Millions of Americans self-check for breast cancer monthly. However, there are some cancers that do not form lumps and may not show up on mammograms. While not new, they are rare. Together, they make up between 2 percent and 8 percent of total breast cancers in the United States. Knowing their symptoms can be lifesaving.
Paget's Disease of the Breast
When cancer cells travel through the milk ducts to the nipple, it's called Paget's disease of the breast. According to the National Cancer Institute, in 97 percent of the cases, abnormal cells are found in the lining of the milk ducts. This means the cancerous Paget cells broke off of an existing tumor, indicating the presence of an invasive breast cancer. According to the National Cancer Institute, in 3 percent of the cases, Paget cells form spontaneously from the nipple tissue.
Symptoms
Early signs of Paget's disease include redness and mild scaling or flaking of the nipple skin. These are not painful and can clear up without treatment, but the cancer is still present. Normally beginning with the nipple, it can spread to the areola--the darker skin surrounding the nipple--and the rest of the breast.
It also can begin on the areola, appearing as a red, itchy rash.
As the cancer multiplies, the nipple(s) can itch, tingle, become hypersensitive or painful, or produce a burning sensation.
There could be an abnormal discharge and the nipple could appear flat. According to the National Cancer Institute, a lump or mass is felt in only half the cases. Paget's accounts for just 1 percent to 4 percent of cancers. The survival rate is from 100 percent to 25 percent, depending on the underlying cancer (if any).
Inflammatory Breast Cancer
When cancer cells block the lymph nodes in the chest, the entire breast can appear red and swollen. The name inflammatory breast cancer (IBC) refers to this inflamed condition.
Most common in younger women and older men, it is more prevalent in younger African-American women.
Writing for the National Research Centre for Women and Families, Susan Dudley, Ph.D., said up to 4 percent of cancers are IBC, which is fast-growing and aggressive.
Symptoms
Initially IBC causes swelling, which can invert or flatten the nipple. Breast skin turns pink or purple and appears bruised or to have a rash.
Skin ridges can form, or it can appear pitted--called peau d'orange (skin of an orange).
Breasts may feel heavy, ache or burn, be tender or enlarge. A doctor should check swollen lymph nodes in the armpits or over the collarbone that persist for weeks or months.
Prognosis
IBC is a stage IIIB or IV cancer. According to Susan Dudley, PhD, writing for the National Research Center for Women & Families, the survival rate is 25 percent to 50 percent, lower than non-IBC cancers because it usually has spread by the time it is diagnosed.
Breast surgeon Dr. Susan Love prescribes antibiotics for two weeks with symptoms that last more than a day or two. Even if the rash is viral, it will clear up by itself or get much worse in that time.
The warning sign is no visible change in 14 days. She recommends an immediate biopsy.
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