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Breastcancer.org
These and other signs may be caused by breast cancer or by other conditions. Check with your
doctor if you have any of the following:

A lump or thickening in or near the breast or in the underarm area.

A change in the size or shape of the breast.

A dimple or puckering in the skin of the breast.

A nipple turned inward into the breast.

Fluid, other than breast milk, from the nipple, especially if it's bloody.

Scaly, red, or swollen skin on the breast, nipple, or areola (the dark area of skin around
the nipple).

Dimples in the breast that look like the skin of an orange, called peau dorange.

Mammography is the most common screening test for breast cancer. A mammogram is an x-ray
of the breast. This test may find tumors that are too small to feel. A mammogram may also find
ductal carcinoma in situ (DCIS). In DCIS, there are abnormal cells in the lining of a breast duct,
which may become invasive cancer in some women.
Mammograms are less likely to find breast tumors in women younger than 50 years than in older
women. This may be because younger women have denser breast tissue that appears white on a
mammogram. Because tumors also appear white on a mammogram, they can be harder to find
when there is dense breast tissue.
The following may affect whether a mammogram is able to detect (find) breast cancer:

The size of the tumor.

How dense the breast tissue is.

The skill of the radiologist.

Women aged 40 to 74 years who have screening mammograms have a lower chance of dying
from breast cancer than women who do not have screening mammograms.
Clinical breast exam (CBE)
A clinical breast exam is an exam of the breast by a doctor or other health professional. The
doctor will carefully feel the breasts and under the arms for lumps or anything else that seems
unusual. It is not known if having clinical breast exams decreases the chance of dying from
breast cancer.
Breast self-exams may be done by women or men to check their breasts for lumps or other
changes. It is important to know how your breasts usually look and feel. If you feel any lumps or
notice any other changes, talk to your doctor. Doing breast self-exams has not been shown to
decrease the chance of dying from breast cancer.
MRI (magnetic resonance imaging) in women with a high risk of breast cancer
MRI is a procedure that uses a magnet, radio waves, and a computer to make a series of detailed
pictures of areas inside the body. This procedure is also called nuclear magnetic resonance
imaging (NMRI). MRI does not use any x-rays.
MRI is used as a screening test for women who have one or more of the following:

Certain gene changes, such as in the BRCA1 or BRCA2 genes.

A family history (first degree relative, such as a mother, daughter or sister) with breast
cancer.

Certain genetic syndromes, such as Li-Fraumeni or Cowden syndrome.

MRIs find breast cancer more often than mammograms do, but it is common for MRI results to
appear abnormal even when there isn't any cancer.

Other screening tests are being studied in clinical trials.

Thermography
Thermography is a procedure in which a special camera that senses heat is used to record the
temperature of the skin that covers the breasts. A computer makes a map of the breast showing
the changes in temperature. Tumors can cause temperature changes that may show up on the
thermogram.
There have been no clinical trials of thermography to find out how well it detects breast cancer
or if having the procedure decreases the risk of dying from breast cancer.
Tissue sampling

Breast tissue sampling is taking cells from breast tissue to check under a microscope. Abnormal
cells in breast fluid have been linked to an increased risk of breast cancer in some studies.
Scientists are studying whether breast tissue sampling can be used to find breast cancer at an
early stage or predict the risk of developing breast cancer. Three ways of taking tissue samples
are being studied:

Fine-needle aspiration: A thin needle is inserted into the breast tissue around the areola
(darkened area around the nipple) to take out a sample of cells and fluid.

Nipple aspiration: The use of gentle suction to collect fluid through the nipple. This is
done with a device similar to the breast pumps used by women who are breast-feeding.

Ductal lavage: A hair-size catheter (tube) is inserted into the nipple and a small amount of
salt water is released into the duct. The water picks up breast cells and is removed.

Screening clinical trials are taking place in many parts of the country. Information about ongoing
clinical trials is available from the NCI Web site.

The risks of breast cancer screening tests include the following:

Finding breast cancer may not improve health or help a woman live longer.

False-negative test results can occur.

False-positive test results can occur.

Anxiety from additional testing may result from false positive results.

Mammograms expose the breast to radiation.

There may be pain or discomfort during a mammogram.

The risks and benefits of screening for breast cancer may be different in different age groups.

Screening tests have risks.

Decisions about screening tests can be difficult. Not all screening tests are helpful and most have
risks. Before having any screening test, you may want to discuss the test with your doctor. It is
important to know the risks of the test and whether it has been proven to reduce the risk of dying
from cancer.

