Signs of Breast Cancer: What to Look For and When to Seek Care
By Sarah Friend, MD
Breast cancer is one of the most common cancers worldwide, but early detection dramatically improves outcomes. Knowing the signs — both subtle and obvious — can help you recognize when something deserves medical attention. Most breast changes are not cancer, but any new or persistent abnormality should be evaluated.
Below are the most important signs to look for, how to examine your own body, and which risk factors may increase the likelihood of breast cancer.
1. A New Lump or Mass
The most recognized sign of breast cancer is a new lump in the breast or underarm (axilla).
What breast cancer lumps often feel like:
- Firm or hard
- Irregular in shape
- Can be fixed or less mobile
- Usually not painful
However, breast cancers can also feel smooth, round, or mobile — which is why any new lump should be evaluated, regardless of how it feels.
What non-cancerous lumps can feel like — but still require evaluation:
Some benign breast conditions may cause lumps that are:
- Smooth
- Soft or rubbery
- Mobile
- Tender (especially around your menstrual cycle)
It’s impossible to know by touch alone whether a lump is benign or malignant.
All new lumps — mobile or not, tender or not — should be checked by a clinician.
2. Changes in Breast Size, Shape, or Appearance
A change that affects only one breast, or looks different than your usual baseline, can be a sign of something that needs evaluation.
Look for:
- One breast becoming larger, smaller, fuller, or visibly different
- A newly inverted nipple
- A developing asymmetry that doesn’t match your normal pattern
- A distinct change in contour or swelling of part of the breast
3. Skin Changes on the Breast
Some breast cancers cause changes in the skin overlying the breast.
Signs that require attention include:
- Dimpling or skin that looks like an orange peel (“peau d’orange”)
- Redness, warmth, or swelling that persists
- Thickened or hardened skin
- Ulceration or sores that don’t heal
Infections, inflammation, and dermatitis can mimic these findings, but persistent or worsening skin changes should be checked promptly.
4. Nipple Changes or Discharge
Nipple-related changes may be early clues.
Concerning findings include:
- New nipple inversion
- Scaling, crusting, or persistent flaking
- Discharge that is bloody, clear, or happens without squeezing
- Persistent itching or irritation localized to the nipple area
Most nipple discharge is benign, but spontaneous or bloody discharge always warrants evaluation.
5. Pain: When It Matters
Breast pain alone is rarely a sign of cancer.
However, pain that:
- Is localized to one specific spot
- Persists for several weeks
- Is associated with a lump or visible change
…should be brought to your provider’s attention.
6. Underarm (Axillary) Changes
Because lymph nodes are part of the breast drainage system, the underarm area can provide early clues.
Watch for:
- A new lump under the arm
- Persistent swelling or fullness
- Nodes that remain enlarged after an infection resolves
Next Steps After Feeling a New Breast Change or Lump
If you notice a new lump, skin change, nipple change, or anything that feels different in your breast, here’s what typically happens next — and why timely follow-up matters.
1. Schedule a Clinical Breast Exam
Your first step is to contact your primary care clinician, gynecologist, or breast specialist.
They will perform:
- A detailed clinical breast exam
- Comparison with your prior baseline
- Assessment of whether the finding feels suspicious or likely benign
Even if the clinician thinks it “feels benign,” they will almost always recommend imaging, because touch alone cannot reliably distinguish benign from malignant.
2. Expect Diagnostic Imaging
Depending on your age, breast density, symptoms, and prior imaging, your clinician may order:
- Diagnostic Mammogram
A targeted study focusing on the area of concern.
This is different from a routine screening mammogram — it includes additional angles and magnified views to better assess the region.
- Targeted Breast Ultrasound
This is especially helpful for evaluating:
- Lumps you can feel
- Dense breast tissue
- Cysts vs solid masses
Most women will receive both a mammogram and ultrasound if they report a new lump.
- Breast MRI
Not typically first-line for a new lump, but may be added for:
- Patients with high genetic risk
- Difficult-to-interpret imaging
- Multiple concerning areas
3. Follow Through With Recommended Testing
If imaging is abnormal, the next step may include:
- Short-term follow-up imaging
- A core needle biopsy
- Referral to a breast specialist
Most findings are benign, but confirming this with proper imaging keeps you safe.
4. Don’t Delay Routine Screening
Many concerning breast signs are found during routine screening, not because a woman felt a lump.
Please don’t forget your screening mammogram schedule:
- Annual mammograms starting at age 40 (earlier for high-risk individuals)
- MRI + mammogram for those with strong family history or genetic mutation
If you’ve fallen behind on screening, this is your reminder to get back on track — screening saves lives.
Who Is at Higher Risk for Breast Cancer?
Breast cancer can occur in anyone, but certain individuals carry higher risk and should be particularly vigilant.
Strong Family History
Risk is higher when you have:
- A first-degree relative with breast or ovarian cancer
- Multiple family members with cancer
- A relative diagnosed before age 50
- Family history of metastatic prostate or pancreatic cancer
Known Genetic Mutations
High-risk genes include BRCA1/2, PALB2, CHEK2, ATM, TP53, CDH1, PTEN, and others.
These often prompt enhanced screening or preventive strategies.
Hormonal & Reproductive Factors
Includes early menarche, late menopause, prolonged estrogen exposure, late first pregnancy, or nulliparity.
Environmental & Lifestyle Factors
Modifiable risks include:
- Alcohol intake
- Obesity
- Limited exercise
- Significant radiation exposure in youth
When to Call Your Doctor
You should seek evaluation if you notice:
- Any new breast or underarm lump
- Persistent skin changes
- Nipple discharge (especially bloody or spontaneous)
- A change lasting beyond one menstrual cycle
- A new finding plus a strong family history or genetic mutation
If something feels “off,” trust yourself — early evaluation is always better.
How myFriendMD Can Help
At myFriendMD, I help patients:
- Understand their breast symptoms
- Review imaging, reports, or biopsy results
- Prepare questions for breast specialists
- Assess personal and family history
- Navigate genetic testing options
- Make calm, confident decisions
You never have to navigate breast concerns alone — clarity and support are just one session away.
