Breast cancer: symptoms, tests, treatment and follow-up

The NHS lists the following possible symptoms:

• A lump or swelling in the breast, chest or armpit.

• A change in the skin of the breast, such as dimpling that may look or feel like orange peel.

• A change in colour: on black or brown skin it may look darker than usual, on white skin it may look red.

• A change in the size or shape of one or both breasts.

• Nipple discharge, if not pregnant or breastfeeding, which may have blood in it.

• A change in the shape of the nipple, such as turning inwards, or a rash on it that may look like eczema.

The NHS says to see a GP if you have a lump or swelling in the breast, chest or armpit, any change in the breasts or nipples that is not normal for you, or pain in the breast or armpit when other family members have had breast or ovarian cancer. It adds that you can have these symptoms without pain, that breast pain by itself is not usually a symptom of breast cancer and that many symptoms, including lumps, are common and have other causes. It encourages checking your breasts regularly so you know what is normal for you.

NICE guidance for GPs says to use a suspected cancer pathway referral for people aged 30 and over with an unexplained breast lump, and for those aged 50 and over with discharge, retraction or other concerning changes in one nipple only. It says to consider that referral for skin changes that suggest breast cancer or an unexplained lump in the armpit in people aged 30 and over, and to consider non-urgent referral for people under 30 with an unexplained lump.

No. Cancer Research UK says most breast lumps are not cancer, and that lumps that are not cancer are called benign lumps. The NHS says tests usually show that a lump is not cancer, and that lumps can be caused by a harmless non-cancerous tissue growth (fibroadenoma) or a build-up of fluid (breast cyst). Do not try to self-diagnose the cause of a lump; always see a GP.

The NHS says treatment depends on the size and type of cancer, where it is, whether it has spread and your general health, and that the specialist team will explain benefits and side effects and create a treatment plan with you.

The NHS describes breast cancer as cancer found in the breasts and the most common cancer in women in the UK. Cancers differ in size, type and spread, and these differences are the basis for treatment decisions. This page covers breast cancer in women and people with breasts; the NHS has separate information for men, and secondary (spread) disease is described below.

The NHS says the GP will ask about symptoms and family history, examine your breasts if needed and, if they think the symptoms could be cancer, refer you to a breast clinic, which does not definitely mean you have cancer. At the clinic you may have a breast examination, a breast X-ray (mammogram), an ultrasound and a biopsy, in which a small sample of cells is taken, usually with a needle, for testing. You may not need all of these tests, and you will usually have all the tests you need in one visit.

The NHS says some results may be available that day, while others, such as a biopsy, can take 1 to 2 weeks. If you are told you have breast cancer, you may need more tests such as a CT, MRI or PET scan or blood tests to show how far the cancer has spread and what type it is.

NICE says that oestrogen receptor, progesterone receptor and HER2 status should be recorded and available when treatment is discussed at the multidisciplinary team meeting, and recommends BRCA1 and BRCA2 genetic testing for women under 50 with triple-negative breast cancer, including those with no family history.

Cancer Research UK describes inflammatory breast cancer as a rare type that can have different symptoms: the whole breast may look inflamed and feel sore, hard and like orange peel, and it may feel like an infection. Paget’s disease of the breast is a rare skin condition whose possible symptoms include a scaly rash on the nipple and the surrounding area that can be itchy and look a bit like eczema.

Breast cancer in men is rare, and Cancer Research UK says the most common symptoms are a lump in the breast that is nearly always painless, and changes in the nipple. The NHS has separate information for men.

The NHS says it is not always clear what causes breast cancer. You might be more likely to get it if you are over 50, have dense breast tissue, have relatives with breast or ovarian cancer (possibly through an inherited faulty gene such as a BRCA gene), or have certain breast conditions such as benign breast disease, ductal carcinoma in situ or lobular carcinoma in situ. Higher levels of oestrogen, progesterone or testosterone may play a part: starting periods before 12, going through the menopause after 55, not having given birth or giving birth first after 30, not breastfeeding, using the contraceptive pill in the last 10 years or taking hormone replacement therapy, although the NHS says the last two only slightly increase risk and for many people the benefits outweigh the risks. Smoking is also linked.

The NHS says to reduce your risk you can cut down on alcohol and avoid more than 14 units a week, try to lose weight if overweight and quit smoking, and that going to breast screening when invited can help find cancers too small to see or feel. Close relatives with breast or ovarian cancer may make you eligible for NHS genetic testing, and the NHS also offers BRCA testing to people aged 18 or over with at least one Jewish grandparent.

NICE says everyone with breast cancer should have a named clinical nurse specialist or other specialist key worker, and prompt access to specialist psychological support. It says breast reconstruction should be offered to people after mastectomy, both immediate and delayed options whether or not they are available locally, while recognising that some people prefer not to have reconstruction.

The NHS says you will have regular check-ups during and after treatment, and that if you have any symptoms or side effects that you are worried about you should talk to your specialists rather than waiting for your next check-up.

The NHS explains that breast cancer that spreads to other parts of the body is called secondary breast cancer, which most commonly affects the bones, liver, lungs or brain, with general symptoms such as tiredness, loss of appetite or weight, feeling unwell, nausea and difficulty sleeping. It says that if cancer cannot be cured the aim is to slow its spread, help with symptoms and help you live longer, and that this can help many people live a normal life for a number of years. A symptom control or palliative care team supports comfort and wellbeing.

Assessment and treatment are normally through NHS breast clinics and cancer teams. Private breast clinics offer same-day assessment, but any cancer treatment plan should be agreed by a multidisciplinary team. Ask who your key worker will be, whether the receptor status has been recorded and discussed, and how follow-up mammograms will be arranged.