Symptoms and signs of operable breast cancer. Report from the Yorkshire Breast Cancer Group

Abstract

Early detection of breast cancer depends upon a high index of clinical suspicion as screening programmes are not yet generally available in the United Kingdom. The symptoms and signs of operable breast cancer in 1,205 women presenting prospectively and unselected to the surgical clinics of members of the Yorkshire Breast Cancer Group from 1976 to 1981 are reviewed.Seventy-three per cent of the women were postmenopausal. Seventy-six per cent of the patients presented with a discrete lump. Pain as a presenting symptom was rare, but when questioned 33 per cent of the women admitted that the lump was painful. Forty-two per cent of patients had skin tethering or fixation, but only 22 per cent had nipple retraction or displacement. Forty-two per cent of women had lesions which appeared to have well-defined edges. Only 32 per cent of lesions were clinically T0 or T1, the majority (56 per cent) being T2, and 12 per cent were T3.Standard descriptions of symptoms and signs in breast cancer have so far failed to define in what percentage of patients, diagnostic features are present, and have also omitted to emphasize that in a considerable proportion of women classical signs may be absent. Any breast lump in a postmenopausal woman must be considered malignant until proved otherwise and it is wise to pursue an active diagnostic policy in the premenopausal patient, with early referral for a surgical opinion in both cases.