12 Signs of Breast Cancer: Insights from Specialist Dr Hanna Bjerke

Breast cancer remains one of the most common cancers worldwide, impacting millions of individuals each year. Early detection is essential for effective treatment and a better prognosis. To enhance awareness, we’ve collaborated with Dr Hanna Bjerke, a leading specialist in breast radiology at Unilabs Norway, to bring you this detailed guide to 12 critical signs of breast cancer. Staying informed is vital for early detection, so let’s explore the key symptoms to monitor. 

1. A New (hard) Lump in the Breast or Armpit 

A new lump or mass, whether deep within the breast or in the underarm area, is one of the most common and recognisable signs of breast cancer. These lumps often feel hard, like an orange seed or frozen pea, and are typically immovable. They can vary in shape and size. Regular self-examinations are vital for understanding what is normal for your body, enabling you to detect any changes quickly and seek medical advice. Dr Bjerke emphasizes that "a lump isn't always easy to feel. A mammogram can identify a lump long before it becomes noticeable by touch." Any new lump, regardless of its size, should be checked by a healthcare provider, as it could be cancerous. While most lumps are benign, such as fluid-filled cysts or fibroadenomas, it's important not to ignore a hard lump or any change that doesn’t align with your menstrual cycle. Early detection of breast cancer significantly improves the chances of successful treatment. 

2. Thickening or Swelling of Part of the Breast 

Breast cancer can lead to thickening or swelling in certain areas of the breast. This occurs when cancer cells obstruct blood or lymph vessels, or a tumour is developing close to the skin's surface. This differs from a hard lump, which forms when cancer cells cluster tightly together.  explains, "You might notice that a part of your breast feels different from the rest, perhaps less 'squishy' and more 'dense.' While this can be a normal aspect of menstruation or breastfeeding, a persistent or worsened thickening in the breast could be a sign of breast cancer."  

3. Skin Irritation or Dimpling 

Skin changes like irritation or dimpling can occur from tight clothing leaving temporary marks on the skin. However, if a dimple on the breast persists, it could be a sign of breast cancer. This occurs when a tumour deep within the breast pulls the skin inward, causing an indentation unrelated to underwire bras. Sometimes the lump causing the dimple can be felt, but not always. “To check, try raising your arms above your head to see if the breast skin moves uniformly.” Dr Bjerke suggests, "Using a light source directly overhead can help cast shadows that make indentations more visible." 

4. Nipple Crust 

Crusting on the nipple can often be due to a benign skin condition like eczema or a common issue during breastfeeding. However, if the problem persists despite using skin treatments, it could be a sign of a type of breast cancer known as Paget’s disease. Dr Bjerke notes, “In Paget’s disease, cancer cells spread within the breast and settle in the nipple, forming a persistent red or white crust that can be sore and doesn’t heal.” 

5. Sunken Nipple 

Breasts and nipples vary widely in shape and size. Retracted nipples may be a normal feature from initial breast development. However, if you observe your nipple sinking, flattening, or turning inward, it might indicate the presence of a new breast cancer tumour growing underneath, drawing the nipple inward as it expands. “This change is often subtle and gradual, so regular self-exams are vital,” Dr Bjerke advises. 

6. Redness or hot skin 

Red or hot skin on the breasts usually suggests an infection, often occurring during breast development, breastfeeding, or because of eczema. However, if these symptoms persist despite treatment, it might indicate Inflammatory Breast Cancer, a condition that obstructs lymph flow in the breast, leading to swelling and redness without a noticeable lump. This may cause the breast to feel warm or hot, or experience a burning sensation, and the skin may appear pink, reddish-purple, or bruised. Dr Bjerke notes that “redness or hot skin is not the same as breast tenderness, which comes and goes with the menstrual cycle.” She cautions, "Because inflammatory breast cancer can be hard to detect on a mammogram and progresses rapidly, it’s crucial to report any changes. If antibiotics don't resolve the symptoms, seeking the advice of a breast specialist is essential."  

7. Nipple Discharge 

Nipple discharge is often harmless and usually linked to normal conditions such as breast development, infections, cysts, pregnancy, or breastfeeding. However, if you notice fluid leaking from the breast outside of these situations, especially if it is clear or contains blood, it is important to have it evaluated by a healthcare provider. 

8. Change in Breast Size or Shape 

It's normal for one breast to be different in size and shape from the other. Such variations are typical of our bodies. Breastfeeding can also lead to changes in breast size or shape due to milk production. However, if one breast suddenly changes in size, flattens, swells, or droops without any clear link to your menstrual cycle, this might be a warning sign of breast cancer. The growth of a tumour can cause the affected breast to enlarge or alter in shape. Dr Bjerke advises that “any noticeable change in the size or shape of the breast, particularly if it happens suddenly, should be checked by a healthcare provider.” 

9. “Orange Peel” skin 

When the skin of the breast takes on a dimpled appearance resembling orange peel it is known as "peau d'orange" (French for "orange peel"). This symptom occurs as the breast swells, causing the hair follicles to become prominent, and giving the skin a dimpled look. The colour of the skin may or may not change. Peau d'orange is indicative of Inflammatory Breast Cancer, a type of cancer that obstructs lymphatic flow in the breast, leading to swelling and redness without the presence of a distinct hard lump. 

10. Skin Sores 

In some cases, breast cancer can progress to the point where it causes the skin to break down, leading to an open wound on the breast. These sores may become infected, resulting in a bad odour or leakage. Typically, this symptom is accompanied by a noticeable hard lump and indicates an advanced stage of the disease, suggesting that the cancer has been present for a considerable period. 

11. Bump 

Sometimes, a lump on the surface of the breast can be cancerous, but not all lumps are cancerous. Many are benign, such as cysts (fluid-filled sacs) or fibroadenomas (non-cancerous growths of breast tissue).  Dr Bjerke notes that “It's common for women to have lumpy or bumpy breasts. However, if you notice something concerning, it’s crucial to consult a healthcare provider.” 

It’s also important to distinguish this from an injury to the breast. Direct trauma cannot cause cancer but might result in a lump known as “fat necrosis,” which is scar tissue that forms as the body heals damaged fatty breast tissue. 

If initial tests like a mammogram or ultrasound do not provide clear answers, a biopsy, which involves examining cells from the lump under a microscope, can help determine whether the lump is cancerous. 

12. Visible Veins on the Breast 

Enlarged veins are a less common symptom of breast cancer, typically grouped under "other unusual changes" or "skin changes." New blood vessels or veins are usually not indicative of cancer and are more often associated with factors like weight gain, breastfeeding, or Mondor's disease. However, if veins become more prominent on the breast or near the collarbone, especially if accompanied by a swollen arm, it could indicate a breast cancer tumour. Dr Bjerke explains “The tumour may be drawing more blood to itself, causing the veins to swell to accommodate the increased blood flow.”