You've been told all your life to be on the alert for breast lumps, the primary sign of breast cancer. But a lump isn't always the first sign of malignancy, or it may not be the first change a woman notices, says Andrew Putnam, director of the Palliative Care Program at Lombardi Comprehensive Cancer Center and Georgetown University. "Sometimes a lump is deep in the breast tissue, or the tissue surrounding it is very dense, making it hard to feel," says Putnam. And inflammatory breast cancer causes another set of symptoms entirely. "So it's important to be on the alert for other red flags as well."
Any one of these five lesser-known symptoms of breast cancer is important enough to send you straight to the doctor for a checkup, followed by a mammogram or MRI if recommended.
1. Itchy, sore, or reddened breasts
Skin that feels rashy or hot to the touch is one of the telltale signs of inflammatory breast cancer, a rare form of the disease that's less well known than the more common breast tumors. Inflammatory breast cancer may cause breasts to become swollen and irritated or sore. The skin may be unusually red or scaly, or you may notice purplish areas that look like bruising. Dimpled or "orange peel" skin is characteristic in some cases of inflammatory breast cancer. "It looked like I suddenly had cellulite on my breasts," is how one woman described this sudden change in skin texture, which may be bumpy or indented.
At first, the achy feeling may mimic the soreness typical of PMS, or the redness and itchiness might suggest an allergic skin reaction. But you'll know that's not it if it doesn't go away after a few days.
Why it happens: In inflammatory breast cancer, which makes up just 3 percent of all breast cancer cases, fast-growing cancer cells block blood vessels that feed the skin. Because red, itchy, hot skin is typical of inflammatory breast cancer, it's often mistaken for mastitis or infection of the milk ducts around the nipple.
2. Upper back pain
Although it's not well known, spine specialists routinely look for the presence of tumors, because some women experience back pain before any other sign of breast cancer. The pain, which is typically in the upper back between the shoulder blades, is easily confused with sore muscles, a pulled tendon or ligament, or osteoarthritis of the spine.
Why it happens: 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. Breast cancer also tends to metastasize or spread to the spine or ribs, becoming secondary bone cancer.
3. Nipple changes
One of the most common locations for a breast tumor is just underneath the nipple, which can cause changes in the appearance and feel of the nipple itself. And nipple changes are often the giveaway for men with breast cancer. You may notice that one of your nipples sticks up less than it used to. It may even appear uncharacteristically inverted or flattened. Many women also notice a decrease in sensitivity to touch, 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.
Why it happens: A tumor in the milk ducts, just behind the nipple or to one side, 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 may cause irritation and infection, leading to discharge.