The risks of breast cancer screening tests include the following:

Finding breast cancer may not improve health or help a woman live longer.
Screening may not help you if you have fast-growing breast cancer or if it has already spread to
other places in your body. Also, some breast cancers found on a screening mammogram may
never cause symptoms or become life-threatening. Finding these cancers is called overdiagnosis.
When such cancers are found, treatment would not help you live longer and may instead cause
serious side effects. At this time, it is not possible to be sure which breast cancers found by
screening will cause problems and which ones will not.
False-negative test results can occur.
Screening test results may appear to be normal even though breast cancer is present. A woman
who receives a false-negative test result (one that shows there is no cancer when there really is)
may delay seeking medical care even if she has symptoms.
One in 5 cancers may be missed by mammography. False-negative results occur more often in
younger women than in older women because the breast tissue of younger women is more dense.
The chance of a false-negative result is also affected by the following:

The size of the tumor.

The rate of tumor growth.

The level of hormones, such as estrogen and progesterone, in the womans body.

The skill of the radiologist.

False-positive test results can occur.

Screening test results may appear to be abnormal even though no cancer is present. A falsepositive test result (one that shows there is cancer when there really isnt) is usually followed by
more tests (such as biopsy), which also have risks.
Most abnormal test results turn out not to be cancer. False-positive results are more common in
the following:

Younger women.

Women who have had previous breast biopsies.

Women with a family history of breast cancer.

Women who take hormones, such as estrogen and progestin.

The skill of the radiologist also can affect the chance of a false-positive result.

Anxiety from additional testing may result from false positive results.
False-positive results from screening mammograms are usually followed by more testing that can
lead to anxiety. In one study, women who had a false-positive screening mammogram followed
by more testing reported feeling anxiety 3 months later, even though cancer was not diagnosed.
However, several studies show that women who feel anxiety after false-positive test results are
more likely to schedule regular breast screening exams in the future.
Mammograms expose the breast to radiation.
Being exposed to radiation is a risk factor for breast cancer. The risk of breast cancer from
radiation exposure is higher in women who received radiation before age 30 and at high doses.
For women older than 40 years, the benefits of an annual screening mammogram may be greater
than the risks from radiation exposure.
There may be pain or discomfort during a mammogram.
During a mammogram, the breast is placed between 2 plates that are pressed together. Pressing
the breast helps to get a better x-ray of the breast. Some women have pain or discomfort during a
mammogram.

The risks and benefits of screening for breast cancer may be different in different
age groups.
The benefits of breast cancer screening may vary among age groups:

In women who are expected to live 5 years or fewer, finding and treating early stage
breast cancer may reduce their quality of life without helping them live longer.

As with other women, in women older than 65 years, the results of a screening test may
lead to more diagnostic tests and anxiety while waiting for the test results. Also, the
breast cancers found are usually not life-threatening.

It has not been shown that women with an average risk of developing breast cancer
benefit from starting screening mammography before age 40.

Women who have had radiation treatment to the chest, especially at a young age, are advised to
have routine breast cancer screening. Yearly MRI screening may begin 8 years after treatment or
by age 25 years, whichever is later. The benefits and risks of mammograms and MRIs for these
women have not been studied.
There is no information on the benefits or risks of breast cancer screening in men.
No matter how old you are, if you have risk factors for breast cancer you should ask for medical
advice about when to begin having breast cancer screening tests and how often to have them.

Stage 0
Stage 0 is used to describe non-invasive breast cancers, such as DCIS (ductal carcinoma in situ).
In stage 0, there is no evidence of cancer cells or non-cancerous abnormal cells breaking out of
the part of the breast in which they started, or getting through to or invading neighboring normal
tissue.
Learn about what treatments you can generally expect for stage 0 in the Options by Cancer
Stage: Stage 0 page in Planning Your Treatment.
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Stage I
Stage I describes invasive breast cancer (cancer cells are breaking through to or invading normal
surrounding breast tissue) Stage I is divided into subcategories known as IA and IB.
Stage IA describes invasive breast cancer in which:

the tumor measures up to 2 centimeters AND

the cancer has not spread outside the breast; no lymph nodes are involved

Stage IB describes invasive breast cancer in which:

there is no tumor in the breast; instead, small groups of cancer cells larger
than 0.2 millimeter but not larger than 2 millimeters are found in the lymph
nodes OR

there is a tumor in the breast that is no larger than 2 centimeters, and there
are small groups of cancer cells larger than 0.2 millimeter but not larger
than 2 millimeters in the lymph nodes

