Breast cancer symptoms, early signs and how to check your breasts

The most common breast cancer symptoms

The best-known symptom of breast cancer is a new lump, but it is not the only one. Look out for:

• a new lump or thickening in the breast or armpit, often painless and firm;
• a change in the size or shape of one breast;
• dimpling, puckering or an "orange peel" texture of the skin;
• a nipple that has recently turned inwards, or a change in its position;
• a rash, crusting or scaling on or around the nipple;
• discharge from the nipple, especially if it is bloodstained or comes from one breast only;
• redness, swelling or warmth of the breast that does not settle;
• persistent pain in one specific area of the breast or armpit.

Pain on its own is rarely the only sign of cancer – most breast pain is hormonal – but pain that is new, localised and persistent should still be checked.

Early signs that are easy to miss

Some changes are subtle. A lifelong inverted nipple is usually harmless, but a nipple that pulls inwards for the first time is a reason to see a doctor. Similarly, swollen lymph nodes under the arm or above the collarbone, or a breast that feels heavier and looks different from the other, can be early signs. Many women have some natural breast asymmetry; what matters is a change compared with what is normal for you.

Benign conditions – cysts, fibroadenomas and fibrocystic changes – are far more common causes of lumps, especially in younger women. Our page on benign breast lumps explains them. Only an examination and imaging can tell the difference.

Breast self-examination step by step

Many health services encourage "breast awareness": getting to know how your breasts normally look and feel, so that you notice changes. A simple routine once a month, about a week after your period (or on the same date each month after the menopause), works well.

1. Look: stand in front of a mirror with your arms by your sides, then raised above your head, then with your hands pressed on your hips. Look for changes in shape, skin or nipples.
2. Feel lying down: lie on your back with one arm behind your head. Using the flat pads of three fingers of the other hand, make small circles over the whole breast with light, medium and firm pressure.
3. Follow a pattern: move up and down in strips, from the collarbone to below the breast and from the armpit to the breastbone, so that no area is missed.
4. Check the armpit: feel the armpit and the area above the collarbone for swollen nodes.
5. Check the nipple: look for discharge, crusting or new inversion; do not squeeze hard.
6. Repeat in the shower: soapy skin can make it easier to feel changes.

Self-examination does not replace screening, and finding something does not mean you have cancer – it means it is time to see a doctor. After breast surgery, scars and implants change how the breast feels; ask your surgeon to show you what is normal for you.

When to see a doctor

Book an appointment with your GP or a breast clinic without waiting if you notice any of the changes above, if a lump is still there after your next period, or if a symptom is getting worse. In the UK, a GP can refer you urgently to a breast clinic; in Ireland, symptomatic breast clinics work in a similar way. Do not postpone a visit because you plan to travel or because you are afraid – most women referred turn out not to have cancer, and early diagnosis makes treatment simpler.

It helps to note when you first noticed the change, whether it varies with your cycle, and any family history of breast or ovarian cancer, so that you can tell the doctor.

Breast screening: mammography, ultrasound and MRI

• Mammography is the standard screening test. National programmes in the UK, Ireland and most of Europe invite women of a certain age range (often around 50 to 70 or similar) every two or three years; check the programme in your country.
• Ultrasound is used to examine a lump, especially in younger women with dense breasts, and to guide biopsies.
• MRI is used for women at very high risk (for example BRCA carriers), for some diagnostic questions and to check implants.

Screening is for women without symptoms. If you have a symptom, do not wait for your next screening invitation – see a doctor. If you have had breast surgery or have implants, read our guide to mammography with implants – screening is still possible and important.

Risk factors

The main risk factors are being female and getting older. Others include a strong family history or an inherited gene change (such as BRCA1 or BRCA2), previous chest radiotherapy, dense breast tissue, early first period or late menopause, long-term use of some hormone treatments, alcohol, being overweight after the menopause and lack of physical activity. Many women with breast cancer have no known risk factor, so screening and breast awareness matter for everyone. If several relatives were affected, ask your doctor about genetic counselling; women at high risk sometimes consider a preventive mastectomy.

Cosmetic breast surgery such as a lift, reduction or augmentation is not known to cause breast cancer. Tissue removed during a reduction is routinely examined in the laboratory.

How New City Clinic can help

If you already have test results and would like them reviewed, or you need support after a diagnosis, the oncology team at New City Clinic in Istanbul offers a free online review. Your WhatsApp coordinator will guide you, and you can read more about second opinions and reconstruction in Turkey on newcityclinic.com. For new symptoms, please see your local doctor first – then contact us if you would like a second opinion.