© Springer International Publishing Switzerland 2015
Peter Hogg, Judith Kelly and Claire Mercer (eds.)Digital Mammography10.1007/978-3-319-04831-4_55. Signs and Symptoms of Breast Cancer with Management Pathways
(1)
The Breast Centre, University Hospital Llandough, Penlan Road, Cardiff, CF64 2XX, UK
(2)
Breast Unit, Ground Floor West Wing University Hospital, Clifford Bridge Road, Coventry, CV2 2DX, UK
Introduction
The majority of breast cancers are found by clients noticing unusual changes in their breast or axilla and visiting their general practitioner [1].
Clinical Signs and Symptoms
Clients may present with the following symptoms which require investigation to rule out or confirm breast cancer [2].
Discrete hard lump with fixation – there may be skin tethering, dimpling, altered colour or contour of the breast.
A lump that has enlarged.
A new, discrete breast lump.
A new lump in pre-existing nodularity.
A persistent focal area of lumpiness or a focal change in breast texture.
Progressive change in breast size with signs of oedema.
Asymmetrical nodularity persisting after menstruation.
Skin distortion.
Previous history of breast cancer with a new lump or suspicious symptoms.
Nipple discharge or inversion of the nipple.
Nipple eczema or change that does not respond to topical treatments.
Axillary lump or lymphadenopathy
Ulceration of the breast skin may indicate locally advanced breast cancer
All the above are symptoms requiring specialist referral and most of them are clinical indications for mammography and/or ultrasound. Further criteria for mammograms are clients with a strong family history of breast or ovarian cancer, any new signs or symptoms in patients with a previous history of breast cancer and unilateral breast pain.
However, mammography is not recommended in women under 35 years with the exception of clinically suspicious or malignant findings. Younger women have denser, more glandular breast tissue and consequently mammography is less sensitive in detecting breast cancer [3]. Ultrasound is the imaging method of choice for the majority of women aged <35 years and during pregnancy and lactation.
Location of Cancers in the Breast
Research [4, 5] has shown that the majority of cancers are found in the upper outer quadrants of the breast, this is an area of the breast that has the most glandular breast tissue. The lower outer quadrant of the breast is another glandular area that is predisposed to breast cancer. Studies have found this to be the case in women of all ages and ethnic groups.
Breast tumours are less commonly found in the medial (inner) quadrants of the breast.
However, infiltrating ductal and lobular carcinomas (often seen on mammograms as a dense spiculated mass), calcification, distortions and well defined lesions may all be found anywhere within the breast parenchyma [6]. Patients should not be falsely reassured by the location of abnormalities in the breast and seek a referral to a specialist breast centre for assessment for any of the aforementioned signs and symptoms [16].
Referrals
Referrals to a breast unit often come from general practitioners. Some breast abnormalities may be identified when patients are in hospital under investigation for other medical conditions. Clients may also be referred from A & E departments with breast infections, often these are post natal breast infections or abscess [7]. Occasionally presentations are made following an incidental breast finding during another imaging investigation for example CT and MRI scans.
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