Microscopic invasion is possible in stage I breast cancer. In microscopic invasion, the cancer
cells have just started to invade the tissue outside the lining of the duct or lobule, but the
invading cancer cells can't measure more than 1 millimeter.
Learn about what treatments you can generally expect for stage IA and IB in the Options by
Cancer Stage: Stage IA and IB page in Planning Your Treatment.
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Stage II
Stage II is divided into subcategories known as IIA and IIB.
Stage IIA describes invasive breast cancer in which:

no tumor can be found in the breast, but cancer (larger than 2 millimeters) is
found in 1 to 3 axillary lymph nodes (the lymph nodes under the arm) or in
the lymph nodes near the breast bone (found during a sentinel node biopsy)
OR

the tumor measures 2 centimeters or smaller and has spread to the axillary
lymph nodes OR

the tumor is larger than 2 centimeters but not larger than 5 centimeters and
has not spread to the axillary lymph nodes

Stage IIB describes invasive breast cancer in which:

the tumor is larger than 2 centimeters but no larger than 5 centimeters; small
groups of breast cancer cells -- larger than 0.2 millimeter but not larger than
2 millimeters -- are found in the lymph nodes OR

the tumor is larger than 2 centimeters but no larger than 5 centimeters;

cancer has spread to 1 to 3 axillary lymph nodes or to lymph nodes near the
breastbone (found during a sentinel node biopsy) OR

the tumor is larger than 5 centimeters but has not spread to the axillary
lymph nodes

Learn about what treatments you can generally expect for stage IIA and IIB in the Options by
Cancer Stage: Stage IIA and IIB page in Planning Your Treatment.
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Stage III
Stage III is divided into subcategories known as IIIA, IIIB, and IIIC.
Stage IIIA describes invasive breast cancer in which either:

no tumor is found in the breast or the tumor may be any size; cancer is found
in 4 to 9 axillary lymph nodes or in the lymph nodes near the breastbone
(found during imaging tests or a physical exam) OR

the tumor is larger than 5 centimeters; small groups of breast cancer cells
(larger than 0.2 millimeter but not larger than 2 millimeters) are found in the
lymph nodes OR

the tumor is larger than 5 centimeters; cancer has spread to 1 to 3 axillary

lymph nodes or to the lymph nodes near the breastbone (found during a
sentinel lymph node biopsy)

Stage IIIB describes invasive breast cancer in which:

the tumor may be any size and has spread to the chest wall and/or skin of the
breast and caused swelling or an ulcer AND

may have spread to up to 9 axillary lymph nodes OR

may have spread to lymph nodes near the breastbone

Inflammatory breast cancer is considered at least stage IIIB. Typical features of inflammatory
breast cancer include:

reddening of a large portion of the breast skin

the breast feels warm and may be swollen

cancer cells have spread to the lymph nodes and may be found in the skin

Stage IIIC describes invasive breast cancer in which:

there may be no sign of cancer in the breast or, if there is a tumor, it may be
any size and may have spread to the chest wall and/or the skin of the breast
AND

the cancer has spread to 10 or more axillary lymph nodes OR

the cancer has spread to lymph nodes above or below the collarbone OR

the cancer has spread to axillary lymph nodes or to lymph nodes near the
breastbone

Learn about what treatments you can generally expect for stage IIIA and operable IIIC in the
Options by Cancer Stage: Stage IIIA and Operable IIIC page in Planning Your Treatment.
Learn about what treatments you can generally expect for stage IIIB and inoperable IIIC in the
Options by Cancer Stage: Stage IIIB and Inoperable IIIC page in Planning Your Treatment.
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Stage IV
Stage IV describes invasive breast cancer that has spread beyond the breast and nearby lymph
nodes to other organs of the body, such as the lungs, distant lymph nodes, skin, bones, liver, or
brain.
You may hear the words advanced and metastatic used to describe stage IV breast cancer.
Cancer may be stage IV at first diagnosis or it can be a recurrence of a previous breast cancer
that has spread to other parts of the body

Causes and risk factors

The causes of breast cancer aren't fully understood, making it difficult to say why one
woman may develop breast cancer and another may not.
However, there are risk factors that are known to affect your likelihood of developing breast
cancer. Some of these you can't do anything about, but there are some you can change.
Age

