breast cancers start in the milk ducts just under and around the nipple, affecting the nipple's appearance or causing pain or discharge. There's also a rare cancer, Paget's disease of the breast, that specifically strikes the nipple. A tumor in the milk ducts, just behind or to one side of the nipple, pushes the skin up around the nipple or pushes the nipple aside. As tumors grow, they may attach to -- and thus retract -- the skin or the nipple itself. The tumor might also cause irritation and infection, leading to discharge.
Scary stat: The American Society of Breast Surgeons recently released research that male breast cancer is typically identified later and is deadlier than breast cancer in women.
What to do: Because some women have naturally inverted nipples or have discharge during and post-pregnancy, a doctor won't necessarily notice this symptom. Since you're the one who knows best what your nipples look like, pay close attention to any changes and discuss them with your doctor. Mastitis is a common conclusion for doctors presented with nipple changes, in which case you'll be sent home with antibiotics. If they haven't cleared up the symptoms within ten days, go back and request further evaluation.
Breast cancer warning sign #6: Swelling or lump in your armpit
You know how the lymph nodes in your neck and throat can feel sore when you have the flu? Any pain in the armpit is a sign to check the area carefully with your fingers. A lump under the armpit is likely to be hard and attached to surrounding tissues, so it doesn't move when you touch it. Or tissue may feel thickened and dense compared with the armpit on the other side.
How it feels: Like a sore or tender spot under the arm. You may also feel a lump, though not necessarily. Affected lymph nodes may feel swollen or tender or develop a lump before a tumor is big enough to be felt in the breast itself. In some women, the swelling is more prominent under the arm or up under the collarbone.
What causes it: The lymph nodes in your armpit are where breast cancer spreads first, by way of lymphatic fluid that drains from the breast. Since the lymph nodes are the first place it's likely to metastasize, breast cancer is staged according to whether it's lymph-node positive or negative.
Scary stat: If breast cancer has spread to the lymph nodes, the five-year survival rate declines to 84 percent, as compared with 98 percent for node-negative breast cancer.
What to do: Colds, flu, and infection can also cause swollen lymph nodes, so if you're sick or have an infection, wait for it to clear up before you worry. But if a lump or tender spot in the underarm area persists for a week with no apparent cause, see your doctor.
Breast cancer warning sign #7: Red, swollen breasts
When your breasts hurt, it's easy to conclude that it's the typical soreness of PMS. And if your breasts feel hot or look reddened, you might suspect an infection such as mastitis. But these are also signs of inflammatory breast cancer.
How it feels: It's as if your breasts have a fever. They may feel swollen and sore, or the skin and underlying tissue may feel hot or look red or even purple.
What causes it: Inflammatory breast cancer is the most likely cause of this symptom. But breast tumors can also push on tissues, causing breasts to feel swollen and sore. In this case, you may also see, upon checking, that your breast is distended.
Scary stat: Once breast cancer has spread beyond the breast (stage IV), the average survival is less than four years. So it's extremely important to detect breast cancer as early as possible.
What to do: Call your doctor right away about any symptom that could be inflammatory breast cancer. If the pain is diagnosed as mastitis and you're prescribed antibiotics, you should feel better within a week to ten days. If you don't, call your doctor and request further evaluation.
Medically reviewed by Dr. Farrokh Sohrabi