Breast Cancer: The First Sign Isn't Always a Lump

Around 1 in 6 women eventually diagnosed with breast cancer initially go to their doctors with a symptom other than a lump, according to a new study conducted in England.

Women who have a symptom of breast cancer other than lumps are also more likely to wait to see a doctor, compared with women who do have lumps, the researchers found. That might put them at risk of worse outcomes if the cancer isn't caught quickly.

"It's crucial that women are aware that a lump is not the only symptom of breast cancer," study leader Monica Koo, a doctoral candidate at University College London, said in a statement. "If they are worried about any breast symptoms, the best thing to do is to get it checked by a doctor as soon as possible."

Breast cancer symptoms

Koo and her colleagues used data from the English National Audit of Cancer Diagnosis in Primary Care involving about 2,300 women who were diagnosed with breast cancer between 2009 and 2010. 
They classified each patient by the symptoms that brought her to the doctor, which could include more than one. In total, 83 percent of these women had a breast lump, the most well-known symptom of breast cancer. Seven percent had nipple abnormalities, 6 percent had breast pain, 2 percent had breast skin abnormalities and 1 percent had breast ulceration. Less than 1 percent each had abnormalities of the contour of the breast or breast infections. 

A small number of women also reported symptoms that weren't related to the breast itself. One percent had a lump in the armpit, 1 percent experienced back pain and less than 1 percent experienced muscle pain or breathlessness.

The researchers then grouped the patients together by symptom clusters. The vast majority of the women fell into one of four groups: The researchers found that 76 percent of all the women had a breast lump as their only symptom, and 11 percent had a breast symptom that was not a lump as their only symptom, and 5 percent had only a non-breast symptom.

Six percent had a breast lump as well as at least one additional breast symptom.

Getting care

The researchers then looked at how long it took the women to get to the doctor after their symptoms started. They focused on those who waited more than 90 days, because a three-month delay in seeking a diagnosis is linked to lower five-year survival rates. They found that although only 7 percent of women with a breast lump waited that long, 15 percent of women with symptoms other than a lump, and 20 percent of women with both a lump and other types of symptoms, waited 90 days. 

"This research shows that, all too often, women are delaying going to their doctor with symptoms of breast cancer," Karen Kennedy, director of the National Cancer Research Institute (NCRI) in the U.K., said in a statement. "This could be because people are simply unaware that breast cancer can present in many different ways, not just through the presence of a lump. With a disease like breast cancer, it's essential to be diagnosed as early as possible so that a treatment plan can be developed and started. Awareness campaigns need to raise awareness of all of the potential symptoms of breast cancer so that people know how to spot the signs and when to go to a doctor."

Koo presented her work this week at the NCRI Cancer conference in Liverpool, England.

Original article on Live Science.

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Breast cancer symptoms: Women warned to spot PAIN as well as unusual lumps

The patients who have more unusual symptoms are more likely to delay seeking help, researchers have said.

Symptoms other than a lump include nipple abnormalities, breast pain, skin abnormalities, ulceration, shape abnormalities and an infected or inflamed breast.
 
The new study, which is to be presented at the National Cancer Research Institute (NCRI) Cancer conference in Liverpool, examined data concerning 2,316 women diagnosed with breast cancer in England during 2009/10.

Researchers from University College London (UCL) found that four-fifths of women who sought help had a lump.

But 17 per cent of women went to see their GP with a symptom that was not a lump.

Although most women sought help quickly, those with symptoms other than lumps were more likely to delay seeing a doctor compared with women with a breast lump alone, they found.

Women with breast ulceration, nipple abnormalities, breast infection or inflammation, swollen arm or armpit and pain in the armpit were more likely to wait longer than three months to seek help.

The research found that 15 per cent women with  symptoms waited more than 90 days to see a doctor compared with seven per cent of women who only had a lump.

Monica Koo, from UCL, author of the study, said: ”Our research shows around one in six women diagnosed with breast cancer have symptoms other than a breast lump.

"These women are more likely to delay going to the doctor compared to women with breast lump alone. It's crucial that women are aware that a lump is not the only symptom of breast cancer.

"If they are worried about any breast symptoms, the best thing to do is to get it checked by a doctor as soon as possible.

"Diagnosing cancer earlier really is key in order to increase the chances of survival. Symptom awareness campaigns such as the Be Clear On Cancer campaign should continue to emphasise breast symptoms other than breast lumps."

Dr Karen Kennedy, director of the NCRI, said: "This research shows that, all too often, women are delaying going to their doctor with symptoms of breast cancer.

"This could be because people are simply unaware that breast cancer can present in many different ways, not just through the presence of a lump. With a disease like breast cancer, it's essential to be diagnosed as early as possible so that a treatment plan can be developed and started.

"Awareness campaigns need to raise awareness of all of the potential symptoms of breast cancer so that people know how to spot the signs and when to go to a doctor."

Dr Jem Rashbass, cancer lead for Public Health England, said: "It is hugely important to catch breast cancer early.

"Lumps are not the only sign and our Be Clear On Cancer campaign emphasises that women should tell their GP if they notice any changes to their breasts, such as nipple discharge or changes to the skin of the breast.
"As well as the campaign, breast screening is offered to women aged 50 to 70 and can help detect cancer earlier and improve survival."

Almost 54,000 new cases of breast cancer were diagnosed in the UK during 2013, according to Cancer Research UK figures.

In 2014, 11,400 people died from the disease.

Baroness Delyth Morgan, chief executive of the charity Breast Cancer Now, said: "It is of great concern that women with non-lump symptoms are waiting up to twice as long before visiting their GP.

"This suggests women aren't as aware that these could be a sign of something serious and we therefore need to do much more to raise awareness of the other key signs of the disease.

"With many patients not getting non-lump changes to their breasts checked out as quickly, thousands of women each year could be delaying the start of their treatment, something that could impact on their chances of survival.

"Ultimately, the key to remaining aware is to get to know how your breasts look and feel normally and to report any unusual changes as soon as possible."

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