The risk of developing breast cancer increases with age. The condition is most common among
women over 50 who have been through the menopause. About 8 out of 10 cases of breast cancer
occur in women over 50.
All women who are 50-70 years of age should be screened for breast cancer every three years as
part of the NHS Breast Screening Programme. Women over the age of 70 are still eligible to be
screened and can arrange this through their GP or local screening unit. Read more about breast
screening.
Family history

If you have close relatives who have had breast cancer or ovarian cancer, you may have a higher
risk of developing breast cancer. However, because breast cancer is the most common cancer in
women, it's possible for it to occur in more than one family member by chance.
Most cases of breast cancer aren't hereditary (they don't run in families), but particular genes,
known as BRCA1 and BRCA2, can increase your risk of developing both breast and ovarian
cancer. It's possible for these genes to be passed on from a parent to their child. A third gene
(TP53) is also associated with increased risk of breast cancer.

If you have, for example, two or more close relatives from the same side of your family, such as
your mother, sister or daughter, who have had breast cancer under the age of 50, you may be
eligible for surveillance for breast cancer or for genetic screening to look for the genes that make
developing breast cancer more likely. If you're worried about your family history of breast
cancer, discuss it with your GP.
Read about predictive genetic tests for cancer risk genes.
Previous diagnosis of breast cancer

If you've previously had breast cancer or early non-invasive cancer cell changes in breast ducts,
you have a higher risk of developing it again, either in your other breast or in the same breast
again.
Previous benign breast lump

A benign breast lump doesn't mean you have breast cancer, but certain types of lump may
slightly increase your risk of developing it. Certain benign changes in your breast tissue, such as
atypical ductal hyperplasia (cells growing abnormally in ducts), or lobular carcinoma in situ
(abnormal cells inside your breast lobes), can make getting breast cancer more likely.
Breast density

Your breasts are made up of thousands of tiny glands (lobules), which produce milk. This
glandular tissue contains a higher concentration of breast cells than other breast tissue, making it
denser. Women with dense breast tissue may have a higher risk of developing breast cancer
because there are more cells that can become cancerous.
Dense breast tissue can also make a breast scan (mammogram) difficult to read, because it makes
any lumps or areas of abnormal tissue harder to spot. Younger women tend to have denser
breasts. As you get older, the amount of glandular tissue in your breasts decreases and is replaced
by fat, so your breasts become less dense.
Exposure to oestrogen

The female hormone, oestrogen, can sometimes stimulate breast cancer cells and cause them
to grow. The ovaries, where your eggs are stored, begin to produce oestrogen when you
start puberty, to regulate your periods.
Your risk of developing breast cancer may rise slightly with the amount of oestrogen your body
is exposed to. For example, if you started your periods at a young age and experienced
the menopause at a late age, you'll have been exposed to oestrogen over a longer period of time.
In the same way, not having children, or having children later in life, may slightly increase your

risk of developing breast cancer because your exposure to oestrogen is uninterrupted by

pregnancy.
Being overweight or obese

If you've experienced the menopause and are overweight or obese, you may be more at risk of
developing breast cancer. This is thought to be linked to the amount of oestrogen in your body,
because being overweight or obese after the menopause causes more oestrogen to be produced.
Being tall

If you're taller than average, you're more likely to develop breast cancer than someone who's
shorter than average. The reason for this isn't fully understood, but it may be due to interactions
between genes, nutrition and hormones.
Alcohol

Your risk of developing breast cancer can increase with the amount of alcohol you drink.
Research shows that for every 200 women who regularly have two alcoholic drinks a day, there
are three more women with breast cancer, compared with women who don't drink at all.
Radiation

Certain medical procedures that use radiation, such as X-rays and computerised tomography
(CT) scans, may slightly increase your risk of developing breast cancer.
If you had radiotherapy to your chest area for Hodgkin lymphoma when you were a child, you
should have already received a written invitation from the Department of Health for a
consultation with a specialist to discuss your increased risk of developing breast cancer. See your
GP if you weren't contacted, or if you didn't attend a consultation.
If you currently need radiotherapy for Hodgkin lymphoma, your specialist should discuss the risk
of breast cancer before your treatment begins.
Hormone replacement therapy (HRT)

Hormone replacement therapy (HRT) is associated with a slightly increased risk of developing
breast cancer. Both combined HRT and oestrogen-only HRT can increase your risk of developing
breast cancer, although the risk is slightly higher if you take combined HRT.
It's estimated that there will be an extra 19 cases of breast cancer for every 1,000 women taking
combined HRT for 10 years. The risk continues to increase slightly the longer you take HRT, but
returns to normal once you stop taking it.

