“In my 15 years of experience as a breast radiologist, I’ve seen countless cases where early warning signs were overlooked or dismissed. While most women diligently check for lumps during self-examinations, I frequently encounter patients who’ve ignored other critical symptoms for months or even years. As someone who interprets thousands of mammograms and breast imaging studies annually, I want to share the subtle signs that often slip under the radar but deserve immediate attention,” says Dr Namrata Singal Sawant, a Mumbai-based senior radiologist.

She further shared with HT Lifestyle 5 subtle symptoms you shouldn’t ignore and why early detection matters.

1. Changes in breast texture and appearance

One of the most significant findings I encounter in my practice is architectural distortion, changes in breast skin texture that many patients attribute to normal ageing. The most common early signs of the same are:

• Any dimpling or puckering of the skin can suggest an underlying carcinoma pulling the skin or Cooper’s ligament.
• Characteristic orange-peel appearance (peau d’orange) can be a sign of inflammatory breast carcinoma.
• Shrinking of the size of any one of the breasts. This can be seen in some lobular carcinomas, which are difficult to diagnose.
• Increase in the size of the breast. We must be aware of the natural asymmetry of our breasts, if any. Any increase in the size of the breast, especially asymmetrical, must be viewed with caution. We must contact our medical professional about this.

2. Nipple changes and discharge

Nipple changes often provide crucial diagnostic clues that patients initially overlook.

• Nipple discharge, particularly when unilateral, spontaneous and blood-stained, has led me to identify high-risk lesions and early-stage ductal carcinomas.
• Nipple retraction. Some ladies give a history of their nipples being inverted from childhood. However, if the nipple retraction is a new finding, then it must be looked at with suspicion.
• Nipple directional changes or scaling. Many of the ductal abnormalities, like papillomas, papillary carcinomas, atypia, dysplasia, DCIS or even Intraductal carcinomas can present with any of the nipple symptoms. With the help of advance technologies especially high resolution ultrasonography, MRI and DR mammograms these diagnosis can be made at and much earlier stage. Further evaluation with guided biopsies are suggested.

3. Any lump in the armpits

From my experience interpreting breast MRIs and ultrasounds, lymph node evaluation is a critical component that patients rarely consider during self-examinations. I’ve diagnosed several cases where palpable lymph nodes were the presenting symptom, leading to the discovery of occult breast cancers that weren’t detectable through conventional screening. My clinical advice:

• Any palpable lump in the armpits must be evaluated with ultrasonography and SOS, as well as further investigations like FNAC, biopsy, mammography, MRI, etc. Even primary breast cancers are found in the axillary tail of the breast, which is found in the armpit.
• Any lymph node that remains palpable for more than two weeks, especially if it’s firm, fixed, or progressively enlarging, requires immediate imaging evaluation with ultrasound and possible tissue sampling.

4. Any skin discolouration over the breast

In my radiological practice, inflammatory changes represent some of the most challenging cases to diagnose early. Inflammatory breast cancer, while rare, can initially present as simple skin irritation that patients often treat with topical remedies for weeks before seeking medical attention.

Through my imaging experience, I’ve learned that skin changes that don’t respond to conservative treatment within 1-2 weeks, particularly when accompanied by breast swelling or warmth, require immediate evaluation with specialised imaging protocols. I’ve diagnosed several cases of inflammatory breast cancer where patients initially attributed symptoms to allergic reactions or skin conditions.

5. No signs at all

• I can not stress enough this last point that most of the breast cancers can only be caught at an early stage with the help of screening. Screening implies the patient does not have any complaints and still gets a routine checkup, and a mammography is done.
• According to the recommendations by the Breast Imaging Society of India (BISI), annual screening mammograms are recommended for those between the ages of 40 and 70.
• In case of high-risk individuals with a family history of breast cancer or BRCA 1 or 2 genes positive amongst others, the screening starts at a much earlier age.

After years of interpreting breast imaging and counselling patients, I cannot stress enough the importance of trusting your instincts about your body. In my practice, I maintain an open-door policy for patients who notice changes, no matter how minor they may seem.

Also, the take-home message again is that to diagnose this disease early, we must understand the importance of screening protocols and consult our medical professionals for annual clinical breast examinations.

Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.