Study: Women with breast cancer symptoms but no lump may wait longer to seek medical care


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Some patients take longer than others before getting a potential breast cancer checked by their health care provider. Believing that women who have breast cancer symptoms but have no lump may wait longer, researchers in this study used data from women who were diagnosed with breast cancer in 2009 and 2010 to identify possible explanations. (1/18/17)

Contents

At a glance                  In-depth
Findings               Limitations               
Guidelines Resources and references
Questions for your doctor  


STUDY AT A GLANCE

This study is about:

Identifying whether or not people who have breast cancer symptoms but do not have a lump wait longer to see a health care provider than people who have a noticeable breast lump.

Why is this study important?

A breast lump is not the only symptom of breast cancer, but it is the most common. If people are less aware of other breast cancer symptoms, they might delay going to their health care provider, but early diagnosis is important for all breast cancer patients because it increases the chance of survival.

Study findings: 

  1. About 1 of 6 breast cancer patients went to their health care provider with a symptom other than a breast lump.
  2. Breast cancer patients who had symptoms but no breast lump took longer to have their health care provider check their breasts than women whose only symptom was a breast lump.

What does this mean for me?

In a press release, Dr. Karen Kennedy, Director of the National Cancer Research Institute in the United Kingdom (NCRI), said, “This research shows that, all too often, women are delaying going to their doctor with symptoms of breast cancer. This could be because people are simply unaware that breast cancer can present in many different ways, not just through the presence of a lump. With a disease like breast cancer, it's essential to be diagnosed as early as possible so that a treatment plan can be developed and started. Awareness campaigns need to raise awareness of all of the potential symptoms of breast cancer so that people know how to spot the signs and when to go to a doctor.”

While a breast lump is the most common symptom of breast cancer, many other symptoms should also be checked. According to the American Cancer Society (ACS), other symptoms may include:

  • Breast swelling, with or without a lump
  • Skin irritation
  • Skin dimpling
  • Breast or nipple pain
  • Nipple turning inward (retraction)
  • Redness, scaliness, or thickening of the nipple or breast skin
  • Nipple discharge
  • Lump or swelling under the arm or around the collarbone

While these symptoms do not necessarily mean a person has breast cancer, people who experience any of them should quickly seek help from a health care provider to identify the cause. It is also important to note that although breast cancer is not usually painful, even painful lumps should be checked out by a health care provider.

Expert Guidelines

Experts have created guidelines that include some signs of breast cancer:

  • a lump in the breast or underarm (armpit).
  • thickening or swelling of part of the breast.
  • irritation or dimpling of breast skin.
  • persistent redness or flaky skin in the nipple area or the breast.
  • pulling in of the nipple or pain in the nipple area.
  • nipple discharge other than breast milk, including blood.
  • any change in the size or the shape of the breast.
  • persistent pain in any area of the breast.

There are different screening guidelines which are dependent on risk. 

  • The American Cancer Society screening guidelines for average and high-risk women can be found here.
  • National Comprehensive Cancer Network (NCCN) screening guidelines for average risk women can be found here.
  • NCCN screening guidelines for high-risk patients can be found here.
  • NCCN treatment guidelines can be found here.

Questions To Ask Your Health Care Provider

  • What are the symptoms of breast cancer?
  • Should I be doing breast self exams? How frequently should I check my breasts?
  • Should a doctor be checking my breasts for lumps? Is so, how frequently?
  • What changes in my breast should I look for if I am concerned about breast cancer?
  • Given my family history, how often should I be screened for breast cancer?

IN DEPTH REVIEW OF RESEARCH

Study background:

The study authors noted that some women take longer than others to get their breast cancer symptoms checked.  Minjoung Koo and colleagues from University College London (UCL) presented work at the 2016 National Cancer Research Institute (NCRI) cancer conference in Liverpool that tried to explain why some breast cancer patients took longer to report breast cancer symptoms to their health care providers and ultimately be diagnosed.     

Researchers of this study wanted to know:

Could having symptoms other than a breast lump explain why some women take longer to consult with their healthcare provider?

Population(s) looked at in the study:

Data from 2,316 women with breast cancer who were diagnosed in 2009 and 2010 were used for this study. This data included the symptoms present at breast cancer diagnosis.

Study findings: 

  1. About 1 of 6 breast cancer patients went to their health care provider with a breast cancer symptom other than a breast lump.
  2. Compared to women whose only symptom was a breast lump, women who had breast cancer symptoms but no lump waited longer before having their health care provider check their breasts

Limitations:

This is a retrospective study, meaning the authors used data from previously documented records of patients instead of collecting patient data specifically for this study. This means that other unknown factors may have affected the results. Also, the work was done in England, so factors such as type of health insurance that may have affected access to care in the United States were not addressed.  Additionally, because this research has not been published in a peer-reviewed journal, other researchers in the field who can carefully examine the data and confirm the validity of the work have not reviewed it. Finally, while the data indicates that breast cancer patients who had symptoms other than a lump took longer to go to their health care provider, researchers do not know why this occurred, because they were unable to interview or question patients.                       

Conclusions:

This study suggests that having breast cancer symptoms other than a lump may be one reason why some patients with breast cancer take longer to be diagnosed than others. However, more work needs to be done to understand if that truly is the reason why these patients delayed going to their health care provider. In the meantime, health care providers should be sure to educate patients about non-lump symptoms so that patients can be aware of them and go to their health care provider when any of these symptoms arise.

Posted 1/18/17

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