Breast Cancer: Early Symptoms, Risk Factors and Tests That Could Save Your Life

October 15 marks European Breast Health Day, an occasion that brings particular attention to breast cancer prevention and awareness initiatives. This is an important issue because breast cancer remains the most commonly diagnosed malignancy among women worldwide. According to the World Health Organization, approximately 2.4 million women developed breast cancer in 2024, and around 694,000 died from the disease. Despite advances in diagnosis and treatment, breast cancer continues to be one of the major challenges in modern oncology.
Breast cancer develops when cells in the breast gland begin to multiply uncontrollably. Most commonly, the cancerous process begins in the cells lining the milk ducts or in the glandular lobules. Initially, abnormal cells may remain confined to their site of origin without invading surrounding tissues. This is known as carcinoma in situ. When cancer cells cross the natural boundaries of these structures and begin invading adjacent tissues, the condition is referred to as invasive cancer. In more advanced cases, cancer cells may spread to the lymph nodes and distant organs.
One reason why early breast cancer can be difficult to detect is its small size and growth pattern. A tumour may be located deep within the glandular tissue, and its borders may not always be clearly palpable. Some abnormalities, particularly ductal carcinoma in situ (DCIS), may appear on mammography primarily as clusters of tiny microcalcifications that cannot be felt during breast examination. Such calcifications do not always indicate cancer, but their particular appearance and distribution may suggest the need for a biopsy. This illustrates why a normal breast self-examination cannot guarantee that the disease is absent.
The most widely recognised symptom of breast cancer is a new lump or area of thickening. It does not have to be painful or particularly large. Other signs to watch for include changes in breast shape, localised skin dimpling or retraction, swelling, persistent redness without an obvious cause, and skin resembling an orange peel. Newly developed nipple inversion, spontaneous nipple discharge, particularly if bloody and occurring on one side, or enlarged lymph nodes in the armpit may also be warning signs. In some patients, the first symptom is a persistent eczema-like change affecting the nipple, which may occur in Paget’s disease of the breast.
There is also a rarer but particularly aggressive form of the disease known as inflammatory breast cancer. It can cause rapid breast enlargement and swelling, extensive redness, warmth and skin thickening, often without a clearly palpable lump. These symptoms may resemble breast inflammation or infection. Rapid progression or a lack of improvement following treatment therefore requires urgent reassessment. A diagnosis of inflammatory breast cancer cannot be based solely on the appearance of the skin and requires appropriate investigations and confirmation of malignancy.
Most breast lumps are benign. They are often cysts, fibroadenomas or changes associated with hormonal fluctuations. However, this does not mean that the nature of a lump can be reliably assessed without medical evaluation. The belief that a painful or movable lump cannot be cancerous is incorrect. Any new, persistent or concerning breast abnormality should be assessed by a doctor, regardless of the patient’s age.
The risk of breast cancer increases with age, but many factors influence its development. These include genetic predisposition, a family history of cancer, previous radiotherapy involving the chest, certain breast tissue abnormalities and prolonged exposure to sex hormones. Alcohol consumption, excess body weight after menopause and insufficient physical activity may also increase the risk. Importantly, according to the WHO, approximately 80% of breast cancer cases occur in women who have no particular risk factors other than sex and age. Therefore, the absence of breast cancer in the family does not mean that a woman is protected against the disease.
Inherited predispositions associated with the BRCA1 and BRCA2 genes are particularly significant. When functioning normally, these genes help cells repair DNA damage. Pathogenic variants can disrupt this process, increasing the likelihood of cancer development. However, hereditary predispositions account for only a minority of breast cancer cases. In addition to BRCA1 and BRCA2, variants in other genes, such as PALB2, CHEK2 and ATM, may also be relevant, although the level of risk varies depending on the specific variant. Genetic counselling is especially important in families with a history of cancer at a young age, ovarian cancer, bilateral breast cancer or breast cancer in a male relative.
Not all breast cancers behave in the same way. Two tumours of similar size may differ considerably in their growth rate, response to treatment and prognosis. Determining the biological subtype of the cancer is therefore one of the most important elements of modern diagnostics. Some breast cancers have oestrogen or progesterone receptors, allowing their growth to be inhibited by endocrine therapy. Others show overexpression of the HER2 protein, making targeted treatments possible. There are also triple-negative breast cancers, which lack oestrogen and progesterone receptor expression and HER2 overexpression. These cancers often have a more aggressive course, but in certain circumstances they may respond to chemotherapy and immunotherapy. A diagnosis of breast cancer alone is therefore insufficient to determine the appropriate treatment or prognosis.
In Poland, mammography is the primary screening test for breast cancer. Under the National Health Fund (NFZ) programme, women aged 45 to 74 can generally undergo a free mammogram every two years without a referral. The programme also provides special arrangements for certain groups of women who have previously undergone breast cancer treatment. Screening is available both at permanent diagnostic facilities and in mobile mammography units. Appointments can be booked, among other options, through the central electronic registration system available via the Internet Patient Account (IKP) or the mojeIKP mobile application.
