What symptoms should the patient report regarding their breast health?

Key Breast Symptoms Patients Should Report

Patients should immediately report any new onset palpable breast nodule, skin or nipple retraction, orange peel skin appearance, or unilateral nipple discharge, as these are suspicious symptoms that warrant urgent evaluation. 1

Suspicious Breast Symptoms Requiring Prompt Medical Attention

Physical Changes

• New breast lump or mass - Any new palpable nodule in the breast tissue 1
• Skin changes - Including:
  • Orange peel skin (peau d'orange) 1
  • Skin retraction or dimpling 1
  • Redness or erythema not associated with recent radiation therapy 1
• Nipple changes - Including:
  • Nipple retraction or inversion (especially if new) 1
  • Changes in nipple appearance 1

Nipple Discharge

• Spontaneous discharge - Any discharge that occurs without breast manipulation 1, 2
• Bloody discharge - Has the highest association with breast cancer risk (2.27 times higher than non-bloody discharge) 3
• Unilateral discharge - Especially from a single duct 2
• Clear/watery, serous, or serosanguineous discharge - These are considered surgically significant types 2, 4

Important Characteristics to Note and Report

When experiencing any breast symptoms, patients should note and report:

1. Timing and onset - When the symptom first appeared and whether it's persistent 2
2. Unilateral vs. bilateral - Whether the symptom affects one or both breasts 2
3. Associated symptoms - Presence of pain, itching, or other sensations 1
4. Changes over time - Whether the symptom is worsening, improving, or fluctuating 1
5. Relationship to menstrual cycle - Whether symptoms change with hormonal fluctuations 1

Common Pitfalls in Symptom Recognition

• Ignoring non-lump symptoms - While breast lumps are well-known warning signs, other symptoms like skin changes and nipple discharge are equally important 1
• Assuming discharge is normal - Only spontaneous, persistent, non-lactational discharge warrants evaluation 2
• Delaying reporting of symptoms - Early detection significantly improves outcomes; patients should not wait to report suspicious symptoms 1
• Dismissing symptoms due to recent breast procedures - While some changes may be expected after radiation or surgery, new or progressive symptoms should still be reported 1

Special Considerations

• The upper outer quadrant of the breast and the area under the areola/nipple should be given special attention as these are the two most common sites for cancer to develop 1
• Patients with breast implants should be aware that the same symptoms apply to them, as implants are placed behind the breast tissue 1
• Pregnant or lactating women should still report bloody discharge outside the last trimester of pregnancy or first 3 months of lactation 1

By promptly reporting these suspicious symptoms, patients enable early detection and intervention, which can significantly improve breast cancer outcomes and reduce mortality.