Breast cancer isn't always a lump - 8 early warning signs a doctor says to watch for

While we know that we need to feel for any new lumps or obvious signs of breast cancer, a leading cancer expert is urging women to look closely for anything unusual.

Several visible changes to our breasts and nipples could be an indication of breast cancer. New research by the charity Breast Cancer Now has shown that almost one in three (29%) women in England who regularly check their breasts don’t feel confident noticing a change, and just over one in 10 (11%) check less than once a month because they don’t know what to look for.

While breast cancer survival rates have improved considerably, thanks to treatment advances and awareness campaigns, early diagnosis is still crucial. That's why experts want women to be aware of the lesser-known changes.

Dr Jiri Kubes, radiation oncologist and medical director at the Proton Therapy Center, says: “The biggest misconception is that breast cancer has to announce itself as a lump. It doesn’t. Sometimes the first sign is something you can see rather than something you can feel.”

Several factors can contribute to breast changes, including hormones, ageing and weight loss or gain. If in doubt, make an appointment with your GP.

Key changes to look for

• A new lump or swelling in the breast, chest or armpit.
• A change in the size, shape or feel of one or both breasts.
• Dimpling or puckering of the breast skin.
• A change in the colour or appearance of the breast skin.
• An inverted nipple or a change in the position or appearance of the nipple.
• Unusual nipple discharge, particularly if you are not pregnant or breastfeeding.
• A persistent rash or change around the nipple.
• A breast becoming noticeably harder or different from usual.

Dr Kubes says: “If one area suddenly looks puckered, pulled in or dimpled when it didn’t before, don’t simply put it down to getting older or a change in your weight.

“Knowing what is normal for you makes it much easier to spot something that has changed.”

One of the signs in the list above is a persistent nipple rash, which Dr Kubes says can be mistaken for eczema but could be a rare form of cancer called Paget’s disease of the breast. It can cause a red, scaly rash around the nipple and areola. It may also cause itching, pain, burning, discharge or bleeding. Breast Cancer Now says: “Paget’s disease also usually occurs in one breast, while most other skin conditions tend to affect both breasts.”

Dr Kubes says this symptom “shouldn’t simply be ignored” and to always “get it checked rather than assuming you already know what is causing it”.

How to check your breasts

The NHS has a complete guide on how to check your breasts. It suggests:

• Look at your breasts or chest in a mirror to spot any changes. Start with your arms by your sides and then raise them.
• Feel around each breast or side of your chest in a circular motion, all the way up to your collarbone and under each armpit. Use a mix of light and firmer pressure. Do not press so hard that it hurts.
• Feel around and over each nipple.

The guide also notes that you might find it easier to feel your breasts in the shower or when you're lying down. If you need help remembering to check your breasts regularly, why not set a reminder in your phone?

It’s important to remember that breast lumps are very common and can be caused by other conditions and our hormones. They are not always a sign of cancer. However, it’s always best to get checked by a GP, who may refer you to a specialist.