People with breast cancer won’t always notice a lump. 5 lesser-known symptoms both men and women should watch for

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Most people know that a lump in their breast could be a sign of breast cancer. But few are familiar with other signs of the disease—a condition that affects around 4 million women and thousands of men in the U.S.

That’s according to a survey commissioned by Ohio State University Wexner Medical Center, released Monday. Slightly more than 1,000 people were polled either online or via telephone Sept. 22–24 in a nationally representative sample. 

The survey found that 93% of adults recognized a lump as a potential sign of breast cancer—but most breast cancers don’t present with a lump that can be detected by touch, experts at Ohio State say. What’s more, palpable lumps are often a sign of fast-growing or late-stage cancer that will be more difficult to treat.

Far fewer survey respondents recognized five other symptoms of breast cancer that occur more commonly. While flagging a potential health issue to your doctor can be scary, there’s good news: Thanks to advances in medicine, the five-year survival rate in the U.S. for breast cancer that hasn’t spread is 99%, according to the Susan G. Komen Foundation.

Less frequently recognized symptoms of breast cancer

Symptoms that were recognized by fewer than half of respondents include:

Retracted, inverted, or downward-pointing nipple: Only 31% of respondents recognized this as a symptom requiring medical attention. Nipple changes are the most common sign of breast cancer in men, experts say.

Breast puckering: This appears as an indentation when you raise your arm, according to experts at Ohio State. Only 39% recognized this as a symptom requiring medical attention.

Loss of feeling in part of the breast: Only 41% recognized this as a symptom requiring medical attention.

Pitting/thickening of the skin on the breast: This may cause the surface of the breast to resemble an orange peel. Only 45% of respondents recognized this as a symptom requiring medical attention.

Nipple discharge: This includes clearly, bloody, and/or milky discharge. Milky discharge when a woman is not breastfeeding should be checked by a doctor, but may be a sign of another condition. The most concerning types of discharge are bloody and/or clear, according to the National Breast Cancer Foundation. Only 51% recognized this as a symptom requiring medical attention.

While mammograms are the “No. 1 defense in detecting and addressing breast cancer at the earliest, most treatable stages,” it’s also very important for people—men included—to be familiar with the usual look and feel of their breasts, Dr. Ashley Pariser, a breast medical oncologist at Ohio State, said in a news release about the survey.

That way, they can alert a medical provider when there is even a subtle change, giving them the best chance at effectively tackling the problem, if there is one, she said.

“Breast cancer can present in a number of ways,” she added. While most breast changes are the result of aging and childbirth, “it is important that people feel safe to address those concerns in a timely way with their doctor.”

Breast cancer screening guidelines

Mammography is the primary tool for early breast cancer detection. But a third of women surveyed said they weren’t sure when they should get their first mammogram—and women under 30 were especially confused.

The American College of Radiology and American College of Obstetrics and Gynecologists recommend screening at age 40 for women of average risk. (Breast cancer screening is not routinely performed in men.) But patients should talk with their doctors about their personal situation—including family history and risk factors—to devise a screening plan right for them, according to the experts at Ohio State.

For instance, women with dense breast tissue should be closely monitored because they are at a slightly higher risk of breast cancer, and dense breast tissue can hide small tumors, they say. What’s more, Black individuals and those of Ashkenazi Jewish ancestry are also at higher risk and should have more frequent screenings.

What men should know about breast cancer

While breast cancer is much less common in men, it can—and does—occur. More than 2,000 American men are diagnosed with breast cancer each year, and around 500 of them die, according to the U.S. Centers for Disease Control and Prevention.

One percent of breast cancers occur in men. The most common symptom: changes to the nipple, Pariser said.

It’s important that men “feel empowered to seek medical attention for concerning symptoms, especially if they have a strong family history of breast cancer,” she added.

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