Mammography uses a low dose of X-ray radiation and can detect some abnormalities before they cause any symptoms. Scientific studies confirm that a properly organised screening programme can reduce breast cancer mortality. However, mammography is not a perfect method. False-positive results may lead to additional tests and anxiety, while false-negative results occur when an existing abnormality is not detected. Screening may also identify certain abnormalities that would never have caused symptoms during the patient’s lifetime. The benefits and limitations of mammography should therefore be considered together, rather than treating the test as a guarantee that every cancer will be detected.
Particular attention is paid to mammographic breast density. In some women, glandular and fibrous tissues make up a greater proportion of the breast than fatty tissue. On a mammogram, dense tissue appears as white areas, as do many cancerous abnormalities. This can make them difficult to distinguish. Higher breast density is also an independent risk factor for developing breast cancer. However, this does not mean that every woman with dense breasts should routinely undergo magnetic resonance imaging (MRI). The decision to perform additional examinations depends on overall risk, previous diagnostic findings and individual indications.
In clinical practice, mammography, ultrasound and breast MRI serve different purposes. Ultrasound is particularly useful for evaluating palpable abnormalities. It can, for example, distinguish a fluid-filled cyst from a solid lesion and is often the first imaging examination performed in younger women with symptoms. Mammography, on the other hand, can detect certain microcalcifications and abnormalities that may not be visible on ultrasound. MRI is used, among other indications, for screening selected women at very high risk of breast cancer and in specific diagnostic situations. The choice of examination should be based on the clinical problem rather than the assumption that the most expensive method is always the best.
It is important to distinguish between screening and the investigation of symptoms. A woman who notices a new lump should not wait until her next routine screening mammogram. Similarly, a recent normal examination does not eliminate the need for medical consultation if a new, concerning abnormality subsequently appears. In such cases, a doctor may recommend diagnostic imaging and further management appropriate to the patient’s age and the nature of the symptom. Women younger than 45 may also require breast examinations, but these are primarily determined by symptoms, family history or individual risk rather than participation in the general NFZ screening programme.
Breast self-examination can help women become familiar with the normal appearance and feel of their breasts and recognise new abnormalities, but it does not replace mammography. Large population studies have not demonstrated that regular self-examination performed according to a strict routine independently reduces breast cancer mortality. It is therefore important to be familiar with one’s body, pay attention to changes and report them to a doctor, without regarding a normal self-examination as proof that no disease is present.
When a suspicious abnormality is detected through imaging, a biopsy, most commonly a core needle biopsy, may be necessary. Obtaining a tissue sample allows histopathological examination, which can confirm or exclude cancer and determine its characteristics. Imaging findings are often classified using the Breast Imaging Reporting and Data System (BI-RADS), which helps assess the likelihood of malignancy and guide further management. A high BI-RADS category does not itself constitute a cancer diagnosis, but indicates the need for appropriate further investigation, most commonly a biopsy.
Modern breast cancer treatment may involve breast-conserving surgery, mastectomy, radiotherapy, endocrine therapy, chemotherapy, immunotherapy and molecularly targeted medicines. In some patients, systemic treatment begins before surgery to reduce the size of the tumour and assess its response to therapy. The choice of treatment depends on factors including disease stage, lymph node involvement, the biological subtype of the tumour, the patient’s overall health and her preferences. A breast cancer diagnosis does not automatically mean that the entire breast must be removed or that chemotherapy will be necessary.
Early diagnosis is extremely important for prognosis, although it is not the only determining factor. Cancer confined to the breast generally offers substantially greater opportunities for successful treatment than disease that has already spread to distant organs. However, tumour biology is also important. Some small cancers may have aggressive characteristics, while others develop relatively slowly. For this reason, doctors assess disease stage, histopathological findings and biological markers together, rather than relying solely on tumour size.
Breast cancer also affects mental health. Anxiety while awaiting biopsy results, fear for one’s life, loss of a sense of security and changes in body image may begin during the diagnostic process. During treatment, some patients experience depression, anxiety disorders, insomnia or difficulties concentrating. Certain therapies may cause menopausal symptoms, affect sexuality and fertility, and increase fatigue. After treatment, fear of cancer recurrence is a common problem, even when follow-up examinations show no abnormalities. Psycho-oncological support and, when necessary, psychiatric care can form an important part of comprehensive treatment.
The risk of developing breast cancer can be partly reduced by limiting alcohol consumption, engaging in regular physical activity and maintaining a healthy body weight, particularly after menopause. However, no lifestyle can provide complete protection against breast cancer. A cancer diagnosis should not be regarded as the result of negligence or poor decisions made by the patient. In prevention, participating in screening programmes and promptly investigating new symptoms are just as important as reducing modifiable risk factors.
European Breast Cancer Awareness Day serves as a reminder that effective prevention does not require waiting for the first symptoms to appear. The disease can develop without symptoms, and its course depends on many factors that cannot be assessed simply by how a person feels. Any new, concerning symptom requires medical consultation, while the absence of symptoms should not be a reason to avoid screening. Early detection can significantly improve the chances of successful treatment.

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