Skin Changes of Breast Cancer
October is National Breast Cancer Awareness Month. As breast cancer is the second leading cause of cancer death in women, patients should be aware of skin changes on or around the breast that may be a sign of breast cancer.
Breast cancer occurs when abnormal cells start to grow in one or both breasts and invade the surrounding tissue. Important things to look for include a reddish discoloration of the skin, retraction, dimpling or puckering, a change in size or shape of the breast, and crusting or discharge of the nipple. Unilateral changes are generally more suspicious than those involving both breasts, however a diagnostic workup should be done either way. Inflammatory breast cancer can present with redness, swelling, warmth, tenderness, and textural changes (puckering and firmness) involving a large part of the breast. An excellent collection of photos of the cutaneous signs of breast cancer can be viewed here.
Other conditions that can cause changes in the breast skin or nipples include eczema or atopic dermatitis, Paget's disease, contact dermatitis, mastitis, psoriasis, and seborrheic dermatitis to name a few. The most serious of these is Paget's disease which comprises 1-3% of all primary breast cancers. Paget's disease can mimic nipple eczema, but with a more persistent course, and may be accompanied by an invasive ductal carcinoma. Early diagnosis is key, so all patients should see their doctor immediately for evaluation at the first sign of changes.
A thorough work-up should be done in all patients who present with skin changes or nipple retraction. Your doctor will perform a complete breast examination looking for palpable masses or mammogram abnormalities and may perform additional studies such as ultrasound or tissue biopsies. It is important to record and tell your doctor the timing of the changes and how long they have been present. Congenital nipple retraction present since birth is generally insignificant, whereas recent nipple inversion is more serious, especially if it is only on one breast. Remember that roughly 1 in every 100 cases of breast cancer occurs in men. So any man who has a breast lump should also be evaluated.
The earlier that breast cancer is found, the more likely it is that the cancer can be curable. Routine screening for breast cancer is done using mammograms, clinical breast exams and self-breast exams. The U.S. Preventive Services Task Force (USPSTF) recommends screening mammography, with or without a clinical breast examination, every 1-2 years for women aged 40 and older. Anyone, male or female, regardless of age, with suspicious changes in the breast tissue should seek out evaluation from a qualified physician.