Want to know more?

Breakthrough Breast Cancer: Breast cancer risk factors

Breast Cancer Care: Am I at Risk of Developing Breast Cancer?

Cancer Research UK: Breast cancer risks and causes

Live Well: Breast cancer genes

Macmillan: Breast cancer causes and risk factors

Contraceptive pill and cancer risk

Research has shown that women who use oral contraception (the pill) have a slight, but
significant, increased risk of developing breast cancer.
However, the risk starts to decrease once you stop taking the pill, and your risk of breast cancer
is back to normal 10 years after stopping.
The Cancer Research UK website has more information about the contraceptive pill and cancer
risk.
Mastectomy may be the right choice for you if the following is true for you:

If the tumor is larger than 5 centimeters, you will probably need a mastectomy.
Depending on stage and other factors, some tumors smaller than 5 centimeters may still
require mastectomy, although others may be addressed by lumpectomy.

If your breast is small and a lumpectomy would leave you with very little breast tissue,
your doctor may advise you to have a mastectomy.

If your surgeon has already made multiple attempts to remove the tumor with
lumpectomy, but has not been able to completely remove the cancer and obtain clear
margins, you may need a mastectomy.

If lumpectomy plus radiation is not an option for your small tumor (for example,
under 4 centimeters) because you have had prior radiation to the same breast, you have a
connective tissue disease (lupus, rheumatoid arthritis), you are pregnant, or you do not
want to commit to daily radiation treatment, you may need to have a mastectomy.

If you believe mastectomy would give you greater peace of mind than lumpectomy,
you might decide to have a mastectomy.

BRCA1 and BRCA2 are human genes that produce tumor suppressor proteins. These
proteins help repair damaged DNA and, therefore, play a role in ensuring the stability of
the cells genetic material. When either of these genes is mutated, or altered, such that its
protein product either is not made or does not function correctly, DNA damage may not
be repaired properly. As a result, cells are more likely to develop additional genetic
alterations that can lead to cancer.

Specific inherited mutations in BRCA1 and BRCA2 increase the risk of female breast and
ovarian cancers, and they have been associated with increased risks of several additional
types of cancer. Together, BRCA1 and BRCA2 mutations account for about 20 to 25
percent of hereditary breast cancers (1) and about 5 to 10 percent of all breast cancers
(2). In addition, mutations in BRCA1 and BRCA2 account for around 15 percent of
ovarian cancers overall (3). Breast and ovarian cancers associated with BRCA1 and
BRCA2 mutations tend to develop at younger ages than their nonhereditary counterparts.

A harmful BRCA1 or BRCA2 mutation can be inherited from a persons mother or father.
Each child of a parent who carries a mutation in one of these genes has a 50 percent
chance (or 1 chance in 2) of inheriting the mutation. The effects of mutations in BRCA1
and BRCA2 are seen even when a persons second copy of the gene is normal.

A womans lifetime risk of developing breast and/or ovarian cancer is greatly increased if she
inherits a harmful mutation in BRCA1 or BRCA2.
Breast cancer: About 12 percent of women in the general population will develop breast
cancer sometime during their lives (4). By contrast, according to the most recent estimates, 55
to 65 percent of women who inherit a harmful BRCA1 mutation and around 45 percent of
women who inherit a harmful BRCA2 mutation will develop breast cancer by age 70 years (5,
6).
Ovarian cancer: About 1.3 percent of women in the general population will develop ovarian
cancer sometime during their lives (4). By contrast, according to the most recent estimates, 39
percent of women who inherit a harmful BRCA1 mutation (5, 6) and 11 to 17 percent of
women who inherit a harmful BRCA2 mutation will develop ovarian cancer by age 70 years
(5, 6).
It is important to note that these estimated percentages of lifetime risk are different from those
available previously; the estimates have changed as more information has become available, and
they may change again with additional research. No long-term general population studies have

directly compared cancer risk in women who have and do not have a harmful BRCA1 or BRCA2
mutation.
It is also important to note that other characteristics of a particular woman can make her cancer
risk higher or lower than the average risks. These characteristics include her family history
of breast, ovarian, and, possibly, other cancers; the specific mutation(s) she has inherited; and
other risk factors, such as her reproductive history. However, at this time, based on current data,
none of these other factors seems to be as strong as the effect of carrying a harmful BRCA1 or
BRCA2 mutation.